Migraine Headaches: Types, Triggers and Treatments

Wednesday, June 25, 2014 2:48 PM comments (0)

migraine blogHeadaches can be more than just a pain; they can make work and day-to-day activities feel impossible. Headaches and migraines are as different as the individuals who experience them and the key to treating them is proper diagnosis.

Steven Meyers, MD, Neurologist and Headache Specialist at NorthShore, discusses common headache and migraine triggers and some treatment options that might help take the pain away:

How do you determine the cause of a migraine?
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. If they can find the one thing to avoid or eliminate, they can eliminate their headaches but that rarely happens.

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 their individual desires regarding treatment options. I recommend always starting with your primary care physician. Schedule an appointment to discuss your headaches specifically. Don't wait for a yearly physical or when seeing your doctor for something else. If you cannot get the information you need then ask for a referral to a headache specialist.

How can you figure out what type of headache you are experiencing?
Proper diagnosis is essential for treatment. Your doctor should be able to make an appropriate diagnosis. If uncertainty persists, then you should see a headache specialist. Migraine, tension and cluster are the three most common primary headache disorders. Primary means no underlying cause, such as a tumor, aneurysm or other disorder, can be pinpointed as the cause of the headache.  Doctors 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. If your doctor cannot tell you the type of headache you have, get a second opinion.

Is there any evidence that migraines are genetic?
Yes. As I briefly mentioned earlier, migraine is definitely a genetic disorder. Most persons with migraine have a positive family history. In rare cases, specific genetic abnormalities can be tested for, but in the vast majority of migraine sufferers we don’t yet know what the genetic abnormality is.

What are some common migraine triggers?
There are many possible triggers and no two patients are the same. Why one trigger brings on a migraine in one person but not another is not known. Common triggers can include certain foods, though this has become somewhat controversial, with some recent studies questioning food as a trigger.

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 hormonal changes in women during the menstrual cycle are all possible triggers.

It is also 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.

What can you do about triggers that aren’t controllable, like weather and hormones?
In general I divide triggers into those you can control and those you can’t, like weather. Hormonal changes are potentially treatable but this can be tricky and there are pros and cons of pursuing this approach. Avoiding those triggers that are preventable could be helpful. When that is not sufficient, it’s 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.

What can a migraine sufferer do to shorten the duration of a migraine?
There are many options to treat migraine attacks. We refer to this type of treatment as abortive therapy. There are migraine-specific medications that we prefer to use. When these medications can’t be used for a specific reason or if they don’t work for a specific patient, we may prescribe other types of pain medications and/or anti-nausea medication. Some patients find relaxation, massage, or the use of ice or heat beneficial as well. Sleep, when possible, can also shorten the duration of an attack.

Is this normal to experience headaches at certain times of day, particularly in the morning?
Some patients do get headaches at very specific times of the day; however, it’s 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. 

Are there any new medications for migraines with minimum side effects?
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 development and research can be frustratingly 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.

Are feverfew and butterbur effective herbal treatments for migraine prevention?
Feverfew and butterbur are two plant-based supplements available without a prescription. They both have been used for decades, particularly in Europe, to prevent headaches. They both have been studied in good scientific research trials in the U.S. and both have been found to be effective, safe and 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.

The main problem is finding out what dose to use, as every supplement may be different in terms of strength and purity. Additionally, there are potential interactions with other medications. I would definitely recommend speaking to your doctor before starting any treatment.

What are your thoughts on combining acupuncture and chiropractic adjustments with conventional treatments from a neurologist for migraines?
Both acupuncture 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.

When suffering from a headache, does consuming a little caffeine help a headache or make it worse? Any other recommendations, suggestions or treatments do you have to help ease the pain of a migraine headache?
Caffeine is interesting. Consuming caffeine can be helpful.  Several common headache medications add caffeine to make them more effective. 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. 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.

Comment

Reduce the Pain, Choose the Right Medication

Tuesday, April 01, 2014 8:00 AM comments (0)

aspirinIt can be challenging to choose the right over-the-counter pain medication. While the choices are many, it’s very important to make a decision based on your symptoms and other medical issues. Not all pain relievers are created equal, and knowing the difference between various types can be very helpful.

Before taking any medication, you should consult with your physician and/or pharmacist. Additionally, you should carefully read labels for warnings and other information. This is especially true for combination products used for treating pain and other conditions, such as colds, allergies, arthritis and muscle aches.

Acetaminophen and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are the most commonly used over-the-counter pain medications. The main difference between the two is that NSAIDs help reduce pain, fever and inflammation. Acetaminophen only reduces pain and fever.

George Carro, Pharmacist at NorthShore Evanston Hospital, helps clarify the differences between these common over-the-counter pain relievers to help you make a better, more-informed decision:

Acetaminophen (Tylenol®) tends to be milder on the stomach. Keep in mind that acetaminophen will not help with inflammation. Acetaminophen is an active ingredient in many other medications, including cold and flu preparations. Be sure to read all labels carefully so you do not exceed the recommended maximum daily dose of acetaminophen.
Safe for Children? Acetaminophen is generally considered safe for use in children. Always be sure to confirm proper usage and dosing information with your pediatrician.
Side Effects? Liver toxicity, including liver damage and failure, can be associated with improper use of this drug.  Alcohol consumption in combination with acetaminophen use may increase this risk.

NSAIDs—Aspirin (Bayer®), Ibuprofen (Advil ®or Motrin®), Naproxen (Aleve®) and others—can help relieve pain and reduce inflammation.
Safe for Children? As with any drug for children, it is recommended to discuss proper usage and dosing information with your pediatrician. Please consider the following for use in children:

  • Aspirin should not be used in children under the age of 16 years. It has been associated with Reyes’s syndrome, a potentially fatal disease in children.
  • Ibuprofen is not recommended for use in children under the age of 6 months.
  • Naproxen is not recommended for use in children under the age of 12 years.

Side Effects? The most common side effects include stomach and kidney problems. It is recommended to take all NSAIDs with food to help minimize stomach irritation. If you have heart conditions, stomach ulcers or blood disorders, please consult with your physician before taking these medications.

No drug—prescription or over-the-counter—is without risks. Always consult with your physician if you have any questions or concerns about your medications. Our NorthShore pharmacists can also answer questions and help you make informed, over-the-counter pain reliever selections.

Comment

What’s Triggering Your Headaches?

Friday, August 23, 2013 12:00 PM comments (0)

headachesHeadaches can be more than just a pain, interrupting your day-to-day life and making it difficult to concentrate on even the simplest tasks. The key to finding your way through the pain could be determining its type and trigger. 

There are many types of headaches and they vary in severity from person to person and type to type:

  1. Tension. Sometimes referred to as an “everyday” headache, they are the most common type and usually manifest as a constant ache around the head, at the temples or the back of the neck.
  2. Cluster. These are recurring headaches that come in cycles. They begin suddenly, and can be severe and often debilitating.
  3. Migraine. Migraines are severe headaches that can last between 4 and 72 hours. The pain is often exhibited on one side of the head. Migraine sufferers report sensitivity to light and sound, and often nausea and/or vomiting. 

What could be triggering your headaches? Steven Meyers, MD, Neurologist and Head of the Headache Program at NorthShore, discusses some common headache triggers:

  • Hormone level fluctuations. This most often occurs for women during menstruation. During menstruation, hormone levels can increase and drop dramatically, causing headache and migraine.
  • Sleep. When and how long you sleep can be very important. Disruption to your sleep pattern, irregular hours, too little or too much sleep can all cause headaches. Avoid changes in your sleep pattern when possible, and this includes oversleeping on the weekends.
  • Diet. Common foods, drinks and additives can cause headache pain. To determine your food sensitivities, keep a diary of your headaches and what you eat. By eliminating the food, you could decrease the frequency and severity of your headaches. If you suffer migraines, keep alcohol consumption to a minimum.
  • Caffeine. Small amounts of caffeine can help when you have a headache but frequent and excessive consumption can cause and even worsen headaches.
  • Stress. Stress levels can make a big impact on your health. Reducing stress levels can reduce the frequency and severity of headaches. Try exercise, stretching and relaxation techniques like meditation. 
  • Weather. Headaches can be triggered by changes in weather patterns in some particularly sensitive people. There is not much that can be done when it comes to weather but anticipating these changes and taking preventative measures could help.

Do you suffer from headaches? Do you know your headache triggers?

Comment

Migraine Headache Surgery: A New Treatment Option

Thursday, September 06, 2012 9:39 AM comments (0)

Migraine-SurgeryRelief from migraine headaches can come in many different forms – from pain medication, preventative drugs, massage and acupuncture to at-home remedies including relaxation techniques and proper sleep.

Approximately 20 percent of women and 10 percent of men in the United States suffer from migraine headaches. Those who are able to identify “trigger” sites on the head or face where the migraine pain starts or localizes may be able to consider a plastic surgery treatment option. Botox, traditionally used to relax facial muscles to reduce wrinkles, can also be used to relax muscles around the nerves that may trigger migraines.

Michael Howard, MD, a plastic surgeon at NorthShore, works closely with our neurologists to evaluate candidates for migraine headache surgery.  Dr. Howard identifies some of the factors that may help determine if a patient is a good candidate for this surgery:

  • A diagnosis of migraine headache is confirmed with the patient’s neurologist. In most cases, success in reducing pain has not been achieved through other treatment methods, such as medication.
  • Specific trigger sites for headaches can be determined. These are often caused by a compression or entrapment of specific nerves in the head and neck region. 
  • A Botox injection test is performed at the trigger sites.
  • Patients with a positive result from injection—a 50 percent or greater reduction in migraine frequency, duration or severity —may be considered for this treatment.
  • Once patients are considered appropriate candidates, and trigger sites have been identified, the procedure finds the nerves responsible for the headaches through a small incision in the skin. The nerves are then cut and the incisions are closed. Recovery is fast and most patients are able to resume their normal activities within a few days.

Do you suffer from migraine headaches? Do you know your trigger sites?

Comment

Cluster Headaches are a Seasonal and Painful Affliction

Friday, July 06, 2012 7:59 AM comments (0)

Cluster-HeadacheDubbed ‘suicide headaches,’ cluster headaches strike without warning. Symptoms include pain on one side of the head (usually behind the eye or temple) that occur seasonally, in the spring and late fall.

Dr. B.T. Horton, the researcher who first identified these headaches in 1939, said his patients had to be constantly watched for fear of suicide because the pain is so excruciating.

Steven Meyers, MD, Neurologist with NorthShore, offers the following known facts about cluster headaches:

  • Tend to strike young adults and men more often than women
  • Put African Americans at more risk than Caucasians
  • Can last for days, weeks or longer
  • Most often occur at a precise time of day or night, in a regular pattern
  • Pain can mysteriously ease almost as quickly as it begins
  • May be triggered by changes in daylight in the spring and fall. The cyclical nature suggests a connection to the body’s biological clock.

While there is no cure for cluster headaches, there are treatments that can decrease the severity of pain, shorten the duration and even prevent them. The key is correct diagnosis. Relatively rare, they affect less than 1% of the population and are frequently mistaken for migraines. Be sure to see your doctor for an accurate diagnosis and relief.z

Do you suffer from cyclical, painful headaches? What do you do to relieve headaches?

Comment
× Alternate Text