More than a Headache

Migraines present complex issues that stretch far beyond typical irritations.

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healthcare, pain, stress, age and people concept - senior man suffering from headache at home

From nausea and piercing pain to vision loss and facial weakness, those who suffer from migraines – known as migraineurs – manage and endure an intricate web of symptoms.

“Migraine is not just a headache,” says Charles Morgan, a vascular neurologist and medical director for the INTEGRIS James R. Daniel Stroke Center of Oklahoma. “A great many migraines occur with no pain at all. Migraine is an episodic, neurologic disorder, usually associated with a prodrome – a sense that something is going to happen – and it may be as simple as fatigue. The patient may say, ‘Uh oh, I think this is going to be a migraine day.’”

healthcare, pain, stress, age and people concept – senior man suffering from headache at home

Morgan says a migraine often, but not always, comes with an aura. The most common type is visual, and descriptions include shimmering or flashing lights, or an area of vision loss that moves from one side to the other.

“The aura can be extremely variable between patients, but often is stereotyped during repeated attacks for a single migraine patient,” he says. “If there is a headache, it can precede the aura, occur at the same time as the aura, or follow the aura. The pain can be a mild or severe, sharp or throbbing.”

Yoon-Hee Cha, a neurologist with Warren Clinic in Tulsa and an assistant professor at the University of Tulsa, serves as a principal investigator at the Laureate Institute for Brain Research.

“About 30 percent of migraine sufferers will experience visual aura at some point … most typically preceding the headache,” Cha says. “There are other, more rare forms of migraine, however, such as migraine associated with stroke-like symptoms, migraines that actually cause strokes, migraines with symptoms that appear to come from the brain stem, and migraines that have very prominent autonomic symptoms. There are also migraines that are only associated with visual loss and not headaches, which we call retinal migraines.”

Among the struggles of migraineurs is that while their condition is debilitating, it’s often unseen by others.

“Invisible illnesses are some of the most devastating because the pain and suffering are real, but there are no outward manifestations that prove the person’s experience,” Cha says. “This experience can lead to depression due to a sense of helplessness that develops when pain is not controllable in a reasonable amount of time.”

Migraine or Headache?

Yoon-Hee Cha, a neurologist with Warren Clinic in Tulsa, explains that for a formal diagnosis of migraine, a person would have to experience:

  • At least five episodes of headaches lasting 4 to 72 hours that are associated with either nausea and/or vomiting or light and sound sensitivity;
  • And at least two of the following types of head pain: one-sided; pulsating; moderately severe or greater; or aggravated by physical activity.

“From a practical standpoint, a moderately severe headache that is associated with hypersensitivities is how you would distinguish a migraine from other primary headache disorders such as tension headache or cluster headache,” Cha says.

Who Gets Migraines

  • According to the Migraine Research Foundation:
  • Migraine is the third most prevalent illness in the world.
  • About 12 percent of the U.S. population, including children, suffer from migraine.
  • Migraine is most common between the ages of 25 and 55.
  • 18 percent of American women, 6 percent of men and 10 percent of children experience migraines.
  • Migraine is hereditary, with about 90 percent of migraine sufferers having a family history.

Treating Migraines

Charles Morgan, vascular neurologist, divides migraine management into two categories.

Acute Treatment “In this category, anti-inflammatory medications, such as aspirin, naproxen and ibuprofen, are the mainstays,” Morgan says. “For infrequent headaches, a combination of acetaminophen with low-dose caffeine available over-the-counter is very reasonable, but that is not a good choice for frequent migraine because that combination tends to cause a rebound headache.”

Prevention Morgan says for frequent headaches that interfere with work and social life, a migraine-preventing medication can help.

“There is a long list of medications prescribed by neurologists for migraine prevention, some of which are FDA approved for this indication, many of which are not,” he says. “Commonly prescribed migraine preventers include beta blockers such as propranolol, some seizure medications such as sodium valproate or topiramate, and candesartan, a blood pressure medication. Each of these medications has some potential side effects and you will want to talk with your physician before starting them.

“There is a recently approved medication for migraine prevention (erenumab), which in studies has offered good protection from frequent severe migraines and have a good safety profile. It is quite expensive and is considered a last resort. It is given by injection on a regular basis.”

Morgan emphasizes that narcotics aren’t the best choice for treatment.

“Narcotics for recurrent migraine are a very bad idea,” he says. “It is terribly ineffective in the long run and leads to rebound headache and addiction.”

The Maybe Medicine Cabinet

Migraineurs report using a variety of methods and medications to ward off pain
 – some prescribed by doctors, others they’ve found themselves. To each his own,
but ask your physician before trying anything new.

Antidepressants

Some antidepressants, such as nortiptyline, may help to reduce the frequency of migraines. Tricyclic antidepressants are not approved by the FDA for this purpose, but doctors can legally prescribe them off-label.

Caffeine

Some migraineurs say they quickly suck down an icy soda and take a couple over-the-counter pain relievers at the first sign of trouble – and that cold can of caffeine does the trick by heading off a splintering migraine, or at least reducing the symptoms.

Anti-convulsants

Topiramate and valproic acid are commonly prescribed to prevent migraines. For people with frequent migraines, these medications might do the trick.

Package of suppository isolated on white background

Suppositories

For those who suffer debilitating nausea and/or vomiting with a migraine, some pharmacies make special ibruprofen suppositories, which can provide over-the-counter pain relief without you trying to hold pills or liquid down when you’re at your worst.

Daith piercings

Some swear by daith piercings, while some call them bunk. The daith is the fold of cartilage near the center of your outer ear. Some report experiencing fewer migraines after having a piercing placed there.

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