Oh, My Aching Head

Diagnosing Migraines and Finding Faster Relief

[ Written By Janine S. Pouliot ]

You’re experiencing pain so excruciating it feels like your head is being squeezed in a vice. It’s so extreme that waves of nausea wash over you. Another minute of this and you think you’ll go mad, but still it continues on and on. Is this some sort of perverse medieval form of torture? Well, it could be. But instead, what’s really happening is a migraine headache. Oh… is that all? Unfortunately, it’s not that simple for the more than 29 million Americans suffering from migraines, according to the National Headache Foundation. Patients are all too aware that without proper treatment, their lives can be completely disrupted. Migraines are nothing to take lightly.

Chandra Jackson, Alpharetta, knows firsthand just how incapacitating full-blown migraines really can be. Now 32, she’s suffered from the affliction since her teens. And it cost her a normal youth. “I had extremely painful migraines that would last days on end,” she recalled. “I couldn’t even get out of bed. They finally got so bad I ended up missing an entire year of high school.”

But at long last Jackson found treatment that worked and she is now on the path to living pain free. “I still have a way to go,” she pointed out, “but I feel so much better. I can walk two miles a day. I’m sleeping better. In fact, I’m so happy there’s actually drool on my pillow,” she joked.

Name Confusion
Migraines are an often-misunderstood disease and have become the ubiquitous catchall term for anything resembling a bad headache. Did you drink too much the night before? You probably woke up with a whopper and complained to friends you had a migraine. Or did your boss just chew you out in front of colleagues and you suddenly feel the onset of a headache you swear must be a migraine? Painful? For sure. But a migraine? Not necessarily.

“Migraines are a vascular phenomena,” explained Dr. Kenneth Joel, medical director, North Fulton Regional Hospital Pain Control Center and chairman of the Department of Anesthesia. “That means there is constriction and dilation of the blood vessels that cover the brain. It may not be your garden variety headache.”

It’s exactly this engorgement and restriction that leads to the kind of throbbing pain characteristic of a migraine. If what you’re feeling is consistent discomfort, chances are you aren’t having a migraine. But severity also can be a telltale sign.

“Patients can be frightened when they come in,” noted Dr. Susan Tanner, a holistic health care provider with Spherios Medical Center, Roswell. “They may think they have a tumor or are going to have a seizure.” That’s how intense migraines can be. But while they may not be life threatening, they should not be ignored either.

“If you’re having the worst headache you’ve ever had in your life, go to the hospital,” Joel warned. “It’s possible this could be something serious like bleeding in the head. As a result, you must be evaluated.” Once a critical condition such as stroke is ruled out, it’s time to look at what causes your particular migraine and how it can be addressed.

A Telling Tale
Unfortunately, migraines are one of those amorphous diseases for which there is no conclusive test. What you tell the doctor is the biggest factor in determining a diagnosis. “The first step is to sit down and take a long [look at your] medical history,” Tanner said. “We start from the time you were born, or actually before you were born. Heredity does play a role.”

Like a crime scene investigator searching for the tiniest clues, Tanner probes for possible triggers. “It’s important to trace all of the patient’s activities, environmental exposure, medications, foods consumed, then we begin to put together a picture.”

While there is no yea-or-nay test, there are certain guidelines that specialists follow to nail down a positive verdict. “When interviewing a patient, we get an effective diagnosis 93 percent of the time, if they have the following symptoms: photophobia or a dramatic sensitivity to light, nausea and an inability to function as a result,” Joel said.

But being the elusive disease that it is, migraines can be further split into categories. “There are three separate types of migraines,” explained Dr. Gregory J. Esper, director, General Neurology, and medical director, Department of Neurology, Emory University. “In the classic version, the headache is preceded by visual changes or an aura roughly half an hour ahead of time. This can include loss of vision in one field, light coming in speckles, colored wavy lines or blurred vision.”

The second type, known as a common migraine, has no warning symptoms. And the last, called complicated or complex, can mimic typical stroke-like symptoms. “One side of the body may experience numbness prior to the headache,” Esper noted. “Or there can be a tingling or weakness in the face, arm or leg and some facial drooping with difficulty speaking.” This is why doctors suggest seeking immediate medical attention during the first episode to rule out the possibility of something more severe.

Triggers to Know
Although the medical community doesn’t know for sure what sets off a migraine, there are several well-
identified triggers that seem to serve as catalysts in most cases. According to the Mayo Clinic, a nonprofit medical practice dedicated to research and treatment of complex illness with offices in Rochester, Minn., Jacksonville, Fla., and Phoenix and Scottsdale, Ariz., these include:

• Particular foods such as alcohol and red wine, aged cheeses, chocolate, pickled or marinated vegetables or meat, caffeine and the seasoning MSG
• Skipping meals
• Sensory stimulus, such as bright lights or sun glare
• Odors, even pleasant ones such as perfume or flowers, as well as more noxious smells such as paint thinner or second-hand smoke
• Various types of medications
• Hormonal changes in women

In fact, migraines are much more closely associated with women than men. The National Headache Foundation reports that women are three times more likely to suffer from them than their male counterparts. “Studies suggest a relationship between migraines and female hormones,” Esper pointed out. “During periods of ovulation or menses, migraines are more common. Headaches are also either markedly reduced or elevated during pregnancy.” Hormonal medications such as contraceptives or hormone replacement therapy may also worsen the frequency and severity of headaches.

But hormones may not be the whole answer. “One of the reasons we say that migraines occur more often in women may be due to missed diagnoses in men,” Esper added. “Male headaches do not come to the attention of the medical community. While women tend to go to the doctor more often, men may simply think they have a sinus headache, the most typical misdiagnosis.”

Taking Action
Whatever the catalyst, the pain of migraines is very real. It occurs when excited brain cells trigger the trigeminal nerve (the cranial nerve responsible for sensation in the face) to release chemicals that irritate and swell blood vessels on the surface of the brain. These swollen blood vessels then send pain signals to the brain stem, an area of the brain that processes pain information. Voila! You’ve got yourself a killer headache.

But toughing it is out until it goes away is the worse course of action. That’s because migraines do not simply clear up on their own the way, say, a hangover does. Migraines are a recognized medical condition that often requires specific pharmaceutical treatment. The biggest problem is finding an individualized custom approach. It may be a matter of trial and error and requires a certain amount of patience. When it comes to migraines, there is no one-size-fits-all therapy, nor does treatment provide instant gratification.

For Dian Clein, Alpharetta, now in her 60s, the process toward well-being was a long one. She spent 12 years battling her migraines by visiting a laundry list of doctors who prescribed a smorgasbord of medications. “Some were wonderful for the migraine, but had side effects,” she said. And then the migraines came back. “I was taking too much stuff. I had one doctor tell me to take as much as I needed. I started getting rebound headaches.”

But like Jackson, Clein finally located a physician willing to work with her and identify treatment for her specific case. These days, she’s feeling much improved.

Several Options
In simplistic terms, treatment falls into two main areas: pharmacological and non-pharmacological. Under the first classification, drugs are split again between abortive and preventative. Abortive meds attempt to stop the migraine once it’s already underway. There’s a mixed bag here, including over-the-counter stuff like Excedrin and Motrin, which have received FDA approval for this usage. Prescription anti-inflammatories are also recommended, although they may have gastrointestinal side effects, since greater than usual dosages may be necessary.

Plain old painkillers are also prescribed routinely for patients in the grip of a debilitating headache. “Narcotics like Vicodin and Percocet are good for breaking the cycle of pain,” Joel noted. “But they can actually cause a rebound effect when patients try to come off them.” So limited use is best.

Moving up the scale is dihydroergotamine (DHE), which is ergot alkaloids and works by tightening blood vessels in the brain. It’s delivered by self-injection or as a nasal spray called Migranal. However, used over long periods, it can damage the heart and other organs. In general, abortive measures are most successful when taken at the first onset of a migraine while pain is still mild.

Alternatively, there are the preventative meds. These include the anti-seizure drug Topamax, which stops migraines before they begin. There’s also a slew of other options utilized for long-term treatment such as beta blockers normally prescribed to treat abnormal heart rhythms, calcium channel blockers (also used to treat the heart) and antidepressants. “There is a clear relationship between serotonin and migraines,” Esper said. Antidepressants impact serotonin and thus can help prevent the development of headaches.

But the key to success with a preventative approach is commitment. “One of the reasons preventative medications don’t work is because patients do not give them a chance,” Joel noted. “You have to be on them for one to two months before you reach maximum efficacy. It’s like treating diabetes. You may have to use them forever. Unless there’s a dramatic change in your lifestyle or some other factor, when you go off, it’s likely your migraine will return.”

Since migraines can also result from arthritis in the spine and other spinal problems, one method employed relieves inflammation with injections or heated energy.

The last direction of help includes holistic and alternative medicine. Some patients swear by this technique. This is the method espoused by Tanner at Spherios Medical Center. “We look to see if a patient should eliminate certain foods or is low in some  minerals, particularly magnesium. We follow very specific protocols to bring levels back up to where they should be. We also do certain types of massage to relieve muscle contractions and reduce stimulation of blood vessels. But I don’t want patients to think a cure is just sitting here waiting for them. This is a fairly intensive program and we ask patients to give us six months to restore their body to health.”

Whatever treatment is selected, migraine patients know that seeking help is far superior to suffering. Finding appropriate medical attention is the first step toward identifying the suitable approach for you. PN

Photos Courtesy of photos.com