You're sitting at work, preparing notes for the morning meeting, when you gradually begin to notice white, jagged lights flickering at the edge of your vision. The left side of your face goes numb, and so do your hands. Your head suddenly seems swollen to three times its size. You know that you're about to get yet another migraine. Hours later, your meeting is going on without you, and you are in the bathroom battling skull-crushing pain and nausea, and you're unable to see out of one eye. It feels as though someone's taken one of those cartoon sledgehammers to your head, except not nearly as funny. The next day, a co-worker makes fun of you for missing work because of a headache.
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Hormone changes may be one reason that women experience migraine pain more frequently than men.
Migraines are debilitating conditions that affect the lives of between 12 and 24 million Americans (18 percent of women and 6 percent of men), and remain grossly underdiagnosed. They are anything but your normal tension or sinus headaches, lasting anywhere from several hours to several days and in some reported cases, months or even years. Migraines are often accompanied by symptoms such as loss of vision, vomiting, tremors and stroke-like symptoms such as numbness to parts of the body. Migraine headache pain usually focuses on one side of the skull, though for some it can happen on both. Many people say that their migraines switch sides of the head.
Amazingly, doctors are still not entirely sure exactly how someone gets a migraine or why certain things set them off (or trigger them). Previously, they believed that it was caused by blood vessels dilating. While this could be a contributor to pain and the cause of an aura (lines, colors, zigzag patterns or blind spots visible prior to migraine pain), doctors no longer believe this to be the underlying problem. Newer evidence suggests that other factors, such as the release of chemicals and increased sensitivity to pain, occur at the same time, which is the actual cause of most migraine pain. Most recently, doctors have classified migraine as a neurobiological condition, or one that originates in the brain.
Anatomy of a Migraine
Nobody is completely sure of what causes some people to have migraines and some not to. Doctors do know that they run in families. If one of your parents has migraine problems, you have a 50 percent chance of developing them. If both of your parents have migraines, you chances jump to about 70 percent.
© iStockphoto/Don Bayley
Genetics play a major role in your chance of developing migraines.
Likewise, doctors don't know for sure what happens when a trigger causes a migraine, or what exactly happens in the brain. Right now they think that migraine is caused by a progression of several things:
- You encounter a trigger: Let's say you forgot to eat breakfast and lunch was late.
- Pain-sensing cells in your brain stem (nociceptors) pick up on this change in your routine and release a chemical (neuropeptides).
- This chemical attacks other pain-sensing cells nearby, making them more sensitive to pain. They also release neuropeptides.
- Some of these chemicals begin to work on the muscles surrounding the blood vessels near the surface of your brain. Those muscles relax, making the blood vessels dilate and causing more blood to flow. This is where doctors think the aura in a classic migraine comes from.
- Some of the neuropeptide chemicals cause the cranial (skull) vessels to begin leaking, making the tissue around the area swell.
Doctors now think that the combination of these factors -- increased sensitivity, swelling brain tissues and swelling of blood vessels -- is the cause of migraines.
Migraine Triggers
Triggers are the things that set migraines off. Triggers can crop up just about anywhere. They can be environmental, like the weather or that really bad cologne your boss wears. They can be behavioral, such as getting up too early or too late. They can even be food related, as in the case of alcohol, caffeine or strong cheese.
Here are some of the more common triggers:
- Food: There is little scientific evidence that food can physically trigger a migraine, but try telling that to a desperate migraine sufferer who can't eat cheese anymore. It's most likely that food-related migraines are linked to food allergies. Some foods high on the trigger list include nuts, hard cheeses, and gluten, which is found in wheat, barley and beers. Soy, MSG (or monosodium glutamate, a preservative and flavor enhancer), chocolate, dairy products, alcohol and caffeine are also high on the list of triggers. If you are used to drinking coffee or tea every day, not drinking it can also be a trigger. Many foods with strong smells and tastes are also suspect: Onions, sauerkraut, chili peppers and anchovies are some.
©iStockphoto/Angela S.
Migraine triggers come in a variety of forms. Anchovies are a common trigger for many.
- Behavior: The one certain thing about migraine is that it loves change. Varying your routine just a little can trigger a migraine. Behavioral triggers include things like sleeping too much or not getting enough sleep, not eating on time or at the same times, being hungry, being stressed, having sex, and either not getting enough exercise or exercising too hard.
Now for the things you can't control quite so easily:
- Hormones: Migraines are often caused by hormone changes, which is why three times as many women as men have migraines. Many women first experience migraine pain when they start puberty. After that, they may have migraines every time they get their period. Lots of women get fewer -- and may even stop getting -- migraines when they get pregnant and after menopause. It is very unusual for women over 60 to get migraines. Some hormone replacement medicines (like estrogen) can be triggers.
- Environmental factors: Many factors in the world around you can trigger a migraine. Bright and flashing lights (like from a TV), loud noises (from concerts), strong smells, and changing weather patterns -- usually rain -- can all be triggers.
Sound hopeless? It's not. If you have migraines, keeping a diary of what you eat, what time you get up, and any major changes that happen in your routine might help you pinpoint your triggers so that you can learn to avoid them or know when to take medication.
Types of Migraines
The head is a funny thing. There are millions of ways it helps you every day, but there are lots of different ways it can cause you pain, too. While doctors don't really know why certain people get certain types of migraines, they do know some fundamental differences. A higher percentage of women suffer migraine pain. Men, on the other hand, are ten times more likely than women to get cluster headaches, which usually cause pain behind one eye. Migraines run in families, whereas cluster headaches don't. Migraine pain is usually concentrated on one side of the head or the other, while cluster headache pain is usually behind one eye or the other.
These are some of the different types of headaches and migraines:
- Chronic migraines: People who experience more than 15 migraines in a month are diagnosed with chronic migraine.
- Classic migraines: These are migraines with an aura -- the lines, colors, zigzag patterns and blind spots at the edge of vision that occur before migraine pain hits.
- Common migraines: This is when you have migraine pain with no aura. These can come on suddenly, but some have symptoms like euphoria or cognitive problems before the onset of pain.
- Ocular migraines: Some people get aura symptoms -- zigzagging lines, blind spots, floating lights -- without the head pain of a classic migraine. These usually last about 30 minutes. The good news is that these are harmless, probably caused by changes in the eye's blood vessels. The bad news is that there's no way to prevent or cure them; you just have to stick them out. If you have these and think they're disrupting your schoolwork or profession, schedule a checkup with your eye doctor to make sure they aren't symptoms of a more serious eye disease (they usually aren't).
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When migraines begin to interrupt your school or work day, it's time to see a doctor.
- Abdominal migraines: These are more common in children; however, adults can have this form, too. These are often difficult to diagnose because when an abdominal migraine strikes, the symptoms of a migraine are present (increased light and sound sensitivity, nausea, vomiting). Yet, similar to an ocular migraine, there is no head pain. If you believe your child is experiencing abdominal migraines, contact your pediatrician.
- Cluster headaches: Cluster headaches are not migraines. They are quite possibly the most painful of all headaches. The pain explodes suddenly, usually about two hours after the person has gone to sleep. Unlike that of a migraine, the pain comes on quickly and is concentrated behind one eye or the other. They can last anywhere from 15 minutes to two hours, often disappearing as quickly as they came. They are called cluster headaches because they occur repeatedly for several weeks at a time -- and then go away for months, or even a year or more -- before another cluster begins. Cluster headaches do not seem to run in families, and they don't seem to be caused by brain diseases or chemical factors. Lack of sleep and other behavioral factors seem to be the primary cause.
- Thunderclap headaches: Like cluster headaches, a thunderclap headache is very sudden and severe -- like a thunderclap -- though it lasts a much shorter time and does not recur nightly. These are usually signs of something seriously wrong, like blood pooling in the brain. If you experience one of these, get to the doctor right away!
With such a wide array of symptoms, how do doctors diagnose migraines? Read on to learn how physicians are able to differentiate between migraines and what can appear to be deadly conditions.
Migraine Diagnosis
Migraines can be difficult to diagnose because the symptoms are often extreme and can resemble many other serious conditions, including stroke, heart attack, brain tumors and meningitis. Most migraine conditions are diagnosed after taking an extensive family history, considering your list of symptoms and ruling out other possible conditions.
While there are no definitive tests for migraines, a doctor may order several tests:
- MRI (magnetic resonance imaging): This test is used to view the soft tissues of the brain and rule out tumors, dementia and nerve problems. An MRI uses a very strong magnetic field to read the pulses coming from your brain tissues. You'll lie down on a table and be moved into a big tube, which will make thrumming sounds. From this, the doctors can see a detailed, 3-D view of your brain's tissues. Some people who are claustrophobic (afraid of closed spaces) may be uncomfortable with an MRI test. This test takes about 20-45 minutes.
©iStockphoto/Dr. Heinz Linke
A trip through an MRI machine is a good way for doctors to see exactly what's going on inside of your skull.
- CT Scan (computerized tomography): This test is given to rule out blood clots or cancerous tissues. CT Scans are very detailed x-rays. Whereas most x-rays use just one ray, CT scans use lots of rays from different angles to get a 3-D image of your head. Sometimes a doctor will inject a contrast dye into your veins so he or she can see your brain more clearly. The test takes about 15 minutes.
- Spinal Tap: A spinal tap is used to test for serious brain diseases like bacterial meningitis and encephalitis. It can also check for certain cancers and multiple scleroses. With this test, a doctor will give you something to numb your spine. He or she will then use a long needle to puncture the base of your spine and collect some of the fluid there. The cerebrospinal fluid protects your brain and spine from getting hurt.
Symptoms of migraines can vary from person to person, trigger to trigger, and migraine to migraine. Some people get migraine with an aura, which is a sort of warning system before a migraine starts. Auras can be white or colored lights that flicker at the edge of sight, hallucinations, blind or dark spots at the edge of vision, numbness or tingling (usually in the face or hands). Some people can experience aura symptoms anywhere from 10 minutes to 3 days before migraine pain is actually felt.
Sometimes, people without aura (common migraine) can experience euphoria or other mild symptoms before a migraine sets in.
After the onset of a migraine, in addition to throbbing pain on one side of the skull or sometimes both, most people experience nausea or vomiting, loss of appetite and tiredness. Many people have cognitive problems (problems speaking or hearing, understanding simple written words and problems spelling).
How to Treat Migraines
There are two ways to treat a migraine: before they start (preventive), or after symptoms begin (acute). Acute treatment is something you do or take, usually a medication, after symptoms start. Preventive treatments are for people who experience frequent migraines who want to avoid getting them.
Acute treatments are most often known by their common names: Tylenol and Advil (ibuprofen). These are non-steroidal anti-inflammatory drugs, or NSAIDs. These medications work best early in the migraine symptom cycle, before head pain begins. Many of these are effective for headaches without intense pain. A study has recently shown that, for migraines, an effective treatment is the combination of aspirin, acetaminophen and caffeine. Some brands, such as Excedrin, have begun implementing this combination in their migraine medications.
©iStockphotoIvan Ivanov
An injection is the fastest way to get migraine pain relief.
Other acute treatments include triptans, a serotonin-mimicking drug that some people with migraine pain call a miracle drug. Sumatriptan (Imitrex) can be taken in pill form or as a nasal spray, which acts more quickly and is good if you have problems with nausea and vomiting. If you have severe migraines with vomiting and end up in the hospital, the doctor might give you Imitrex in an injection form. However, if you purchase your very own Imitrex injector, you'd be able to give yourself the same injection without the added steps (and extra time) involved in scheduling a doctor's office visit. Nasal and subcutaneous (under-the-skin injection) treatments get into the blood stream faster to help relieve pain more quickly.
Preventive treatments are treatments used by people who have chronic migraines. Doctors have found that prescribing some medications for off-label use (using medications for something other than what they were made for) are very effective in helping with migraine symptoms.
Antidepressants are a very common preventive treatment. There seems to be a connection between serotonin, a brain chemical that regulates your mood, and migraines. An antihistamine called cyproheptadine is also known for helping to regulate serotonin levels. Using a drug that increases serotonin seems to be very effective in regulating migraines as well as mood. Because serotonin is a vasoconstrictive chemical, meaning it makes your blood vessels and tissues shrink, doctors think that antidepressant drugs that increase your serotonin levels help to prevent the inflammation of the brain vessels and tissues. Because of this, however, people with vascular disease, high blood pressure and coronary disease should not take these drugs because they can narrow the coronary arteries.
Beta-blockers are drugs you might think of taking if you have cholesterol problems or other heart conditions, but they have found a place in migraine treatment. Other cardiovascular drugs are also effective, such as calcium-channel blockers and blood pressure medication. Doctors don't know exactly why these seem to help -- it might be because they lessen pressure on blood vessels -- but they've been proven in helping people have fewer and less painful migraines. These are especially helpful if you have heart problems as well as migraines and can't take drugs that raise serotonin levels.
Antiseizure medications are another treatment possibility, although they are usually saved for treatment until some others are ruled out. These work by blocking the neurotransmitters that start migraine attacks.
Alternative Therapies
Many people who experience migraine pain find relief in alternative therapies. These are tricky because there are often not many reputable scientific studies to prove or disprove whether they work, even if thousands of people swear by them. Listed below are some of the more popular therapies and what they involve:
- Exercise, massage, breathing and relaxation exercises: These exercises can be helpful as far as establishing a routine, increasing blood flow, and helping the sufferer deal with stress more effectively, thereby preventing some known migraine triggers.
©iStockphotoRobert Churchill
Alternative therapies often involve teaching relaxation methods, while at the same time increasing blood flow.
- Yoga: This is a form of exercise that uses stretching, poses and breath control to strengthen muscles and increase blood flow. It promotes calmness and is often used in combination with meditation exercises.
- Biofeedback: This is the practice of dealing with concentrating on your inner reactions, consciously controlling your pulse, muscle tension, blood flow, and oxygen intake with the help of a therapist, who measures your response to flashing lights and images.
- Acupuncture: It may sound painful, yet most patients claim it's not. This is the practice of controlling your health and wellness through insertion of tiny needles in strategic places on the body.
Some examples of herbal remedies and supplements include:
- Riboflavin: Yet another reason your mother told you to eat your broccoli! Riboflavin, or vitamin B-2, helps heal and strengthen brain cells. You can take this as a supplement, or eat foods high in vitamin B.
- Coenzyme Q10 supplements: This is a preventive medicine that is increasingly popular. Coenzyme Q10 is made by the body to help tissues and muscles function. Scientific studies vary on how well this actually works to prevent migraines. Again, since migraine is such a personal condition, this has worked very well for some and not at all for others.
- Feverfew: Feverfew is an herbal supplement that has been effective in preventing and in the acute (short-term) treatment of migraines. It is an anti-inflammatory, sort of like ibuprofen. This might be a good treatment to try. Like all medicines, though, taking too much can cause side effects.
- Butterbur: Butterbur is another herbal supplement that seems to be very effective. This herb, however, may contain cancer-causing compounds, so people with a high risk of cancer and women who are pregnant may want to stay away from this one. Scientists are working on isolating the good parts of the plant and getting rid of the bad to make a better migraine treatment.
Long-term Migraine Effects
Migraine is a debilitating condition that costs billions of dollars a year in healthcare fees, sick days and poor performance. It can change throughout your life depending on your stress levels, your hormone levels, your age and your triggers, which can also change.
Doctors often diagnose migraines based on ruling out other problems, like heart and other brain issues. Migraine sufferers should know, though, that constant scientific research is being done to understand more about the disease. What has come to light, however, is that migraine may be a symptom of other neurobiological (brain) disease.
©iStockphotoKonstantin Sutyagin
Is a cure for migraines on the horizon? Researchers are doing all they can to make it a reality.
A recent study has also confirmed that women over 45 who suffer classic migraines are much more likely to have cardiovascular problems.
It is very important if you have migraines to have regular checkups and report any changes in your symptoms to your doctor so that they can catch and fix problems quickly.
By now it should be obvious that migraine is much more than a normal headache, and the people that experience this intense pain face quite a bit of difficulty in their everyday lives. The next time a coworker or schoolmate is out because of one, take their word for it and resist the urge to say anything disparaging. If not, they might be inclined to show you exactly what they experience -- with the help of a sledgehammer.
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