By Vivek Sinha
Migraine headaches are extremely common and impact up to 12 percent of the population. For those people who suffer from migraines, the results can have significant impact on their personal and professional lives. Medications may help, but the symptoms can often linger for hours or even days, causing significant disruption.
What are migraines? What causes them? Can they be prevented? As a primary care physician, I am often asked these questions by patients and their loved ones. Like all medical conditions, the best initial treatment for migraines is education.
First: What are migraines? People sometimes mistake migraines for bad headaches. In actuality, a migraine is a medical disorder that causes a severe headache that is often accompanied with nausea and sensitivity to light and sound. A typical migraine is actually a cascade of events that takes up to several days to progress. The four phases of the cascade are the prodrome, the aura, the headache and the postdrome.
The prodrome period occurs in 75 percent of migraine attacks and can appear 24 to 48 hours before the actual headache starts. Common symptoms are increased yawning, depression, irritability and neck stiffness.
The aura period occurs for approximately 25 percent of migraine sufferers. The typical aura usually occurs immediately prior to the onset of the headache and usually lasts no longer than an hour. Patients often complain that they feel like their five senses are being affected. Common examples of auras are the appearance of bright flashes or zigzagging shapes, loss of fields of vision, tingling on the side of the face or limbs, burning pain or numbness or weakness in parts of the body.
If the person has the aura symptoms, the headache period begins shortly thereafter. Otherwise, the headache starts after the prodrome period. Headaches often present on one side of the head and can have a throbbing nature. As the headache severity progresses, people often start to feel nausea and occasionally vomit. Sensitivity to light and/or noise is also a common complaint during this time, which is why migraine sufferers will often need to lie in a dark, quiet room. Many times, the migraine resolves once a person falls asleep. Typically speaking, an untreated migraine can last from a few hours to several days.
The postdrome period begins after the headache has resolved. Sudden, rapid movements can often cause a sharp recurrence of pain, and people often feel drained or fatigued. Not every migraine presents with a postdrome period.
While there are no specific diagnostic tests for migraines, there are specific diagnostic criteria. The International Classification of Headache Disorders offers several criteria that the physician can go through with the patient. Some of the criteria include headaches lasting four to 72 hours, headaches with a pulsating quality or headaches associated with nausea, vomiting, light and sound sensitivity, headaches with visual disturbances and other aura symptoms.
Physicians often need to perform lab work and imaging studies to ensure that there is not an underlying condition that is causing these symptoms, such as diabetes, thyroid problems or electrolyte problems. The physician must evaluate blood pressure and perform a physical and neurological exam to ensure that there are no abnormalities. Oftentimes, a CT scan or an MRI is indicated to ensure that infections, strokes or brain lesions are not present.
Once a physician has diagnosed a patient with a migraine, the next questions are, “What can I do about it? How do I treat them?”
The answer is a two-step process. First and foremost, the best treatment is prevention. If we can figure out what is triggering the migraine, then perhaps we can stop it from occurring, or at the very least, decrease the frequency of migraines. Some common triggers for migraines include emotional stress, not eating, sleep disturbances, certain odors, bright lights, alcohol, smoke, heat and certain foods. It is important to note that a person may have more than one trigger, or they may have different triggers at different times. Therefore, obtaining a very thorough history is critically important in determining how best to treat the migraine.
If patients do need medication to manage migraines, the first step is to classify the type of migraine. For mild to moderate migraine attacks that are not associated with nausea or vomiting, over the counter pain relievers such as Motrin, Advil, Aleve, Tylenol or Excedrin are usually sufficient.
If the migraine attacks are more severe and associated with nausea, vomiting and sensitivity to light and noise, then a prescription medication is often necessary. The first line is a class of medications called triptans or ergots. They can come in the form of oral pills, dissolvable tablets, nasal sprays or even injectables.
Generally speaking, the earlier the medication is taken, the better the chance that it will work. It’s also important to note that a person can have migraines of varying severities at different times, so evaluating the migraine in real time is an important step in determining which medication the person should use for that particular situation. Never start any new medication, either prescription or over the counter, without first speaking to your doctor.
There are many new advancements in migraine treatments and prevention. The bottom line is that while migraines have the potential to severely disrupt one’s life, there is hope. There is a lot that the medical community can do to treat and evaluate a patient’s symptoms. So, if you suffer from migraines and they’re affecting your quality of life, speak to your doctor, get informed and take control.
The writer is the chief medical officer of Belleview Medical Partners, an office and house call practice based in Old Town.
