Recognizing And Treating Migraines

“Migraine is a common complaint in the primary care setting that can be very diffi cult to treat. It can be disabling for patients, resulting in a loss of function ranging from daily activities to inability to go to work.” — ALICIA BOONE, DO

BY KATE SAGE, D.O. Recognizing and Treating

Migraines

Focusing on female health means more than just breasts, ovaries and vaginas. Th ere are some common medical conditions that aff ect women more than men, or infl uence women diff erently. One such condition is the migraine. Seventeen percent of women have migraines each year, versus just six percent of men.

Worldwide, migraines are the second most common disabling medical problem. And unfortunately, migraines are undertreated. Dr. Alicia Boone, DO, an Internal Medicine Doctor at Mercy Health Saint Mary’s Hospital in Grand Rapids says, “Migraine is a common complaint in the primary care setting that can be very diffi cult to treat. It can be disabling for patients, resulting in a loss of function ranging from daily activities to inability to go to work.”

STAGES A migraine is more than just a headache. In a typical migraine, there are four stages.

1.  e  rst stage is called the prodrome. Seventy-seven percent of migrainers have this, and it’s usually a sign that the migraine is coming. Migrainers may experience yawning, neck stiff ness, sleepiness, or food cravings, among other things.

2.  e second stage is the aura. Twenty-fi ve percent of people have an aura, which means that the vast majority of migrainers (75%) don’t have an aura with their migraines. An aura can occur before the headache or with the headache. An aura can take many diff erent forms. It can be visual, like a bright spot or a black spot in the vision. It can also be sensory, like a tingling sensation. Th e aura can be auditory, such as a ringing in the ears. Commonly, the aura can be a combination of all those senses, or something completely diff erent. It’s important to remember that even if there’s not an aura present, the headache can still be a migraine.

3. Stage three is the migraine itself. Usually it’s on one side of the head. Th e pain is often described as pulsing or throbbing, and the migrainer may have nausea, vomiting, and sensitivity to light and/or sound. Th is part can last hours to days. It can also rebound, meaning that it may get better with medicine for a few hours, but when the medicine wears off the migraine may come back and can be even worse.

4.  e fourth stage is the postdrome. Migrainers describe feeling drained or exhausted. Th ere may still be some migraine type pain with sudden movement of the head or with movement.

TRIGGERS So what causes a migraine? Th is is tough to answer. Th ere is some evidence of a genetic component, but that is complicated and it appears to involve multiple genes. Science has shown that women age 30-39 are most aff ected and that there are various diff erent subtypes.

Many migrainers can identify triggers if they spend some time keeping a migraine diary. Some triggers that have been scientifi cally proven include stress, menstruation, visual stimuli, weather changes, nitrates, fasting, and wine. Other triggers that are commonly discussed by patients, but haven’t been offi cially proven include sleep disturbances, smoking, odors, and chocolate.

DIAGNOSIS Th ere are specifi c criteria for diagnosis that your doctor can review. Typically, additional testing is not needed. First-line treatment includes avoiding triggers and taking Non-Steroidal Anti-Infl ammatory Medications (NSAIDs) such as Ibuprofen, Naproxen or Aspirin. If the migraine is not controlled with NSAIDs, there are prescription medications, called triptans, which have been proven to help. Th ese should be taken at the fi rst sign of a migraine.

If a person has nausea with migraines, sometimes a prescription anti-nausea medication can help. If a migrainer tends to vomit, there are injectable or nasal triptans that avoid the stomach. Migrainers may also be a candidate for prophylactic medicine if they have long lasting migraines, frequent migraines, or if they don’t respond to traditional treatment. Th ere are several categories of medications that are taken daily that may help with this.

Some other treatments include Botox injections, neurostimulators (electrical pulses into the skin), or a referral to a neurologist. Dr. Boone says, “Th ere are a wide variety of treatments. My patients have had great success working with neurologists here in the community to get medications and interventional treatments to help get them back to their daily lives.”