Migraine headaches affect 28 million people in the United States yearly, affecting more women than men. This chronic disorder can lead to functional and economic disabilities and emotional stress. Only 39% of migraineurs are diagnosed by a medical professional, indicating that most live undiagnosed using over the counter analgesics for some relief. The problem with that approach is that this condition is rarely managed effectively with some transforming from episodic to chronic, which can lead to a downward socioeconomic spiral.
A migraine headache is very different kind of headache that starts deep within the tissues of the brain, involving the brain stem, trigeminal nerve, and blood vessels on the surface of the brain. During a migraine attack, an electrical message surges through the nerves in different parts of the brain. Chemicals are released into the brain tissue that inflame and irritate the nerves and blood vessels. The person then feels pain, increase sensitivity to lights and/or sounds called photophobia and phonophobia. The headache may be accompanied by nausea and vomiting. Some people sense an aura before the start of a migraine which is described as seeing flashing lights. Once thought relatively benign or unimportant to brain function, neurologists now believe that having migraine headaches increases a person’s risk of having a stroke. It is important to be properly evaluated by a neurological specialist and treated appropriately to minimize the short and long term effects.
Migraines headaches can occur because of certain events, foods, or changes in the body. These are called triggers. They are not the cause of migraines but can make susceptible persons more prone to attacks. These include hormonal changes caused by menstruation, ovulation, birth control pills, and hormone replacement therapy. Environmental triggers include bright sunlight, strong pungent odors, and changes in weather. There are many foods and drinks that are known to be possible triggers to migraines also. These include alcoholic beverages such as red wine, hot dogs and aged cheeses that have a lot of nitrates, chocolate, and nuts. Physical triggers to migraines include increased stress, fatigue, changes in sleep patterns and increased physical activity. Understanding and identifying these can help manage migraines more effectively.
Migraine headaches can last from 4 to 72 hours if untreated. The triptans are a type of medication that can help curtail acute migraines, but they are not for everyone such as persons with cardiac disease. Prevention or prophylactic medications are able to lessen the number, intensity, and duration of attacks. There are several different kinds, but finding the right one depends largely on the presence of other coexisting disorders. A neurological specialist is the best health care provider to evaluate and treat migraines
Michael M Tuchman, MD, FAAN
Vivian Carta Sanchez, NP