By John Vester, M.D.
The onset of a headache can stop you in your tracks and leave you hunting around for medication to make the pain go away.
If it’s just a mild headache, aspirin or ibuprofen can often provide quick relief.
But for the millions of Americans who suffer from the debilitating pain of migraines, a different approach is often in order.
Fortunately, a number of treatments that can reduce the pain and frequency of migraines — or even help stop them before they start — are increasingly available, including through doctors at University Medical Center at Princeton.
An estimated 29.5 million Americans, or 13 percent of the population experience migraines, according to the National Headache Foundation, and migraines are so common that one in every four U.S. households has a migraine sufferer.
In fact, this summer, the topic of migraines received widespread attention when Rep. Michele Bachmann, who is seeking the Republican nomination for president, acknowledged suffering from migraines, but said they were well controlled with medication and did not impact her ability to lead.
Migraine Symptoms
Migraines are characterized by throbbing pain, usually on one side of the head. Sufferers often report nausea and a heightened sensitivity to light and sounds.
Migraine pain can be so debilitating that patients can do little more than lay still in a dark, quiet room until the pain passes. Studies show at least 25 percent of migraine suffers have missed at least one day of work in a three-month period due to migraines.
Migraines can last anywhere from a few hours to a few days. Some sufferers report “auras” — warning periods of intense “pins and needles” sensation and visual disturbances such as wavy lines, dots or flashing lights and blind spots — before the actual migraine.
Migraine Triggers
The tendency to suffer from migraines is often hereditary. Patients with migraines have a built-in oversensitivity in their brains, essentially making them hard-wired for these types of headaches.
Additionally, people between the ages of 20 and 45 are more likely to experience migraines, and although migraines affect both women and men, women are three times more likely to experience migraine pain than men.
Migraines can be triggered by a number of different factors. These factors vary from person to person, but in general, they include:
• Changes in diet, exercise and sleep patterns.
• Medications, especially certain cholesterol drugs and antibiotics.
• Foods, such as processed meats, MSG, sweet red wine and aged cheese.
• Changes in barometric pressure and weather patterns.
• High altitudes.
• Caffeine.
• Cigarette smoke.
• Stress.
These triggers can set a migraine in motion, but doctors have not yet been able to establish an exact cause for migraines.
The most commonly accepted theory involves imbalances in brain chemical neurotransmitters, which help regulate pain messages in the trigeminal vascular system. When this system is stimulated, blood vessels in the outer covering of the brain become dilated and neuropeptides are released, causing inflammation in the brain. This in turn, floods the brain with pain signals, overloading its pain-processing area and causing a migraine.
The good news is that there are a number of effective treatments for migraines, and that with proper medical management it is even possible to prevent migraines from occurring.
Migraine Treatment
and Prevention
The first step in treating migraines is proper diagnosis. With a thorough medical history and evaluation of symptoms, your doctor can typically determine if you suffer from migraines or if there might be another reason for your headaches. In some cases, you may be referred to a neurologist for a CT scan, an MRI, or an EEG to help detect underlying conditions such as epilepsy or infection.
Once migraines are diagnosed, treatment can be either acute — meaning the goal is stopping migraines that are already occurring — or preventative, working to stop migraines before they start.
The most effective forms of acute treatment are triptans. Triptans are a class of medications that have an effect on brain receptors and help restore brain chemical balance. This can stop an attack within hours or even minutes.
There are also options that can help stop an attack before it starts. These preventative treatments are becoming increasingly popular and include anti-epileptic medications, which have an effect on migraines; antidepressants, which moderate serotonin levels; and beta-blockers, normally used for high blood pressure.
Preventative treatment is recommended for people who suffer frequent migraines.
Lifestyle changes have also been shown to assist in preventing migraine. Helpful changes include:
• Knowing and avoiding your specific headache triggers (light, smells, etc.)• Following a lifestyle plan prescribed by your doctor or neurologist.
• Eating regularly and avoiding trigger foods.
• Sticking to a healthy sleep schedule.
• Exercising, including yoga.
• Deep breathing and meditation
Moreover, some migraine sufferers have found alternative therapies such as acupuncture, acupressure, Botox injections, or herbal remedies to be useful. These treatments, however, have not been proven scientifically.
If migraines cause you to miss work or keep you from living your life, consult your doctor. He or she can help you come up with a plan of action to make those days of a throbbing head in a dark, quiet room a thing of the past.
To find a physician with Princeton HealthCare System, call (888) 742-7496 or visit www.princetonhcs.org.
John W. Vester, M.D., is board certified in neurology and EEG. He is Chief of Neurology at University Medical Center at Princeton.
