If you suffer from severe, often debilitating migraines, there is hope on the horizon.
Migraines have plagued Cara Donn*, a longtime Marion County resident, since her teens.
“I usually get an aura about an hour before the headache sets in,” says Cara, adding that she’ll often feel nauseous.
“The only thing that really seems to work for me is lying down in a dark room with no stimuli to try and sleep,” she says. “It helps to have an ice compress on my head and the back of my neck. For me, a typical migraine lasts 12 hours or more; the worst ones last a couple days.”
After decades of dealing with chronic migraines (She’s been diagnosed by a neurologist.), Cara has learned which specific triggers tend to bring on a migraine. Her triggers include barometric pressure changes, bright lights/glare and/or abrupt changes in lighting, stress and dehydration.
“If I’m really upset and don’t get it out of my system, that stress can bring on a headache,” she notes. “Since I’ve started paying close attention to my water consumption, which is something I can control, my headaches are less frequent.”
Unfortunately, Cara is not alone.
“Migraine[s are] an extremely common disorder affecting over 36 million people in the United States alone. This is only counting those people who are diagnosed, not those yet to be diagnosed,” observes Dr. Lance Kim, an expert in migraine care who has practiced at Florida Neurology Center in Ocala since 1998.
“Migraine[s cause] a significant economic burden to society, costing this country about $11 billion a year in both direct and indirect care cost, including treatment and loss of productivity,” he adds.
Dr. Kim is a multiple board-certified neurologist, and one of his subspecialties is migraine headaches. He is one of only about 200 doctors in the country who are board certified in headache medicine.
Dr. Kim finds that migraine headaches are a very common complaint, but patients often don’t get a proper diagnosis in a timely manner and delay receiving helpful treatments. Many patients end up with ineffective or wrong treatment, which is a common reason for undue suffering with a debilitating headache. Seeking help from a physician who is well-versed in migraines is strongly recommended in order to get the correct diagnosis and treatment.
A number of published scientific papers have shown that many people go to the emergency room because their headaches are so severe and end up leaving with a prescription for narcotics, which is the wrong medication to treat migraines, because it could paradoxically worsen the headache. In addition, narcotics have highly addictive properties, which can make it hard for a person to get off that wrong medication in order to then take the proper medication.
Cara’s mother also suffered from migraines, which is not unusual.
“Migraine[s are] a hereditary neurological disorder,” says Dr.Kim. “People prone to migraine[s] are born with brains that are hyper-excitable, meaning their brain cells are more easily excited than those without migraine.”
In other words, their brains are biochemically different from the brains of people without a migraine disorder.
And although it might seem unfair, approximately 70 percent of migraine sufferers are women.
Dr. Kim explains that in boys and girls who suffer from migraines, it occurs equally in both sexes. After puberty, though, migraines become twice as prevalent in females. By middle age this prevalence only increases.
“This is attributed to estrogen, which plays an important role in migraines, because it’s known to increase the amount of nitric oxide (a chemical known in the pathogenesis of a migraine) in the brain,” says Dr. Kim. “As a woman’s body produces more estrogen, more of this nitric oxide is also produced in the brain.”
This explains why, for many women, their headaches are associated with hormonal changes around menstruation and pregnancy. Migraine intensity and frequency generally improve after menopause, likely due to the sharp decrease in estrogen.
Once someone has a clear diagnosis of migraine, there are two types of medication that can help.
“Group one” medications (such as Topamax) are prophylactic drugs taken to prevent migraine.
“If you have bad migraine[s] more than four days a month, you need a proper preventative medication,” says Dr. Kim. “There are many medications that can be used, but treatment needs to be targeted to each individual because other medical issues you may have, and other medications you’re on will determine the preventative medication you can take.”
“Group two” medications (such as Triptans) are taken only when a person is actually experiencing a migraine.
“Acute abortive medications (e.g. Triptans or Ergots) are known to work well for those people whose migraines are diagnosed early and treated promptly,” says Dr. Kim. “Migraine[s are] a time-sensitive condition; there is a window where it responds well to treatment, but if you miss this window, you’ll have less success in treating [the migraine].”
It’s important to understand that group one and group two medications work in very different ways, so they cannot be used interchangeably.
“Preventative treatments have a high degree of success, but for patients who have tried all the preventatives but still have migraines, we often consider Botox injections given in the muscles of the forehead and neck on average every three to four months,” says Dr. Kim. “This is not the first line of treatment, and its mechanism of action for migraine is not completely understood. My opinion is that Botox aborts peripheral sensitization (temporarily denervates the peripheral nerve endings in the head).”
Although it’s been about 27 years since the last major migraine treatment was released, that’s about to change.
“The FDA is releasing a medication that is a completely new class of drug that was developed as a result of new science technology and over 20 years of research,” says Dr. Kim, noting that this drug could be available as early as late May 2018.
“This medication class, a CGRP antagonist, is going to be a true game-changer for migraine sufferers and will revolutionize the way we treat patients with debilitating migraine headaches,” he states.
Dr. Kim says the medical community is excited about the release of this new medication in light of the grave impact migraines currently have on our society. He’s extremely hopeful this new treatment option will have a powerful positive impact, not only on patients’ lives but also in reducing the financial burden of migraine on society as a whole.
Symptoms and Diagnosis
There are a number of differences between a “regular” headache and a migraine.
“With a migraine, there’s a very clear onset and offset (when it starts and ends), whereas a non-migraine is more of a blur. The patient may not be sure exactly when it begins and subsides,” says Dr. Kim.
The majority (about 75 percent) of migraines tend to be unilateral, meaning the headache is one-sided. Only about 25 percent are bilateral (pain on both sides of the head), but being bilateral doesn’t rule out that it’s a migraine.
Common migraine symptoms include:
- Throbbing (pulsating) pain
- One-sided (unilateral) pain
- Sensitivity to light
- Sensitivity to sound
- Sensitivity to smell
- Vision changes, cloudy or blurred vision
- Aura (flashes of light, jagged or flickering)
- Stiff neck
- Overall weakness
- An accurate self-diagnosis of migraine is easier than one might think.
“If you answer ‘yes’ to the following: throbbing, unilateral pain, photosensitivity and queasiness, there is a 95 percent chance you have [a] migraine,” says Dr. Kim.
Migraines involve more than just a headache itself. For many people, migraines progress through four definite stages, though not everyone experiences all four. The symptoms of the other stages can be just as disabling as the headache itself.
Stage 1 (also called prodrome)
As much as 24 to 48 hours before a migraine attack, there can be any of the following symptoms:
- Moodiness, sudden changes in mood
- Cognitive impairment (difficulty recalling information, thinking of words, etc.)
- Unusual photosensitivity
- Limb weakness
- Stiff neck
- Increased thirst and urination
- Food cravings
Stage 2 (aura)
Only about one-fourth of migraine patients experience an aura before or during their attacks. For those who do experience an aura, it may involve:
- Visual disturbances (seeing flashes or splotches of light)
- Wavy or zigzag vision
- Loss of vision/blind spots
- Numbness and tingling
- Hearing noises/music
- Slight weakness on one side of the body (almost like a mini-stroke)
Stage 3 (headache)
Depending on whether or not it’s treated, this phase can last anywhere from four to 72 hours and can include:
- Throbbing pulsing pain
- Most commonly on one side of head
- Sensitivity to light, sounds and sometimes smells and touch
- Nausea (with or without vomiting)
- Blurred vision
- Feeling lightheaded
Stage 4 (post-drome)
Even after the headache has subsided, there are typically lingering symptoms that can be severe enough for the person to miss work/school. Lasting up to 24 hours, the final stage often mimics symptoms from stage one and may include:
- Moodiness, sudden changes in mood
- Confusion and cognitive impairment
- Sensitivity to light and sound
Know Your Triggers
What leads to a migraine attack in one individual may not affect another, but there are a number of common triggers, also known as “precipitating factors.” Migraine doctors recommend keeping a journal to help determine which triggers precipitate the onset of your migraines.
Triggers can include:
- Sleep deprivation/changes in sleep pattern
- Hormonal changes
- Missing meals
- Weather changes
- Sensory stimuli (bright lights/sun glare)
- Specific foods (aged cheeses, salty/processed foods)
- Food additives such as aspartame, monosodium glutamate (MSG)
- Highly caffeinated beverages
- Alcohol and/or drugs
- Certain smells (perfume, secondhand smoke, paint thinner, etc.)
- Intense physical activity (including sex)
- Medications (oral contraceptives, vasodilators, etc.)
Migraine Or Sinus Headache?
Many people suffering from symptoms that meet the guidelines of migraine diagnosis mistakenly think they have a sinus headache. Dr. Lance Kim of Florida Neurological Center explains that this is because the nerve endings in the sinus cavity are “hyper excited” and can give the sensation of a sinus headache.
“True sinus headaches are, in reality, not that common,” says Dr. Kim. “Anyone who has muscle tension, pain and/or spasms around the neck likely has a migraine.”