Migraine: New Treatments Changing Lives
If you suffer from migraine headaches, you’re not alone. About 12 percent of all Americans experience migraines, a form of vascular headaches, that is characterized by throbbing and pulsating pain caused by the activation of nerve fibers within the wall of brain blood vessels. When a migraine strikes, some blood vessels narrow, temporarily, decreasing the flow of blood and oxygen to the brain, while other blood vessels open wider and increase blood flow. The result can be excruciating.
What are common symptoms of a migraine?
Migraine headaches are characterized by moderate to severe (often throbbing) pain that sometimes strikes one side of the head, but can affect both sides. Untreated attacks can last from 4 to 72 hours. Other common symptoms include increased sensitivity to light, noise, and odors; and nausea and sometimes vomiting. Routine physical activity such as climbing stairs, movement or even coughing or sneezing can worsen the headache pain. About 85% of all migraine sufferers report being aware of consistent, identifiable triggers prior to the onset of a headache. Some common triggers include stress, weather (barometric pressure) changes, noises, odors, sleep deprivation, missing a meal and hormones.
When you are experiencing a pounding, painful headache, all you want is relief. Frequent, severe headaches can be a symptom of many different conditions so it is important to talk to your healthcare provider immediately if you experience any of the following symptoms:
• Sudden, severe headache that may be accompanied by a stiff neck.
• Severe headache accompanied by fever, nausea, or vomiting that is not related to another illness.
• “First” or “worst” headache, often accompanied by confusion, weakness, double vision, or loss of consciousness.
• Headache that worsens over days or weeks or has changed in pattern or behavior.
• Recurring headache in children.
• Headache following a head injury.
• Headache and a loss of sensation or weakness in any part of the body, which could be a sign of a stroke.
• Headache associated with convulsions.
• Headache associated with shortness of breath.
• Two or more headaches a week.
• Persistent headache in someone who has been previously headache-free, particularly in someone over age 50.
• New headaches in someone with a history of cancer or HIV/AIDS.
Well-Being spoke to Michael Winkelmann, M.D., Physiatrist, of NewSouth NeuroSpine and Christina Treppendahl, Certified Family Nurse Practitioner from the Mississippi Headache Center about how migraine is diagnosed and treated today.
How are migraine headaches diagnosed?
Because there are so many kinds of headaches, before a physician can accurately diagnose and treat the symptoms they first must get to the root of the problem and often that means ruling out some possibilities in order to reach the right diagnosis.
Both Dr. Winkelmann and Ms. Treppendahl stress that it is imperative to take a full medical history and perform a physical exam, possibly including a CT scan, to make sure the headaches are not caused by disease, an aneurysm, tumor or trauma, before concluding that the diagnosis is indeed migraine.
“Many times when patients finally come to us about their headaches they have been treated for other problems such as eye strain, stress headaches or sinus headaches,” says Dr. Winkelmann. “Often by this point the patient’s headaches are seriously affecting their daily life and in some cases have become debilitating.”
What are some common treatments that are prescribed once a patient is diagnosed with migraine?
“Once the diagnosis of migraine has been made,” explains Ms. Treppendahl, “treatment falls into two categories: prevention and attack medications and therapies.”
“Every migraine sufferer should have an attack plan, which is medication taken at the onset of a migraine to stop the attack,” notes Treppendahl. “If a migraine is treated appropriately in a timely manner, the patient should be able to resume normal functioning within two hours if not sooner.”
Attack medicines typically include a triptan medication like Relpax or Maxalt, an NSAID like Cambia or diclofenac, and an antiemetic such as Phenergan or Reglan. There are injectable forms of migraine attack medications that can stop migraine faster than any pill, and there is also a new powder form of FDA-approved migraine attack medication that gets into the blood stream very rapidly.
“Prevention includes avoiding known triggers if at all possible, keeping a regular sleeping and eating pattern, and if necessary, adding daily supplements or prescription medications to reduce the frequency, severity, and duration of the migraines,” Ms. Treppendahl adds.
There are about five categories of prevention medication commonly utilized:
1. Natural supplements including magnesium and other supplements are widely used especially in young patients, pregnant or nursing women, and other sensitive patients.
2. Certain muscle relaxers taken generally at bedtime can help with Tension Type Headaches and headaches that involve neck problems.
3. A type of blood pressure medication called beta blockers is FDA approved to be used in the treatment of migraine headaches.
4. Certain antidepressants have great efficacy for preventing migraines.
5. Anti-seizure medications are especially helpful in lowering the number of migraine attacks as well as making the treatment phase of the plan more effective.
The type of prevention used depends on the patient’s physical health, drug allergies, risk factors and previous experience with other medication used in the past for headaches.
What are some of the more innovative ways migraine is now being treated?
“Generally, we start with a conservative approach to treatment first,” Dr. Winkelmann notes. “When more conventional treatments have failed, we may resort to Botox injections. For many patients who have not responded to other medications, these injections have proved successful at preventing or lessening the severity of migraine attacks. But this treatment is not for everybody. A patient usually is not a candidate for Botox injections unless other treatments failed or have proved inadequate.”
The Botox treatment requires injections in three locations: on either side of the back of the neck just below the skull; near the temples in front of the ears; and on either side of the front of the forehead. The effects of the treatments last on average from three to six months.
According to Ms. Treppendahl, one non-pharmacologic treatment for migraine is myofascial release. Myofascial release (MFR) is an interactive, hands-on therapy technique that is based on the theory that all body structures that can cause pain are connected throughout the myofascial system. Fascia is also referred to as connective tissue that is normally relaxed and wavy in configuration. Trauma, surgery, or even poor posture can cause tension on the system resulting in scar tissue and pain. Trained therapists massage the fascia to ease tension and relieve pain.
Are there risk factors for migraine?
The one consistent factor with migraine sufferers is that there is a family history. Recent evidence has identified a gene associated with common migraine. Hormones also play a large role in migraine.
“We see a greater majority of women in our practice,” notes Dr. Winkelmann. “Often women patients report that their migraines began when they reached puberty and seem to worsen at any time when they have significant hormonal changes.”
Overall, age is not a determinant of migraine. Some patients begin having severe migraine headaches when they are less than six years old and have them throughout their lives.
“Stress also can be a big factor in the onset of migraine,” adds Ms. Treppendahl. “Whether the stress is physical, such as illness or trauma or emotional such as PTSD. A history of migraine is also associated with a high rate of mood disorders, such as anxiety disorders, chemical dependence and abuse, as well as increased suicide attempts.”
What is the most important thing migraine sufferers should know?
There is help! See a specialist! Know there is hope!
“I have been practicing medicine for twenty-five years and have seen patients who were completely disabled by migraine,” notes Dr. Winkelmann. “With accurate diagnosis and treatment, they are living normal, productive lives. It has completely changed their lives.”
“Migraine is a chronic condition just like any chronic condition such as lupus, diabetes, or Crohn’s disease,” adds Ms. Treppendahl. “It requires serious treatment, as well education about the triggers, prevention methods, diet and lifestyle factors that affect the frequency and severity of the problem. We empower our patients by giving them the tools to manage their own chronic conditions.”
Michael Winkelmann, M.D., Physiatrist, received his Doctor of Medicine degree from the University of Vienna Medical School, Vienna, Austria. He received additional training in spinal Injury Service from the Rehabilitation Center, Tovelbad Austria, and at the Rice University Sports Physicians Group in Houston, TX. He was FMGEMS, Board Certified in 1986, is Board Eligible in Internal Medicine and is a Diplomate of the American Board of Physical Medicine and Rehabilitation, as well as Board Certified in Physical Medicine and Rehabilitation. At NewSouth NeuroSpine, he is a member of the staff of the Division of Physical Medicine.
Christina Treppendahl, Family Nurse Practitioner – Board Certified (FNP-BC), graduated from Vanderbilt University School of Nursing with Master’s degree in Neonatal Nursing. She practiced as a Neonatal Nurse Practitioner in Jackson for ten years prior to going back to school at Mississippi University for Women for a Post Master’s degree in Family Nurse Practitioner. She began working with Dr. Mitchel Myers at the MS Headache Center 2010, where she specializes in the diagnosis and treatment of primary headaches. She is an associate member of the American Headache Society.