Dr. Holly Hauser
Perhaps there is no condition for which the old saying, “An ounce of prevention is worth a pound of cure,” is more apt than the migraine headache. The debilitating headaches can often be quite amenable to treatment and especially to prevention.
This complex headache is very common and plagues more than 30 million people just in the United States, about 75% of them women. Dayna Arnstein, M.D., an Internal Medicine specialist with a very personal interest in migraine headaches, works for Scripps Clinic Medical Group in San Diego. Despite these impressive numbers, she notes that migraine continues to be, “under-recognized, under-diagnosed, and under-treated.” Why would that be?
Classic migraines are described as unilateral (affecting one side of the head), throbbing, associated with nausea, and are preceded by an “aura.” This aura differs for different people, but is often visual or sensory. Visual changes such as spots in the visual field or specific smells (not actually present in the environment) are characteristic complaints. People who have frequent, classic migraines know when the headache is about to appear.
Others may not get the classic aura, but usually have a warning sign of some kind. Dr. Arnstein has been getting migraine headaches since her early 20’s. She says, “I rarely get a classic aura. My typical warning is a heavy feeling around my eyes.”
The good news about the aura is that it gives sufferers a warning sign that is quite dependable. When the aura starts, these folks can take “abortive” treatments which often stop the migraine in its tracks. These medications, often in the “triptan” class of drugs, are quite effective at treating a single headache, but do not prevent migraines or cure them. Dr. Arnstein notes that the throbbing headache and nausea of a migraine are “miraculously lifted” when she takes a medication in the triptan class.
Using these triptan medications too often — or overuse of any pain medication — can cause “rebound” headaches. Therefore, most patients are given careful guidelines about using their medications judiciously.
However, a fair number of migraine sufferers get frequent headaches, more often, in fact, than they should use abortive treatments. For these patients, prevention becomes quite important.
Migraine prevention can include both traditional Western and alternative treatments. There are several medications commonly used in traditional western medical practice to reduce the frequency of the disabling headaches. The medications can range from cardiovascular drugs, thought to reduce the blood vessel spasm associated with migraine; antidepressants, which act on the neurotransmitters in the brain; anti-seizure drugs, which may “calm” overexcitable nerve cells in the brain; hormone therapies, which are especially useful in women who are able to identify hormonal triggers; and botox, which may be affecting sensory nerves. One caveat: hormone therapies such as the birth control pill used in women with a classic aura may increase the risk of stroke. Migraine sufferers should discuss this issue and other possible side effects with their physician before starting any treatment course.
In addition to these traditional drug treatments, there are other treatments which may be very effective in migraine prevention and be more easily tolerated by some. These include acupuncture, biofeedback, manual therapy, herbs and supplements, aerobic exercise, stress reduction, muscle relaxation exercises, and getting an appropriate amount of sleep. Several studies published in peer-reviewed journals have demonstrated the efficacy of feverfew, a member of the sunflower family, in migraine prophylaxis, or prevention. It has also been studied and found to be effective in a sublingual (under the tongue) form combined with ginger for migraine treatment.
For Dr. Arnstein, inadequate sleep is a major factor in triggering headaches. During her residency, she frequently suffered with migraines after long nights on call. She notes, “My ability to perform, concentrate, focus and attend work was affected. I can remember being nauseous and vomiting between patients, and trying to carry on with my throbbing head, so as not to inconvenience my fellow residents. Once I knew what I was dealing with, the headaches became much more manageable. I was able to take abortive meds immediately at onset, and carry on with my work and studies in a very productive manner. Prophylaxis also became part of my medical regimen…to keep my headaches less intense and less frequent, also allowing me to be more productive and continue with my activities.” She has never missed a day of work due to the condition, and manages her migraines through a combination of lifestyle and medication approaches.
Determining the best treatment and prevention combination for each individual is an important part of managing migraine effectively. Dr. Arnstein strongly recommends keeping a headache diary. This can help you and your treatment team begin to understand your own headache triggers. It can also help you identify when prophylactic treatment is indicated. When you have more than five headache days per month on a pretty consistent basis, even when you are avoiding your known triggers, it time to discuss prophylaxis with your physician.
Dr. Arnstein feels that suffering from migraines actually improves her clinical work. She says, “As a migraine sufferer, I can completely understand and relate to my patients. When they talk about their stuffy nose and sinus headache around their menstrual cycle, and I find out their mother had migraine, we figure out how to best manage their migraine that has been masquerading as a ‘sinus headache’ all these years, but not responding. Migraines cause vasodilation and can cause the vessels around the nose and sinus to become dilated and engorged, just like the ones that are throbbing around the eyes. Many patients go undiagnosed. Migraines come in many shades. I have learned this as a patient, and as a physician with a great interest in this subject. I make sure I stay up to date on the latest literature, clinical trials and new remedies.”
Getting the right diagnosis, understanding your own triggers, and using preventive measures can help keep migraines in check. Researching the myriad options available for those with migraines, and determining the right ones for you, are important to finding your way to better health.
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