The Ultimate Guide to Migraines

Reed Migraine - Ultimate Guide to Migraines
Have you ever suffered from a migraine?

Thirty-six million Americans suffer from migraines according to the National Headache Foundation. Those who suffer from this disorder experience headaches and intense throbbing pain, that limits their work and daily activities.

Today, one in four households contains a family member who suffers from migraines. And for many, migraines are a recurring problem that eludes effective treatment.

Dr. David W. Dodick, a neurologist at the Mayo Clinic in Arizona and president of The Headache Society, “Migraine is so much more than a bad headache. This inherited neurological disorder renders sufferers vulnerable to repeated activation of brain networks that result in severe head pain and a variety of other symptoms” in The New York Times blog.

At Reed Migraine Centers, we understand migraine pain. We’ve devoted our careers to improving the lives of migraine sufferers, and we are the only medical center with access to The Reed Procedure®, a peripheral nerve stimulation procedure developed by our founder, Kenneth Reed, M.D.

Read on below for everything you need to know about migraines. If you think you are suffering from this chronic condition, find out if the The Reed Procedure® could work for you.

 

Chapters and Resources

Resources and associated links are categorized into the following chapters:


Each of the topics is worth spending some time at least reviewing the content, but you can of course focus on the topics of most interest to you.

 

1. What is a migraine?

"Migraine is a neurobiological disorder involving both neurological and vascular changes in the brain during an attack" says Susan Broner, MD, medical director of the Manhattan Headache Center in New York City in Prevention magazine.

“People with a genetic predisposition have a reduced threshold for the activation of the brain's 'pain centers' and become hypersensitive to stimuli that cause pain. These set off a wave of nerve cell activity and neurotransmitter release that activates blood vessel inflammation, feeding pain structures deep in the brain."

A migraine headache is classified as a painful headache with side effects including nausea, vomiting, vision changes, and extreme light sensitivity. It is a very common type of headache with throbbing or pulsing pain.

Migraines vary in severity; some are mild and tolerable, while others impact the sufferer to the point that they have to lie down in a dark room immediately to cope with the pain. Each migraine can be four hours to three days in duration, or even longer in some cases.

According to the Migraine Research Foundation, women suffer from migraines three times as often as men. Of those who suffer, 50% have more than 1 attack each month, and 25% have 4 or more severe attacks per month.

Most people with migraines experience repeated attacks over a period of years, and the tendency to get them often runs in families. Most chronic sufferers experienced their first migraine during childhood or adolescence.

 

2. What are symptoms of a migraine?

Because most people who experience migraines are chronic sufferers, they have learned to recognize the symptoms. However, migraines can sometimes be mistaken for severe headaches.

There are four stages of migraines, although you may not experience them all:

Prodrome - The prodome is a stage preceding a migraine, where subtle changes may occur. These include constipation, food cravings, hyperactivity, depression, irritability, stiffness of the neck, or increased yawning.

Aura - Most people do not experience aura. These sensory warning symptoms can occur before or during migraines. The most common is a visual disturbance such as flashes of light.

Touch and movement can also be impacted. Others can include speech and language problems, called aphasia; blind spots or vision loss; or a tingling sensation in an arm or leg. Limb weakness is also a possibility, although rare.

Aura usually lasts for 20 minutes to an hour after beginning gradually and building over several minutes.

Headache - The migraine itself lasts from four to 72 hours for most people, and the frequency of episodes varies depending on the person.

A migraine is typically pain on one or both sides of your head which has a throbbing or pulsing sensation, accompanied by nausea / vomiting, blurred vision, sensitivity to light, and occasionally sounds and smells as well. Lightheadedness, which can cause fainting, is a possibility as well.

It’s important to note that these are the symptoms of an untreated migraine. If you think you’re suffering from a migraine, click here to learn more about treatment options.

Postdrome - Postdrome is the final phase. Many people feel fatigued drained of energy following the headache, although some report feelings of mild euphoria.

 

3. What causes migraines?

Much about the exact cause of migraines still isn’t understood, but genetics and environmental factors do appear to play a role. Many migraines appear to have triggers, meaning they are caused by things that occur as part of everyday life.

Eight factors that tend to trigger migraines are:

Emotional stress - Emotional stress seems to be one of the most common triggers. Stressful events cause certain chemicals in the brain to be released and help the body stabilize the situation.

This is commonly referred to as “flight or fight” syndrome and the chemical release can cause a migraine by provoking vascular changes.

Migraine severity can also be increased if the emotions surrounding stress like worry, anxiety, excitement, and fatigue, are repressed. Repression of emotions can increase muscle tension and dilate blood vessels.

Excessive caffeine consumption - Blood vessels are sensitive to caffeine consumption and can cause a headache when those accustomed to consuming higher levels of caffeine reduce abruptly.

For this reason, caffeine can be used to treat migraine attacks. Alcohol consumption may also trigger migraines.

Chemicals and preservatives in foods - Foods such as nitrates and monosodium glutamate (commonly called MSG) may be responsible for triggering up to a third of migraines.

Nitrates are often added to meats such as pepperoni, hot dogs, and luncheon meats. MSG is often found in American Chinese fast food. The artificial sweetener aspartame may also trigger attacks.

Changes in the weather - If the weather involves strong storm fronts or winds, changes in barometric pressure, or changes in altitude, this can cause migraines.

For women, fluctuations in the hormone estrogen - The beginning or end of the menstrual cycle can act as a trigger to migraines because of the sudden increases or drops in estrogen.

Some women develop migraines during pregnancy or menopause for this same reason, or report an increase or decrease in migraines surrounding starting or ending oral contraceptives.

Sensory stimuli - Bright lights, sun glare, loud sounds, and strong smells such as perfume, paint, paint thinner, cigarette and cigar smoke, can trigger a migraine headache.

Physical factors - Vigorous workouts, sexual activity, missing sleep or getting too much sleep (i.e. changing your usual sleeping pattern), and jet lag from traveling, can trigger migraines in some people.

Medications - Vasodilators such as nitroglycerin, and oral contraceptives as mentioned above, can trigger migraines.

Genetics also appear to play a role. People with a history of migraines tend to have others in their family who experience them as well.

Researchers are studying the role of serotonin as a trigger for migraines. tend to drop during an attack.

When the level of serotonin in the brain drops, this may cause the body’s trigeminal system to release neuropeptides. When the neuropeptides travel to the meninges, or brain’s outer covering, the result can be a headache.

 

4. What types of migraines are there?

Migraines are described by auras, physiological symptoms that signal the onset on an attack. As such, there are two types of migraines:

      • Migraines with aura, or Classic Migraines
      • Migraines without aura, or Common Migraines

The majority of migraines are the Common Migraine, experienced by 80 to 85 percent of migraine sufferers. There can be symptoms prior to the headache’s onset, but they are vague. Symptoms include anxiety, depression, or fatigue / tiredness several hours before the headache starts.

About 20 to 30 percent of migraine sufferers experience Classic Migraines. The aura precedes the attack of pain by one hour and lasts between 15 minutes and an hour.

The aura can be visual, with symptoms including blind spots, distorted vision, flashes of light, temporary vision loss, or noticing wavy or jagged lines. Auras can also include ringing in the ears (called tinnitus), or changes in taste, smell, or touch. Some describe auras as a ‘funny feeling.’

Some neurological auras cause rare migraine conditions. They include:

        • The onset of a hemiplegic migraine. This may include vision changes, dizziness, or temporary numbness. Hemiplegic migraines can involve nerve or sensory changes on one side of the body including temporary paralysis. These symptoms are similar to a stroke so both need to be evaluated carefully by a medical professional.
        • A retinal migraine. This can cause partial or complete loss of vision in one eye, either temporary or permanent, in combination with a dull ache that starts behind the eye and may spread throughout the head.
        • The aura signifying the onset of a basilar artery migraine. This may include dizziness, loss of balance, and a feeling of confusion. These symptoms come on suddenly and can be accompanied by the inability to properly speak, ringing in the ears, and vomiting. This type of migraine has been linked to hormonal changes and young women are the group who suffers from them most. When the headache pain comes, it usually occurs in the back of the head.
        • A Status migrainosus. This is a rare and extremely severe migraine. The pain and nausea can last 72 hours or more, and is so debilitating that the suffer needs to be hospitalized. It has been linked to medications or medication withdrawal.
        • Another extremely severe migraine is the ophthalmoplegic migraine. This is also a condition requiring immediate medical attention. An ophthalmoplegic migraine includes pain surrounding the eye, including muscle paralysis, and can be caused by an aneurysm or pressure on the nerves in the back of the eye. Other symptoms include double vision or a droopy eyelid.

 

5. When should I call a doctor?

If there is a history of migraines in your family, it would be helpful to keep a headache diary for yourself, and for your children. Migraines often go undiagnosed and untreated, and making a note of their frequency and severity will help you notice if things are changing or escalating.

However, see a doctor or visit the emergency room immediately if you have any of the symptoms below. They may signify a larger, more serious medical issue:

      • A chronic headache that develops or gets worse after physical exertion, coughing, or sudden or straining movements
      • A severe headache like a thunderclap that occurs abruptly
      • A headache accompanied by fever, a stiff neck, confusion, seizures, double vision, weakness, numbness, or difficulty speaking
      • A headache immediately following a head injury

Also, if you are over the age of fifty, and experiencing a headache like none you’ve had before, seek medical attention immediately.

Finally, if you have daily headaches, or have treated a headache with over-the-counter medications and it does not get better, or if your headaches frequently impede your ability to work or enjoy your daily life, talk to your doctor.

Children with any kind of headache should see a doctor immediately for evaluation and proper diagnosis.

 

6. How do you treat a migraine?

Because the exact root cause of a migraine is still unknown, and pain and suffering is so individualized, treatment can be a process involving several different approaches.

When you see a physician for treatment, he / she will evaluate your symptoms, medical history, and in most cases, conduct a physical and neurological examination.

There are no migraine-specific diagnostic tests. However, if you are experiencing headaches with features not typically found with migraines, or other severe symptoms accompany your migraines, your doctor may recommend additional tests or a consultation with a neurologist (specialist in the area of nerves and brain).

Your doctor may also evaluate your migraines based on the list of potential environmental factors and make recommendations based on your responses. Together, you may need to try several different strategies to find the solution that’s right for you and your pain.

There are several ways to treat and prevent migraines: surgical treatment, lifestyle changes and natural remedies, and medication.

Surgical Treatment and The Reed Procedure® - In 1999, Dr. Kenneth Reed and his associate introduced a remarkable new treatment that changed the headache medicine world. The combined peripheral nerve stimulation migraine treatment, called The Reed Procedure®, has since helped hundreds of patients suffering from chronic migraine conditions that have not responded to other treatments.
The documented success rate of The Reed Procedure® is over 80 percent, and the physicians at Reed Migraine Centers across the United States are world-leading specialists. See a list of locations here. No other physician or institution worldwide has more experience in relieving headaches and restoring their full enjoyment of life – without severe migraines.

The Reed Procedure® is a surgery that helps prevent migraines. However, it is not for everyone. To determine if you might be a candidate for this groundbreaking treatment, register for a free webinar to find out.

Medication - Medication can be used to reduce the frequency of migraines and manage the pain associated with them. Medicine is used in combination with lifestyle changes and other treatment programs.

Abortive medications are taken when a headache begins. Preventative medications are taken every day. It is your choice of which approach you would like to take to manage your condition. In the past, doctor recommended a preventative approach for patients with two or more attacks per month. Today, we know that there are other reasons to consider preventative medication, including:

      • Migraines that occur too often
      • Infrequent migraines when abortive medications don’t work
      • Overuse of pain relievers and abortive drugs, or adverse reactions
      • Cost, including the cost of missing work when an attack strikes
      • Complicated migraines with unusual / neurological symptoms

Commonly prescribed preventative medications include:

      • Anticonvulsants
      • Beta-blockers
      • Tricyclic antidepressants
      • Calcium channel blockers
      • Botox (for chronic migraines that occur more than 14 days per month)

You and your doctor can evaluate the options available to you and possible side effects, and may change the medication if the situation doesn’t improve. Don’t despair – migraine treatment can be a process, and eventually you and your doctor will find an effective way to prevent and manage your pain.

Abortive medications should be taken as soon as you notice the aura that precedes the headache, or as soon as the headache starts. This can be challenging, especially for those with daily or frequent headaches because abortive medications should not be overused. Overusing abortive medications can lead to chronic daily headache, commonly called a rebound headache.

When taken at the earliest sign of a headache, non-prescription drugs and inexpensive prescription drugs can be effective. Sometimes doctors may recommend a combination of aspirin, acetaminophen, and caffeine taken once or twice per month. Do not combine any drugs, prescription or not, without speaking with your doctor.

Prescription medications can be highly effective to manage the pain associated with migraines and allow you to function until the migraine subsides. An anti-nausea medication might also be prescribed for those who experience that symptom as part of their migraine.

Natural Remedies and Lifestyle Changes - Other approaches to managing and preventing migraines include lifestyle changes. These range from managing caffeine intake and medications to stress reduction techniques. Many find that their stress level diminishes – and therefore their instances of migraines – when they begin a regular program of moderate exercise, yoga, massage therapy, meditation, acupuncture, aromatherapy and herbal remedies, or biofeedback monitoring. Magnetic stimulation devices, when prescribed and monitored by a physician, have been effective for some patients.

Dietary changes can also have a positive effect on the number of attacks a person experiences. These include eliminating alcohol, reducing the consumption of processed foods, and eating a more nutritionally balanced diet. Keeping a headache diary along with a food diary will help you identify possible triggers in your diet and replace them with healthy alternatives. Incorporating ingredients into your diet that reduce inflammation, such as flaxseeds, are also worth considering.

Finally, don’t underestimate the power of a good night’s sleep. According to Edward T. Creagan, M.D. of the renowned Mayo Clinic, overwhelming data suggests that a lack of predictable and restorative sleep can increase irritability, anxiety, depression and other health problems.

Hot and cold compresses, particularly when applied in a dark room, have also proven effective pain management techniques for some migraine sufferers.

As stated previously, you and your doctor may need to try different approaches, culminating in a surgical option such as The Reed Procedure®, to manage your headache pain and frequency. However, most people who develop migraines will have headaches over a period of years, so treatment is worth pursuing. No one should have to live with pain!

 

7. How do migraines affect children?

Although about 70 percent of school age children report having a headache at least once a year, only about 10 percent suffer from migraines. Those with migraine tendencies will have their first attack by the age of twelve.

There is no definitive answer on whether and how children “grow out” of the tendency to suffer from migraines. However, research does suggest that managing the condition effectively may prevent chronic migraines from occurring during adulthood.

In children, the pain of a migraine headache affects the whole head, not just one side as with adults. Their attacks last less than an hour, with pain subsiding within 2-4 hours. This is a shorter duration than with adults. Other differences include:

      • Sickness following the headache that can be worse than the headache pain itself
      • Abdominal pain without pain in the head
      • Carsickness
      • Sudden headache with pain lasting less than 15 minutes

Other symptoms are similar to adults – light and noise sensitivity, dizziness, fatigue, or vision changes. They vary from child to child and attack to attack. Frequency varies as well, even over weeks or months.

A child’s headache may worsen with physical activity and go away with a short 15-minute nap.

A small percentage of children with migraines experience aura, which can include tingling, dizziness, and limb numbness or weakness, similar to adult sufferers. Vision changes can also be aura. The only difference is that children experience aura closer to the onset of the headache than adults.

Common triggers for children include sleep pattern disruption, dehydration, not enough food, dietary factors, stress, sudden bouts of exercise, flickering light from computer screens, bright lights, weather changes, and other health problems such as cold, flu, or in young women, menstrual cycles.

A child with a headache should be diagnosed by a doctor. You can help aid the diagnosis by keeping a headache diary with your child so that triggers can be easily identified. Observing your child closely is also important; a migraine may occur after you notice your child yawning more frequently than usual, complaining of muscle pain, has a wan complexion, avoiding bright lights or squinting, or seems to be unusually quiet, tired, and irritable. Seeing a doctor will also help your child feel accepted and understood, and reduce anxiety surrounding the condition.

Migraines in children can often be mistaken for sinus disease, eyesight issues, or allergies, so it’s important to see a doctor right away. The doctor will ask your child a series of questions called a Migraine Disability Assessment Scale (MIDAS) and evaluate the family’s history of migraines.

Developing a lifestyle for your child that recognizes possible triggers is another conversation you can have with your child’s doctor.  Setting goals that are realistic is also part of the process. Other therapies include medication at the first sign of headache, massage and physical therapy, and simple treatments such as avoiding carrying heavy backpacks and sleeping, even for a short time.

Medication options for children can be preventative or acute, and can include both pain medication and anti-nausea medication. The risk of over-use and unwanted side effects are particularly important in children, so please consult your doctor at the first sign of a headache in your child. Headaches can also be a sign of a more serious medical problem.

Finally, be sure to discuss your child’s tendency toward migraines and treatment with the teachers and administrators at his or her school.

Conclusion

Now that you know everything there is to know about migraines, don’t ignore the signs. If you start experiencing chronic or severe headaches, don’t hesitate to call the doctors.

Migraines are a serious problem and should be treated as early as possible. If you suffer from migraines, contact Reed Migraine Centers today to see if the procedure is right for you.

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