Migraines cause more than headaches

Have you ever had a headache? A simple question, answered by most of us with a resounding “Yes!”. The cause is sometime obvious (a few drinks too many last night?), and typically the solution is simple. The passage of time usually provides relief. That, and a few ibuprofen generally leads to resolution. But what if your pounding head is not caused by a headache? What else could it be? The most likely explanation is a migraine. But isn’t that simply a severe headache? Any sufferer of migraines will tell you, as would any neurologist, this is not the case.

Migraine is one of the most common conditions in the world, with 12% of the American population experiencing them, which works out to about 39 million men, women and children in the U.S. and 1 billion worldwide. Migraine is the 6th most disabling illness in the world and occurs most commonly between the ages of 18 and 44. Being one of the most prevalent and disabling neurological diseases worldwide means any new migraine-specific therapy is going to be a welcome development. Although many people get them, there is a tremendous amount of unsubstantiated, conflicting, and inaccurate information about the disease.

Most people don’t realize how serious and incapacitating migraines can be. More than 90% of sufferers are unable to work or function normally during the attack. Every 10 seconds, someone goes to the emergency room complaining of head pain, which works out to about 1.2 million visits for acute migraine attacks. While most sufferers experience attacks once or twice a month, more than 4 million people have chronic daily migraine, with at least 15 migraine days per month.

One particular area of ignorance about migraine concerns the lack of an explanation for it. Granted, this has been difficult to determine due to the complexity of this disorder. Yet it is not a new malady, having been recognized since antiquity. Migraines have a strong genetic component, meaning they may run in families, afflicting both parents and their offspring. The complexity of the condition is why there is a paucity of migraine-specific treatments.

Some experts have proposed a new concept concerning the biochemistry of migraines. They have posited that when a person experiences an increase in migraine frequency, the kind that leads to chronic migraines, there is an increase in neural inflammation, meaning there are inflammatory changes of the nerve fibers themselves. This theory is supported by new evidence which has significant implications for migraine treatments.

Migraine disproportionately affects women, with about 28 million women in the U.S. afflicted. That means approximately 85% of chronic migraine sufferers are women. Roughly 1 in 4 women will experience migraine in their lives. Interestingly, before puberty, boys are affected more than girls, but that changes with adolescence, when the risk of migraine rises in girls along with the severity of the attacks. Migraine has even been reported in children as young as 18 months.

Many things can trigger the onset of a migraine attack. Doctors agree that brief changes in your brain activity bring them on. But not every migraine is tied to a trigger. When they are, one of the best ways to prevent them is to learn what your triggers are, then avoid them. For some, this means saying no to certain foods. Some common food triggers include bananas, beans and chocolate. Edible substances high in tyramine, a natural compound formed in protein-rich foods as they age (cheese!), are also common triggers. MSG, a common ingredient in soy sauce and meat tenderizer, is infamous for stimulating the development of a migraine.

The symptoms of a migraine typically include a severe throbbing, recurring pain, usually on one side of the head, but involves both sides a third of the time. In some cases, disabling symptoms are present without the head pain. Attacks often include some other unpleasant symptoms such as visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound, light, touch and smell, and tingling or numbness in the extremities or face. There can even be extreme sensitivity to movements of the head. When an attack occurs, they can last anywhere from 4 to 72 hours. About 25% of migraine sufferers also have a visual disturbance called an aura, which usually lasts less than an hour.

Many migraine sufferers experience vague symptoms as much as a day prior to the onset of an attack, which can include a state of reduced consciousness. This phase is called the prodrome and should not be confused with the aura, which may last up to one hour. Symptoms of this portion of an attack may include visual, sensory, or language disturbance.

Within an hour of resolution of the aura phase, the typical migraine headache usually appears with its throbbing pain and associated manifestations. At this point, without treatment, the headache may persist for up to 72 hours before ending in the resolution phase. This is often characterized by deep sleep. In addition, for up to a day after the throbbing has resolved, many patients will experience malaise, fatigue, and transient return of the head pain for a brief time following coughing or a sudden head movement. This phase is sometimes called the migraine hangover

Currently, treatment is aimed at stopping symptoms and preventing future attacks with a multipronged approach. This can include various preventive and biobehavioral therapies, along with certain drugs that were developed for other diseases, often antiepileptic medications. Abortive therapies, those intended to stop the onset of an attack, include anti-inflammatories (eg ibuprofen) and combination analgesics with acetaminophen, aspirin and caffeine.

The anti-epileptic meds used for migraines are often considered the standard of care. But these drugs are poorly tolerated and many who try these medications do not continue with them. A very different approach is the use of botox for patients with chronic migraine who have failed preventive measures via oral meds. Botox works for some migraine sufferers and is FDA approved, but it is only used for patients who have symptoms more than 15 days a month, the chronic migraine sufferers. Often recommended is magnesium, a deficiency of which can trigger the aura of a migraine. It’s felt that supplementation can be useful in reducing the frequency of attacks.

Some natural remedies seem to be helpful to some and include acupuncture or acupressure, certain essential oils, yoga, biofeedback, and even massage. The effectiveness of these therapies, and others, vary widely. No definitive studies have been performed on most of these, typically meaning there was an insufficient sample size. This makes it difficult to draw conclusions with any certainty.

Many migraine sufferers are on a journey of sorts, to understand their triggers, to determine a healthy diet, and to find the right combination of routine and clinical treatments which provide the best control possible. Each person is different. The unfortunate reality is that there is no one thing that works for all. If you are a sufferer of this very common but potentially debilitating condition, good advice is to learn about your disease, experiment with diet, find your triggers and then avoid them. As to a cure, again, that common refrain, we don’t have an answer.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with a move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments atdrcmclean@outlook.com.