Headaches - Migraines
05/17 -
-By Royce K Bailey MD, MPH, FAAC, MAAC
Approximately 60 million Americans suffer from chronic headaches, and 28 million of them suffer from migraines.
Headache vs Migraine
Ordinary (tension) headaches are usually caused by muscle tension at the back of your head and neck. Migraines differ from ordinary headaches because they are caused by changes in the size of the blood vessels supplying your brain. While the exact cause of each kind of headache remains in debate, most researchers believe that a migraine attack involves the constriction of the arteries in your brain, followed by their reactive widening (dilation) pressing against your non-expandable skull. A migraine headache is a throbbing or pulsating headache that is often on one or both sides of the head associated with or without an aura, nausea, vomiting, sensitivity to light (photophobia), sound, smells, sleep disturbance, unusual tiredness, mood changes and depression. They may occur at any age, but usually begin between the ages of 10 and 40 and diminish after age 50. Some people experience several migraines a month, while others have only a few migraines throughout their lifetime. Approximately 75% of migraine sufferers are women.
Ordinary (tension) headaches are usually caused by muscle tension at the back of your head and neck. Migraines differ from ordinary headaches because they are caused by changes in the size of the blood vessels supplying your brain. While the exact cause of each kind of headache remains in debate, most researchers believe that a migraine attack involves the constriction of the arteries in your brain, followed by their reactive widening (dilation) pressing against your non-expandable skull. A migraine headache is a throbbing or pulsating headache that is often on one or both sides of the head associated with or without an aura, nausea, vomiting, sensitivity to light (photophobia), sound, smells, sleep disturbance, unusual tiredness, mood changes and depression. They may occur at any age, but usually begin between the ages of 10 and 40 and diminish after age 50. Some people experience several migraines a month, while others have only a few migraines throughout their lifetime. Approximately 75% of migraine sufferers are women.
Four Phases Of Migraines
1) Prodrome. The "prodrome" phase warns that a migraine is coming. Symptoms include changes in your mental state, such as irritability or confusion, and physical signs such as thirst or diarrhea. One out of every four migraine sufferers experiences prodrome symptoms as early as 24 hours before the migraine pain attacks.
1) Prodrome. The "prodrome" phase warns that a migraine is coming. Symptoms include changes in your mental state, such as irritability or confusion, and physical signs such as thirst or diarrhea. One out of every four migraine sufferers experiences prodrome symptoms as early as 24 hours before the migraine pain attacks.
2) Aura. A neurological warning (aura) can be experienced 10 to 60 minutes before a headache. Most auras are visual, like bright shimmering lights around objects or at the edges of the field of vision (called scintillating scotomas) or zigzag lines, castles (teichopsia), wavy images, or hallucinations. Some experience temporary vision loss. Nonvisual auras include motor weakness, speech or language abnormalities, dizziness, vertigo, tingling or numbness (parasthesia) of the face, tongue, or extremities-just like a stroke. About one in five migraine sufferers experience auras.
3) Pain. The pain phase can last from several hours to 72 hours.
4) Resolution. After a migraine, many people experience deep fatigue and general malaise for up to 24 hours.
Rebound Headaches
Rebound migraines stem from too much caffeine, prescription migraine drugs or non-prescription pain relievers. Taking something almost daily or as little as three days a week can cause a sufferer to get in a cycle called "rebound." Your body becomes accustomed to the headache treatment and without it you go through withdrawal and your headache returns and you take more meds. Use the ‘2-5 Rebound Rule’, treat your migraine for 2 days and then don’t take anything for at least 5 days thereafter.
Rebound migraines stem from too much caffeine, prescription migraine drugs or non-prescription pain relievers. Taking something almost daily or as little as three days a week can cause a sufferer to get in a cycle called "rebound." Your body becomes accustomed to the headache treatment and without it you go through withdrawal and your headache returns and you take more meds. Use the ‘2-5 Rebound Rule’, treat your migraine for 2 days and then don’t take anything for at least 5 days thereafter.
Menstrual/Hormonal Migraines
Menstrual migraines can occur just prior to or during menstruation. These headaches are related to hormonal changes and often do not occur or lessen during pregnancy. Some women develop migraines for the first time during pregnancy or after menopause. Birth control pills as well as hormone replacement therapy peri-menopausal or during menopause can trigger migraines in some women.
Ocular Migraines
Eye migraines occur when blood flow to the brain responsible for vision (visual cortex or occipital lobe) is disturbed, resulting in ophthalmic or ocular migraines that produce visual symptoms, even without a headache. They have nothing to do with your eye. Characteristically you will see a small, enlarging blind spot (scotoma) in your central vision with bright, flickering lights (scintillations) or a shimmering zig-zag line (metamorphopsia) inside the blind spot. The blind spot usually enlarges and may move across your field of vision. The entire migraine visual episode can last between 2 and 30 minutes.
Silent Migraines
A silent migraine has many features of a regular migraine (may have an aura), but is without the actual headache pain. It is frequently mistaken for other illnesses, because a person may experience visual, auditory and speech problems.
Cluster Migraines
Cluster headaches are a rare type of headache, affecting 0.1% of the population. An estimated 85% of cluster headache sufferers are men. The average age of cluster headache sufferers is 28-30 years of age, although these headaches may begin in childhood. Half of these sufferers’ headaches can be triggered by alcohol. Treatment usually includes anti-inflammatories ie, prednisone.
Cluster headaches are a rare type of headache, affecting 0.1% of the population. An estimated 85% of cluster headache sufferers are men. The average age of cluster headache sufferers is 28-30 years of age, although these headaches may begin in childhood. Half of these sufferers’ headaches can be triggered by alcohol. Treatment usually includes anti-inflammatories ie, prednisone.
Sinus Headaches
A sinus headache can occur when the sinuses become plugged or congested. The sinuses are the bony, air-filled cavities in the face/head that connect to the nose through small openings. During a cold or allergy attack, the openings can become blocked by excess mucus and may become infected. People who have an injury to the bones in the nose, a deformity of the nose, or any condition that hinders the draining of the sinuses, may be at greater risk of getting a sinus headache. Increasing your water intake to one ounce per kilogram (2.2 pounds) of your body weight daily, will help thin the nasal mucous in your nose and diminish your sinus headache.
Tension Headaches
Tension headaches are the most common type of headache and are usually caused by muscle tightness at the back of your head and neck. As many as 90% of adults have had or will have tension headaches.
Triggers For Migraines
Emotional stress, changes in normal sleep pattern, extreme fatigue, specific foods and beverages, caffeine intake or withdrawal, skipping meals- fasting, changing weather conditions, exercise, smoking, bright and flickering lights, and odors can all trigger migraines. Natural chemicals in foods, food additives, artificial sweeteners and beverages, food additives/preservatives like nitrates and nitrites found in ham, sausage and other processed or cured meats, salads in salad bars, monosodium glutamate (MSG) in Chinese food and alcohol, specifically the impurities in alcohol or byproducts your body produces as it metabolizes alcohol, can all act as triggers for your migraine.
Tyramine Induced Migraines
Foods containing tyramine, a vaso-active amino acid, can cause migraines. Tyramine is an intermediate product in the conversion of tyrosine (an amino acid present in many proteins) to epinephrine (an active hormone produced by the inner portion of the adrenal gland).
Specific tyramine/food triggers include:
Aged cheeses: blue cheese, mozzarella, feta, cheddar, Parmesan;
Aged cheeses: blue cheese, mozzarella, feta, cheddar, Parmesan;
Alcohol: red wine, beer, whiskey, champagne;
Caffeine: coffee, chocolate, tea, colas, sodas;
Caffeine: coffee, chocolate, tea, colas, sodas;
Processed meats: pepperoni, salami, liverwurst, bacon, hot dogs, luncheon meats, mincemeat pie;
Bread and other baked goods;
dried fruits-like raisins;
smoked or dried fish, potato chips, pizza, peanuts, chicken livers, onions, olives, Fava or broad beans, sauerkraut, pickles, any fermented soy products (ie miso, soy sauce, teriyaki sauce), any kind of nut, avocados, and canned soups.
Avoid Your Migraine Triggers
- Watch what you eat and drink.
- If you get a headache, write down any food or drink you had before getting it. If you see a pattern over time, eliminate that item!
- Eat regularly. Skipping meals can trigger migraines in some people.
- Cut out caffeine. Excess caffeine (in any food or drink) can cause migraines.
- Avoid artificial sweeteners.-
- Get regular sleep. Changes in your normal sleep habits can cause migraines. Being overly tired can also trigger migraines.
- Learn to cope with stress. Emotional upsets and stressful events are common migraine triggers. Anxiety, worry, fatigue, and excitement can intensify a migraine’s severity. Learn to cope with stress better - through prayer, counseling, and relaxation.
OTC (Over The Counter) Treatments For Headaches
Butterbur (Petasites hybridus) is an extremely popular herbal remedy in Germany, where it is widely used as a preventative for migraines. It also works for allergies. Butterbur inhibits toxic chemicals called leukotrienes, which are released during the inflammatory process. It has also been found to help regulate the degree of widening of the arteries in the brain (Forsch Kompl Klass 2003, 10(1):41-44). The recommended dosage is one 50mg standardized butterbur extract capsule taken twice a day with meals.
Peppermint oil/Capsicum oil. First make sure you are hydrated and avoid caffeine. Water is the best for headaches. Place 4 drops of Peppermint oil on a cotton ball and rub the oil into your temples and the back of your neck. Next, place 4 drops of Capsicum oil on a new cotton ball and rub this oil in the same places that you did with the Peppermint. Using an electronic massager or a friend, massage your temples and the back of your neck with enough force to feel the effects but not enough to cause more pain. Use your middle finger and index finger to massage in circular motions on your temples. Continue drinking water and rest your eyes if necessary. Your head should feel better almost instantly.
Capsaicin, the natural chemical extracted from hot pepper plants (the active ingredient in pepper spray), opens up the sinus passages and blunts pain pathways. It can be used both topically and orally for sinus headaches, cluster headaches and migraines.
Co enzyme Q-10 is an essential element of the mitochondrial electron transport chain and cellular respiration. It is found in soybeans, olive, grapeseeds, sunflower, rice bran, coconut, peanuts, walnuts, sesame seeds, pistachio nuts, hazelnuts, almond, parsley, broccoli, cauliflower, spinach, Chinese cabbage, avocado, blackcurrant, and strawberries. Co enzyme Q-10 can be blocked by cholesterol lowering statins. A 50% decrease in headaches was seen after 12 weeks of taking 150-600mg of Co Enzyme Q 10 daily. (Rozen, TD, Oshinsky, ML, Gebeline, CA, Bradley, KC, Young, WB, Shechter, AL & Silberstein, SD. "Open label trial of coenzyme Q10 as a migraine preventive." Cephalalgia 22 (2) 137-141.)
Feverfew (Tanacetym parthenium). Researchers working at the Department of Neurology, University of Essen, in Germany, studied the effects of feverfew on a group of 147 migraine sufferers. At the end of the four-week study, the researchers found that the patients taking feverfew experienced a significant reduction in the frequency and severity of their migraines compared to those in the placebo group. Not only that but pain, nausea, vomiting and sensitivity to light were also significantly reduced following treatment with feverfew (Cephalalgia 2002, 22(7):523-532). Another study found that feverfew can reduce migraine frequency in up to two thirds of cases (Brit. Med. J. 291:569-73, 1985). The recommended dosage is one 125mg feverfew capsule taken once a day.
Caffeine can be both beneficial and harmful for a headache sufferer. It can serve as a treatment or be addictive causing insomnia, irritability, anxiety, palpitations and headaches. Caffeine can cause withdrawal or rebound headaches. Cut it out.
Avoid Sugar. Many migraine sufferers report experiencing an attack shortly after eating too much sugary food (Headache Quart 1997, 8(4):319-329). In addition to sweets and sugar, refined carbohydrates also cause your blood sugar levels to quickly rise. This interferes with the normal actions of various neurotransmitters, such as serotonin, which are implicated in causing migraines.
Powdered Ginger 400-600mg, 1/3 teaspoon, every four hours (total 4000mg-6000mg a day), fresh, tea, or capsule, improves headaches by decreasing nausea, platelet adhesion and inflammatory prostaglandins.
Magnesium. Migraines have been linked to the deficiency of the trace mineral magnesium. Magnesium helps the transmission of chemical messages from the brain to the arteries and helps control the degree of arterial dilatation (widening). Several hospitals in Canada and Germany use magnesium supplements as a standard treatment for acute migraines and prevention. The dose is 200mg of magnesium citrate capsules taken twice a day. Avoid if you have renal failure or diarrhea.
Omega-3. In one small study at the University of Cincinnati, high dose omega-3 reduced migraines by 40-50%. Walnuts (Black and English), pecans, raw seeds, freshly ground flaxseed, and fish oil are sources of omega-3.
Melatonin is a hormone produced in the brain’s pineal gland; it helps regulate sleep-wake cycles. Imbalances in the level of melatonin in the body may be related to headaches like migraines and cluster headaches. A Brazilian study found a 75% decrease in headaches if the individual took 3mg of melatonin before bedtime each day.
B Vitamins are good for preventing migraines. Vitamins B2, B3 and B6 help prevent vasoconstriction (narrowing of the arteries) and also inhibit blood platelet clumping (micro clots/scabs) which can occur during a migraine attack (Cephalalgia 1994,14(5):328-329). Vitamin B12 increases synaptic function of your nerves, which decreases the inappropriate brain blood vessel response in a migraine.
Prescription Treatments For Migraines
Triptans/Ergotamine
Triptans* and ergotamine** products constrict the blood vessels in your brain reducing your migraine or cluster headache. These work by stimulating serotonin (selective serotonin receptor agonist).
*Imitrex (sumatriptan), almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), rizatriptan (Maxalt), naratriptan (Amerge), zolmitriptan (Zomig),
** ergotamine: methysergide (Sansert), ergotamine (Ergomar, Ergostat, Cafergot, Ercaf, Wigraine), dihydroergotamine (D.H.E. 45, Migranal Nasal Spray), ergonovine (Ergotrate), or methylergonovine (Methergine).
Triptans* and ergotamine** products constrict the blood vessels in your brain reducing your migraine or cluster headache. These work by stimulating serotonin (selective serotonin receptor agonist).
*Imitrex (sumatriptan), almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), rizatriptan (Maxalt), naratriptan (Amerge), zolmitriptan (Zomig),
** ergotamine: methysergide (Sansert), ergotamine (Ergomar, Ergostat, Cafergot, Ercaf, Wigraine), dihydroergotamine (D.H.E. 45, Migranal Nasal Spray), ergonovine (Ergotrate), or methylergonovine (Methergine).
Beta and Calcium Channel Blockers
Beta (1 and 2 receptor) blockers (Inderal-popranolol) are usually used for hypertension, angina pectoris and cardiac arrhythmia, but taken daily can block and dampens the effect of migraine triggers. Calcium Channel blockers (like verapamil) are believed to benefit migraine suffers from their anti vaso-constrictor activity, inhibition of platelet aggregation, serotonin release, and/or serotonin and histamine receptor blockade.
Anticonvulsants (Seizure Medicine)
Seizure medications are used to control epilepsy, but these meds are also used to prevent migraine headaches. These include: Phenytoin (Dilantin), Carbamazepine (Tegretol), Divalproex sodium (Depakote), Gabapentin (Neurotin), and Topiramate (Topamax).
Botox
Since 1992, Botox, the same bacteria that causes deadly food poisoning, has been used in purified and diluted form to temporarily paralyze the muscles that bring the eye brows together, thereby eliminating wrinkles in this region. Doctors injecting botulinum toxin A in the upper third of the face for treatment of cosmetic frown lines had their patients, who coincidentally suffered from migraines, report headache relief.
Cervical/Cranial Surgery
A surprisingly large number of my patients that have had cervical spine surgery for disc disease/stenosis or foramen ovale (the big opening in the bottom of your skull)-Chiari Malformation surgery have found relief from their lifetime of headaches.
The Headache Not To Ignore!
Severe Headache or Medical Emergency? Know your personal headache symptoms. Rarely are headaches as serious as a tumor, stroke, encephalitis, meningitis or aneurysm (blood vessel rupture).
Symptoms to watch for: paralysis of the arms or legs, tingling, numbness, confusion, dizziness, double vision, slurred speech, trouble finding words, weakness, especially on one side of the face/body or the worst headache you ever had.
Prayer
We have neighbors that regularly kneel down together and pray when they develop a migraine headache. Humbling oneself before our merciful God does wonders for their headaches. You need to try it.
References:
MIGRAINE- Google Health, Mayo Clinic.com, Medline Plus, WebMD, Wikipedia, Web 05-07 to 12-10.
MIGRAINE- Google Health, Mayo Clinic.com, Medline Plus, WebMD, Wikipedia, Web 05-07 to 12-10.
