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  • 1. Migraine Headaches Migraine headaches affect 26 million Americans. Seventy percent of those suffering from migraines in America are women, roughly 21 million people (Mayo Clinic, 2003). One in four American households has someone who is affected by migraine headaches. Although many employers do not consider migraines to be a legitimate medical problem, migraines can be a source of considerable disability. It is estimated that migraines cost the American taxpayers $13 billion a year in missed work or loss of productivity (National Institute of Neurological Disorders and Stroke, 2003). Although any head pain can be miserable, migraines are in a class by themselves in terms of the pain and suffering they cause. Migraine pain can be excruciating for those who suffer from them. Migraines can incapacitate the sufferer for hours and affect his/her daily activities for days after. By definition, a migraine is a very bad headache that tends to recur. Nausea and vomit might accompany the headache. The pain is usually on one side of the head. The affected person may become sensitive to lights and noises. Moving around can make the headache feel worse. There are many forms of migraine headaches. The two major varieties are classic and common. (McKinley Health Center, 2003). The difference between the two is the occurrence of the “aura.” The aura is the occurrence of neurological symptoms 10-30 minutes before the classic migraine may attack. Symptoms of a Migraine The pain of a classic migraine is described as intense throbbing. This throbbing or pounding can be felt in the forehead/temple, ear/jaw or around the eyes. This type of 1
  • 2. migraine, the classic, starts on one side of the head but may eventually spread to the other side of the head. An attack can last for one or two painful days. Other symptoms of the classic migraine can include speech difficulty, confusion, weakness of an arm or leg and even tingling in the face or hands. The common migraine, on the other hand, is the other type of migraine. Unlike the classic type, common migraines are not preceded by an aura. There are a variety of symptoms people do experience before common migraines. These include mental fuzziness, mood changes and fatigue. During the headache phase of the common migraine, abdominal pain can occur. Other symptoms can include diarrhea, increased urination, vomiting and nausea. Both the classic and common forms of the migraine headache can strike as often as several times a week or as rarely as once every couple years (McKinley Health Center, 2003). Causes of the Migraine Although much about headaches still is not understood, some researchers think that migraines may be caused by functional changes in the trigeminal nerve system, which is a major pathway in the brain (Clinical Journal of Pain, 2003). It is believed there are imbalances in the chemistry of the brain. A connection has been made between serotonin and migraines. Serotonin is a chemical that is responsible for regulating pain messages in trigeminal pathway of the brain. During a headache serotonin levels drop. It is believed then that this drop triggers a release of substances called neuropeptides, which travel to the brain’s outer covering. There they cause the blood vessels of the brain to 2
  • 3. become dilated and inflamed. The result is a severe headache with intense pain (Mayo Clinic, 2003). There have been other studies, however, that use brain scans to try and understand the cause of migraine headaches. Brain scans have shown that the volume of blood reaching the brain drops during an attack. This has led some experts to believe that migraines occur when blood drains from the blood vessels in the center of the brain to the vessels that are on the outer region of the brain. And yet another possible cause of migraine headaches has to do with a mineral called magnesium. Magnesium is involved in proper nerve cell function. Research has shown that magnesium also drops when a person experiences a migraine headache. It is possible that low amounts of magnesium may cause nerves in the brain to misfire, thus resulting in a migraine (Mayo Clinic, 2003). According to the National Institute of Health, there are other possible causes of migraine headaches. For many years, scientists believed that migraines were caused by dilation of the blood vessels in the brain. Some now believe that the migraine is actually caused by an inherited abnormality in certain cells in the brain (NINDS, 2003). With the help of new imaging technology, scientists can see changes in the brain while a person is having a migraine attack. These scientists believe that there is a migraine pain center located in the brainstem. The brainstem is the region at the base of the brain. As neurons are fired, the blood vessels that surround them dilate and become inflamed. This is thought then to be the cause of the migraine headache. Though the cause or causes of the migraine headache are not precisely known, it is clear that this disorder is a genetic disorder. Specific abnormal genes have been 3
  • 4. identified for some forms of migraines (NINDS, 2003). Sadly then, people with migraine headaches have a lasting predisposition to the attacks. Triggers of Migraine Headaches Whatever the cause of migraines, they do not just occur on their own. Something has to trigger them. Some things can trigger a migraine or make it worse. Triggers can be almost anything. They can range from allergies and stress to the sun and changes in temperature. These factors that can trigger or promote migraines in people should be identified in order to not provoke a migraine. Not all migraines have the same provoking factors and neither do all these factors necessarily provoke an attack. Diet: certain foods appear to trigger headaches in some people. Common food triggers include alcohol (especially beer and red wine), aged cheeses, fermented or pickled food, chocolate, aspartame, and caffeine. Another food related trigger is monosodium glutamate (MSG). MSG is a key ingredient in some Asian foods, certain seasoning, and canned foods that have been processed. Sleep: In some migraine sufferers, too much sleep or too little sleep can trigger an attack. It is important for someone whose migraines are trigger by too much or too little sleep to be consistent in their sleep patterns (American Medical Association, 1998). Hormone changes: Many women who suffer from migraines have attacks that are linked to their menstrual cycles. Changes in estrogen levels, especially a decline in the hormone level, are thought to play a role. Menstrual migraines are more difficult to treat and last longer than other migraines, typically. Research shows that these migraines 4
  • 5. characteristically decline in frequency as the age of the women increases. Also, there is evidence that oral contraceptives or estrogen replacement therapy can provoke or worsen the migraine headache in some women (American Medical Association, 1998). Stress and Anxiety: Another common migraine trigger is stress. Anxiety and fatigue also can provoke a migraine. Environmental Factors: There exist also environmental triggers of migraine headaches. These include such factors as changes in weather, season, altitude level or time zone. Other environmental triggers consist of bright lights, computer screens, and strong odors. And finally other common factors that can be involved in triggering a migraine are certain medications, low-blood sugar, changes in mealtimes, skipped meals or fasting, intense physical exertion, and tobacco (Mayo Clinic, 2003). Screening and Diagnosis If an individual has typical migraine headaches or a family history of migraines, then the doctor will likely to able to diagnose this medical condition on the basis of the person’s medical history. However, if the headaches are unusual and very severe and no family history of migraines exists, then the doctor may recommend certain tests to rule out other possible causes of the pain. A diagnostic procedure of x-raying the individual’s skull and sinuses is also helpful in determining the diagnosis. A magnetic resonance imagining test (MRI) can be used to x-ray the brain. This test results in imagery that produces clear images of the brain. Detector measurements are taken of the brain from thousands of angles. Then this 5
  • 6. information is processed by a computer to produce a three-dimensional representation of the individual’s head. If a doctor suspects that a person’s headaches are caused by an underlying medical condition, the doctor may recommend a spinal tap. In this procedure, a hollow needle is inserted in between two vertebrae in the lower back of the patient. Once in place, the pressure of the cerebrospinal fluid is measured. A sample of the fluid is taken for testing. This procedure takes about 30 minutes. It is used to measure out any other already existing medical condition that could be causing the severe headaches that the patient is experiencing. Treatment of Migraine Headaches Significant advances have occurred and are occurring in the treatment of migraine headaches. Today, most migraine sufferers can better control this disorder and relieve some of its impact. To manage a migraine effectively, an individualized treatment plan can be created with a doctor. The three main components of a treatment plan include: identifying and controlling factors that may be triggers of the migraine headache; describing medications that prevent and treat the attacks; and finally, encouraging healthy behavior and lifestyle changes in the migraine sufferer (American Medical Association, 1998). A vital component of migraine management is to provide therapy that consistently relieves migraine symptoms. Treatment can either stop an attack before it occurs or treat the symptoms when an attack does occur. For those individuals who experience frequent, disabling attacks, a preventive treatment is needed to that the migraines will strike less often and then last for a shorter time. While almost everyone who suffers from migraine 6
  • 7. headaches will need treatment to treat the symptoms, only one in five people with migraines need preventative treatment (American Medical Association, 1998). There are also many migraine drugs available. Migraine medications are also used as treatments for other medical conditions. For example, beta-blockers, which are used to treat hypertension and depression, are also used to treat migraine victims. However, the dosages of these drugs are different when used for migraine than when used to treat these other conditions. Migraine medications that are used to treat the symptoms of migraine attacks work best when taken as soon as the individual feels a migraine coming on. Drugs that are pain relievers such as aspirin, ibuprofen, and acetaminophen are often recommended by doctors for initial treatment of migraines. However, if these over the counter medications do not relieve the pain of the migraine, the doctor might then prescribe a drug or a combination of drugs. Prescription analgesics (pain relievers) including narcotics, are often combined with sedatives to relieve the pain of the migraine. There are also many different anti-inflammatory drugs that are effective in treating migraine headaches. And finally, there are specific drugs used to stop migraine attacks. One of these is derived from ergot alkaloids. The drug names are ergotamine and dihydroergotamine. Another drug used to stop the attack of migraines is triptans. Triptans are fairly new drugs that where developed specifically to stop migraine headaches. These drugs have important treatment similarities but they differ in how they are taken (tablets, shots, nasal sprays) and possible side effects. However, if one drug in these families of drugs does not work, another drug might be very effective (American Medical Association, 1998). 7
  • 8. Women and Migraines Both men and women are affected by migraine headaches but the condition is most common in women. Even though both sexes may develop the disorder in infancy, most often the disorder begins between the ages of five and thirty five. Since migraines are more prevalent in women, it is believed that hormonal changes can influence the occurrence of a migraine, especially related to the female menstrual cycle. These gender differences in migraine may be the result of differences in the central nervous system of men and women as well as the effects of estrogen. Hormonal manipulation may reduce the occurrence of migraines among women (Neurolog, 2003). There is also a researched connection between oral contraceptive pills (OCP) and migraine headaches. Scientists report that some women with migraines who take OCP’s do experience more frequent and severe headache attacks. Migraines and Children Children get migraine headaches too! It is estimated that more than eight million children and adolescents suffer from migraine headaches. This results in more than 1 million lost school days each year. Before the stage of puberty, as many boys as girls can get these painful headaches. But after the onset of puberty, migraine headaches are more common in girls. By age 15, about five percent of adolescents have at one time or another experienced a migraine attack. The migraines may stop as children grow into adulthood, but the disorder may return in middle age. In seventy percent of the cases of children with migraines, there is a family history of migraine headaches (American Medical Association, 1998). 8
  • 9. It is believed that the same mechanism that initiates a migraine attack in adults is the same initiating mechanism in children. However, doctors look for slightly different symptoms to diagnose the disorder in children. In some cases involving children, certain recurring or cyclical symptoms occur. These involve vomiting, dizzy spells, and abdominal pain. These recurrent medical conditions are thought to be forms of juvenile migraines. Another difference with children is where the pain is located in the head. Younger children usually feel migraine pain on both sides of the head. Older children and adults tend to feel the pain only on one side of the head. Fortunately for children migraine sufferers, the attacks are usually shorter in them than in adults. The most common related symptoms in children are nausea and vomiting, diarrhea, sweating, increased urination, thirst, and swelling. Also, visual auras are not as common in children as in adults. In order to diagnose a child with migraines, a medical evaluation of the child is needed. This usually includes a review of the child’s medical history, a physical examination and sometimes a neurological examination. While reviewing the medical history, the doctor may direct questions to the parent and the child. The questions may be specific ones concerning the frequency and severity of the migraine headaches, activities that seem to trigger or provoke the migraine, as well as the symptoms that occur while the child is experiencing a migraine headache. After thorough tests and evaluation, the doctor can prescribe a treatment that is individual to the child. Often migraines in children improve within a year without specific treatment. The doctor may recommend maintaining a regular bedtime, a regular meal time, and avoiding an overload of activities in the child’s life. Just as it is with adults who suffer from migraine headaches, it is also 9
  • 10. helpful to identify and avoid any provoking factors or triggers (American Medical Association, 1998). If drug treatment is needed for the child, the doctor can prescribe simple analgesics (pain relievers). Sometimes combination analgesics that are given to adults can be given to children, but in lower doses. Depending on the frequency, duration, and intensity of the migraine headaches, preventive drugs can also be part of the treatment plan. Many of the drugs used for adults can be prescribed for children. The most commonly used preventive drugs for children with migraine headaches are cyproheptadine and propranolol. Propranolol is not prescribed to children who also suffer from asthma or bradycardia (a heart rate that is below 60 beats per minute). As the children age, other medications may be used to treat the migraine headache in a child or young adult (American Medical Association, 1998). A study was conducted that assessed the quality of life of children and young adults who suffer from migraines. A clinical sample of children with the disorder was compared to a group who did not have the disorder. The results of the study indicated that the impact of quality of life of children with migraines is similar to the impact of quality of life of children who suffer from diseases such as arthritis and cancer. Impairments in school and impairments in emotional functioning were the most prominent factors of the quality of life that were affected (Pediatrics, 2003). Although migraines affect millions of Americans, new drug treatments and individualized treatment plans are proving to be very helpful in preventing and maintaining this disorder. Active participation on the part of the migraine sufferer can spell the difference between success and failure in overcoming the disorder. The more 10
  • 11. that is understood about migraine headaches, the greater the likelihood of success in their prevention and treatment. 11