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Headaches & Migraines: Causes, Prevention & Treatment

Dr. Steven Meyers April 29, 2014 10:00 AM This chat has ended. Thank you for participating.
Brenna (Moderator) - 9:31 AM:
Our chat will begin at 10 a.m. You can submit questions at any point during the chat. This has been a very popular topic, so we apologize in advance if we are unable to get to every question.

Dr. Steven Meyers (NorthShore) - 9:49 AM:
Good morning everyone. Today we will be discussing headaches. I will try to answer as many questions as possible over the next hour.

Andrea (Chicago, IL) - 9:56 AM:
My grandmother, mother and I all suffer from migraines. Is there any evidence it's genetic?

Dr. Steven Meyers (NorthShore):
yes. Migraine is definitely a genetic disorder. Most persons with migraine have a postive family history. In rare cases, specific genetic abnormalities can be tested for but in the vast majority of migraine sufferes we do not yet know what the genetic abnormality is.

Becca - 9:59 AM:
Is there anything you can do to shorten the duration of a migraine?

Dr. Steven Meyers (NorthShore):
There are many options to treat migraine attacks. we refer to this as abortive therapy. There are migraine specific medications that we prefer to use. At times when these medications cannot be used or do not work, we may prescribe other types of pain medications and/or antinausea medication. Some patients find relaxation, massage, or the use of ice or heat beneficial. Sleep, when possible, can also shorten the duration of an attack.

Laurie (Springfield il.) - 10:02 AM:
I am perplexed that many times it seems my migraines are from inflammation in maybe my sinuses and I have to take steroids to get rid of migraine. Why do you think some migraines can be managed by say zomig but then on others I have to take steroids? Is this common?

Dr. Steven Meyers (NorthShore):
Unfortunately, yes it is common. many patients find they need to tailor treatment to the specific type of migraine and what works for one type may not work in a different type. It is always very important to take a medication like Zomig as early as possible once an attack begins. Delaying treatment by as little as 1 hour can make the difference between success and failure. Steroids are not uncommonly used to treat migraines, particularly prolonged attacks that have not responded to other treatments. Why or how they work is not clear but they can be very effective. However, they cannot be used too often and there are many potential long term side effects from steroids.

Lina - 10:05 AM:
What are some common migraine triggers? Why would someone get a migraine and another person wouldn't in reaction to one of these triggers?

Dr. Steven Meyers (NorthShore):
there are many possible triggers and no 2 patients are the same. Why this is is unknown. Common triggers can include certain foods though this has become somewhat controversial as recent studies have begun to question this. Alcohol, particularly red wine and beer, are common triggers. Missing meals, alteration in normal sleep patterns (too much or too little), weather changes, stress, and in women hormonal changes associated with the menstrual cycle are all possible triggers. it is important to keep in mind that triggers are rarely all or none. this means that a trigger may not trigger a migraine every time the patient is exposed. it may only happen every other or every third time. this makes identifying these triggers even more difficult

Sherry (Naperville, IL) - 10:10 AM:
Weather and hormones seem to be my biggest migraine triggers. I can (and do) avoid trigger foods, but I can't avoid weather and hormones so I'm looking for some strategies to lessen the impact of migraines. This can be very tough when both are so unpredictable.

Dr. Steven Meyers (NorthShore):
You are correct. In general I divide triggers into those you can control and those you cannot such as the weather. Hormonal changes are potentially treatable but this can be tricky and there are pros and cons of pursuing this approach. Obviously avoiding those triggers you can may be helpful. When that is not sufficient then it is time to speak to your doctor. If migraines occur frequently enough, then there are medications that can help prevent them or at least reduce the frequency of attacks.

Dottora (Chicago IL) - 10:14 AM:
I had a TBI at age 6. Could there be a relationship between traumatic brain injury & migraine?

Dr. Steven Meyers (NorthShore):
Maybe. We definitely see people develop all kinds of headache immediately after a head injury including migraines. we call these post traumatic headaches or post traumatic migraine. What is less clear is whether a history of head injury is a risk factor for the later development of migraine. Personally, I suspect there is a connection but research in this area is unclear.

Jillian (Evanston, IL) - 10:17 AM:
I notice that I often wake up in the morning with headaches. Is this normal? Can it be avoided?

Dr. Steven Meyers (NorthShore):
this is not uncommon with migraine. some patients get headaches at very specific times of the day and waking up with a migraine is not unusual. However, many different kind of headaches can present this way so it is important that the type of headache be correctly diagnosed in order to come up with an appropriate treatment plan. Treatment of migraines that wake someone from sleep depends in part on how often this happens and under what circumstances. sometimes a preventative medication at bedtime might be appropriate. Acute treatment is sometimes tricky in this situation. As I explained earlier, acute treatments are most helpful when taken as soon as a headache starts. if the headache wakens you from sleep you have no idea how long it has been going on. In this situation typical oral medications may be less effective and sometimes we use nasal sprays or even self injected medications.

Margie (Vernon Hills, Illinois) - 10:22 AM:
My daughter & I both have "aura" which can be pretty scarey to us and other people. Cannot read or talk sometimes. Please go over "aura". This is a bad tome of year with storms coming in and the barometric pressure changing. Any tips??

Dr. Steven Meyers (NorthShore):
Auras are neurologic symptoms that can preceed the onset of the headache and occur in anywhere from 20-30% of migraine sufferers. Most of the time auras are visual - flashing lights or zig zag lines. Less common but well described can be difficulty speaking, confusion, one sided weakness or numbness. These can look very much like strokes which can be quite scary. This time of year can be difficult with all the weather changes and storms. some patients are very sensitive to barometric pressure changes. Auras can be difficult to treat. Our acute therapies do not really help for the auras, only for the head pain. If auras are frequent enough, then daily preventatives can be used to reduce the frequency. this can include prescription medications and/or some over the counter supplements such as magnesium or riboflavin (a B vitamin).

Brenna (Moderator) - 10:27 AM:
Thank you everyone for your participation. We are receiving many questions and will do our best to get through as many as possible. Please avoid submitting the same question twice.

Felicia (South Holland) - 10:27 AM:
Are there any NEW medications for migraines with minimum side effects?

Dr. Steven Meyers (NorthShore):
I hope everyone does not find this depressing but truthfully there is not much new out there at present. There are some very exciting new medications that we hope to see on the market in the not too distant future but drug developement and research can be fustratingly slow. All medications have side effects which vary greatly from person to person. There is some evidence that migraine sufferers are particularly prone to drug side effects and many persons will need to try a variety of medications before finding what works for them.

Karen (St. Charles, IL) - 10:31 AM:
What are your thoughts on the feverfew and butterbur herbal treatments for migraine prevention?

Dr. Steven Meyers (NorthShore):
Feverfew and butturbur are 2 plant based supplements availabe without a prescription. They both have been used for decades particularly in Europe for preventing headaches. They both have been studied in good scientific research trial in this country and both have been found to be effective. Both are very safe with few potential side effects. Overall, they tend not to be as effective as prescription medications in my experience but can be beneficial in certain persons and do tend to have fewer side effects. I do discuss them with patients and do use them. The main problem is knowing what dose to use as every supplement may be different in terms of strength and purity and there is no oversight. Additionally, there are potential interactions with other medications so I would definitely recommend speaking to your doctor before starting anything.

Cheryl (Vernon Hills,IL) - 10:36 AM:
How effective is vitamin C in preventing or treating migraines?

Dr. Steven Meyers (NorthShore):
to the best of my knowledge there is no evidence that vitamin C is effective in treating migraines. Both the American Academy of Neurology and the American Headache Society have published reviews of all therapies for migraine and vitamin C is not recommended.

Katie (Chicago, IL) - 10:39 AM:
I've had severe migraines after exercise. My exercise trainer said it's because I'm not breathing enough during the workouts. Is that true?

Dr. Steven Meyers (NorthShore):
Exercise can trigger migraine though this is not terribly common and in general we recommend regular exercise for migraine patients. Straining such as during weight lifting can be a trigger. this can be somewhat prevented by proper breathing technique.

Nancy (Des Plaines, IL) - 10:42 AM:
What are your thoughts on combining accupunture and chiropractic adjustments with conventional treatments from a neurologist for migraines?

Dr. Steven Meyers (NorthShore):
both accupunture and chiropractic treatments have been studied and found to be helpful in some individuals with migraine. I have many patients who use these therapies and find them helpful either alone or in combination with "conventional" treatments.

sam (skokie, IL) - 10:44 AM:
how can I know my headache is migraine, tension or cluster headache?

Dr. Steven Meyers (NorthShore):
Proper diagnosis is essential for treatment. Your doctor should be able to make an appropriate diagnosis. if uncertainty persists, then you should be seen by a headache specialist. Migraine, tension, and cluster are the 3 most common primary headache disorders. Primary meaning no underlying cause can be determined such as a tumor, aneurysm, or some other disorder causing the headache. They have specific features and there are well established criteria for making specific diagnoses. I cannot emphasize enough the importance of making a specific headache diagnosis is. If your doctor cannot tell you the type of headache you have, get a second opinion.

Jen (Clinton, IA) - 10:48 AM:
I'm 23 and I've had chronic migraines for about 6 years. I don't know what is causing my migraines. I have weeks were I don't get one and there are other weeks were I get them daily (go to bed with one and wake up still with it). It's definitely affecting my life, if I'm having a bad migraine I have to avoid light and loud noises. A masseuse once told me it's because I have a lot of knots in my neck. How do I find the cause of my migraines and I can I deal with them without using medicine?

Dr. Steven Meyers (NorthShore):
Frequent migraines are very fustrating. Many patients search for "the cause" when in fact most of the time there is no single cause. We believe migraine is a genetic disorder, meaning the tendency to experience migraine is passed down in your genes. Everyone wants a simple fix and think if they can find the one thing to avoid or eliminate they can elimiate their headaches. that rarely is the case. Migraine is a chronic illness and like all other chronic illnesses, the severity can vary from person to person. Treatment must be individualized to the specific patient taking into account there individual desires regarding treatment options. I recommend always starting with your general physican. Schedule a specific appointment to discuss your headaches. Don't wait for a yearly physical or when seeing them for something else. If you cannot get the information you need then ask for referral to a headache specialist.

Brenna (Moderator) - 10:53 AM:
There are less than 10 minutes left in this chat. Thank you for all your wonderful questions today. We will try to address a couple more before 11.

Cheryl (Vernon Hills, IL) - 10:55 AM:
When suffering from a headache, does consuming a little caffeine help a headache or make it worse? Besides medication, what other recommendations, suggestions or treatments do you have to help ease the pain of a migraine headache?

Dr. Steven Meyers (NorthShore):
Caffeine is interesting. Consuming caffeine can be helpful. Many common headache medications add caffeine to make them more effective and many patients will drink some coffee or cola along with whatever medication they take when they get a headache. However, the frequent/regular use of caffeine can actually cause headache or make headaches worsen over time. if you use a medication that contains caffeine such as Excedrin, be careful to follow the directions very carefully. These medications should not be used more than 1-2 days per week at the most. I usually recommend that frequent headache sufferers limit caffeine consumption to the equivalent of 2-3 cups of coffee per day. short of medication some patients use relaxation therapy, biofeedback, ice, heat, or sleep to treat migraine attacks.

Brenna (Moderator) - 11:00 AM:
This will be our last question of the chat today. We apologize that we were not able to get to every question. For more information, please join us on Saturday, May 10 from 9:30 AM to 12:00 PM for a free event Understanding Migraines and Headaches

Brenna (Moderator) - 11:00 AM:
Dr. Meyers will be present and will discuss The DodoNA Project: Hardwiring Quality, Safety, and Research at the Point of Care

Brenna (Moderator) - 11:01 AM:
Thank you Dr. Meyers for your time today and thank you all for your participation.

Dr. Steven Meyers (NorthShore) - 11:02 AM:
Our time is up. I hope everyone found this chat helpful. I certainly enjoyed it.
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