Question of the Week

March 27, 2006

A migraine headache....

Pronunciation: 'mI-"grAn, Brit often 'mE-
Function: noun
1 : a condition that is marked by recurrent usually unilateral severe headache often accompanied by nausea and vomiting and followed by sleep, that tends to occur in more than one member of a family, and that is of uncertain origin though attacks appear to be precipitated by dilatation of intracranial blood vessels"

... "is of uncertain origin...."

"The cause of migraine is unknown. One theory is that the nervous system is reacting to changes in the body or the environment. People with migraine may have a more sensitive nervous system response than others do. During an attack, changes in brain activity may cause blood vessels and nerves around the brain to become inflamed."

Though many mysteries surround the causes, certain people do have "triggers" that they can reduce or avoid exposure to in order to reduce the frequency and severity of their attacks.

"Most migraine attacks occur for no apparent reason. However, something may trigger migraine attacks in some people. Triggers can be all sorts of things. For example:
* Diet and foods. For example, dieting too fast, cheese, chocolate, red wines, citrus fruits, and foods containing tyramine (a food additive).
* Environmental. For example, smoking and smoky rooms, glaring light, VDU screens or flickering TV sets, loud noises, strong smells.
* Psychological. Depression, anxiety, anger, tiredness, etc. In some people migraines occur when relaxing following periods of stress. (For example, during weekends or holidays.)
* Medicines. For example, hormone replacement therapy (HRT), some sleeping tablets, and the contraceptive pill.
* Change in habits. For example, a change in sleep patterns (missing sleep, lying in, etc), missing meals, long distance travel, jet lag, etc.
* Other. Periods (menstruation), shift work, the menopause.
...Some people need a combination of triggers to trigger a migraine. For example, some women may only get a migraine if they drink red wine and are having a period. Another example is that a food trigger may only trigger a migraine if you are also over-tired, or stressed."

Some triggers can be avoided and others can be managed, while others are unavoidable, or require major lifestyle changes to eliminate.

"The frequency and severity of painful migraine attacks increase as body weight increases, suggest results of a telephone interview study of nearly 3800 migraine sufferers. ... No association was observed between BMI and the prevalence of migraine, Dr. Marcelo E. Bigal, of Albert Einstein College of Medicine, Bronx, New York, and colleagues report in the journal Neurology. However, as BMI increased, so did the frequency of migraine attacks. The team notes that 4.4 percent of the normal weight group had 10 to 15 headache days per month. This increased to 5.8 percent in the overweight group, 13.6 percent in the obese group and 20.7 percent in the morbidly obese group. The percentage of subjects who reported severe migraines also increased with BMI group, from 53 percent in subjects of normal weight to 57 percent in the overweight group, 59 percent in the obese group and 65 percent in the morbidly obese group, Bigal and colleagues report. A similar relationship was observed between BMI and migraine-related disability, light and sound sensitivity, which increased as weight increased."

Each patient is unique, and it is important for people to work with their doctors to make the lifestyle choices that best fit their situations.

"Many strategies can be used to help prevent migraine. You can work with your doctor to:
* Identify and control triggers that start a migraine
* Make healthy behavior and lifestyle changes
* Evaluate cognitive and behavioral treatments
* Use medications to prevent attacks
A diary can help identify migraine triggers. It can also help track the results of treatment and lifestyle changes."

Options are available.
"Drug therapy, biofeedback training, stress reduction, and elimination of certain foods from the diet are the most common methods of preventing and controlling migraine and other vascular headaches. ... Regular exercise, such as swimming or vigorous walking, can also reduce the frequency and severity of migraine headaches. ... During a migraine headache, temporary relief can sometimes be obtained by applying cold packs to the head or by pressing on the bulging artery found in front of the ear on the painful side of the head."

Prevention is the best medicine, but the next best thing may be catching it early.

"In the first quarter of Super Bowl XXXII last January, Denver Broncos running back Terrell Davis was hit hard and walked off the field with a towel draped over his head. A developing migraine made the sunlight difficult to bear. So how did a person suffering from migraine, a condition that can cause debilitating pain, return after halftime to score the winning touchdown and earn Most Valuable Player status? The answer: He recognized the early warning signs and immediately took an effective drug to control his pain. ... About 15 to 20 percent of migraine sufferers experience visual and other disturbances about 15 minutes before the head pain. ... According to news reports, the Broncos' Davis experienced an aura during the Super Bowl, allowing him to get early treatment to prevent a full-blown migraine."

Knowing personal triggers is good.
Knowing how to catch it early is good.
Knowing what treatment to use is not always easy to determine, and will vary from person to person.

"A recent survey of 30 managed care plans showed nearly 70 percent of prescriptions written for patients with headaches are for narcotics. ... Specialists are now sounding the alarm. Narcotics, they said, are an unproven and risky treatment for headaches and should rarely be used. ... Dr. Stephen Silberstein, president of the American Headache Society at Thomas Jefferson University Hospital in Philadelphia, said long-term use of narcotics can actually magnify headache pain and could render other treatments ineffective. 'Not only does it deplenish your own natural painkillers,' he said, 'but it destroys parts of the brain that are responsible for fighting pain.' Narcotics bring other risks. They can cause hormonal changes and intense physical dependency. Still, many pain-management specialists insisted there were many headache patients who, if carefully selected, will do well on narcotics -- patients for whom no other drugs worked."

Questions of the Week:
How would those who are not personally affected by migraine headaches benefit from knowing about them? How do you know if you have a migraine verses a non-migraine headache? How would this knowledge affect how you treat and/ or prevent your headaches? How can you identify a migraine trigger? How can you develop the best prevention and/ or treatment plan for dealing with migraine headaches?

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

[email protected]
Health Community Coordinator
Access Excellence @ the National Health Museum

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