by Dee Silver, Neurologist
Some people literally see it coming, as flashing lights or wavy lines slow take over their vision. For others, there’s no visual warning — just the pain building up in their heads, often accompanied by nausea, vomiting, and sensitivity to light or noise.
It’s a migraine, and it is likely to last for several hours or even several days.
If you suffer from migraine headaches, you’re far from alone. Migraines affect about 20 percent of women and 10 percent of men. They are responsible for more missed days of work than any other type of headache, and the pain they cause can be debilitating.
We don’t know why migraines happen, but we do know that they “run in the family” for about 60 to 70 percent of patients, suggesting a genetic component. We also know that certain substances, including red wine, monosodium glutamate (MSG), chocolate and certain types of nuts and cheese can trigger them.
There are two main types of migraine headaches, those with aura and those without. In migraines with aura, you may see visual “events” such as flashing or blinking lights, zigzag lines or kaleidoscope-like patterns spread across your visual field. Or, you may lose part of your vision. In any case, aura usually begins about 10 to 15 minutes before the pain sets in.
Migraines without aura have no such visual events — just pain. Some people may have aura without the headache, but this is not as common.
With or without aura, the four defining characteristics of migraines are the same: intolerance to bright lights (photophobia) or loud noises (sonophobia), nausea and vomiting.
Are your headaches truly migraines? Early and accurate diagnosis is important to ensure we are treating the right condition. For example, headaches caused by muscle tension will not respond to migraine treatments, and headaches that seem like migraines may actually signal an underlying condition.
Several key factors help us make a definitive diagnosis. First and foremost is history; physicians look for recurrent, episodic events. Someone who experiences a single incidence of aura along with nausea or vomiting may have a different condition, and it is important to have it checked out.
A diagnosis of migraine will also include at least one, and usually two, of the four defining characteristics.
Typically, migraine headaches strike several times a month, although some may occur every day. Fortunately, we’ve come a long way in treating and even preventing migraines. Here’s an overview of the options:
Drugstore remedies such as aspirin, acetaminophen and ibuprofen may help ease migraine pain. Some even target migraine headaches. However, if you do not find relief with these, you may need a prescription medication.
Abortive medications can stop the process that causes migraine headache pain. Available only by prescription, the most widely used abortive medications are called triptans and include such brand names as Imitrex, Zomig, Axert, Maxalt and Forvert.
The key to successful abortive therapy is to take the medication at the very first sign of migraine. The sooner you take it, the better the result. Generally, 40 to 60 percent of migraine sufferers will find some relief within two hours of taking these drugs.
We consider an abortive therapy effective if a patient is pain-free two hours after taking the drug and does not need to take it again within 24 hours. Although these drugs are all similar, some patients try several brands before they find the one that works best for them.
Often recommended for patients who have more than two or three migraines per month, prophylactic medications can prevent headaches from occurring in the first place. Prescription prophylactics include beta-blockers such as Inderol and tricyclic anti-depressants like Elavil.
Many of these drugs may have side effects, and some cannot be used by women who are pregnant or may become pregnant. Be sure to review your options with your doctor and ask about any concerns.
Yes, the wrinkle treatment may help with migraine pain as well. However, before you jump on the Botox bandwagon, keep a few important facts in mind. One, Botox is a toxin. Two, it should not be considered for anyone who has not had pharmacologically optimized therapeutic management.
In other words, Botox should not be an option for anyone who has not tried every other form of headache treatment available. No one knows why Botox works on migraines, but we do know that its effects are temporary. Treatment must be repeated, and significant side effects occur in people who use it for a long period of time.
If you suffer from migraine headaches, make an appointment with a headache specialist or ask your primary care physician for a referral. Once a diagnosis is made, relief may be right around the corner.
This Scripps Health and Wellness information was provided by Dee Silver, M.D., a neurologist at Scripps Memorial Hospital La Jolla.