Migraines
Sandy~
Copyright 2002 by Nikicj5/and Medical Madness Newsletter@
As seen on WebMD <sorces of
information>
 Migraines are painful headaches often accompanied by nausea, vomiting and sensitivity to light. Who Gets Migraines? The National Headache Foundation estimates that 28 million Americans suffer from migraines. More women than men get migraines and a quarter of all women with migraines suffer four or more attacks a month; 35% experience 1-4 severe attacks a month, and 40% experience one or less than one severe attack a month. Each migraine can last from four hours to three days. Occasionally, it will last longer. What Causes Migraines? The exact causes of migraines are unknown, although they are related to changes in the brain as well as to genetic causes. People with migraines may inherit the tendency to be affected by certain migraine triggers, such as fatigue, bright lights, weather changes, and others. For many years, scientists believed that migraines were linked to expanding and constricting blood vessels on the brain's surface. However, it is now believed that migraines are caused by inherited abnormalities in certain areas of the brain. There is a migraine "pain center" or generator in the brain. A migraine begins when hyperactive nerve cells send out impulses to the blood vessels, causing them to clamp down or constrict, followed by dilation (expanding) and the release of prostaglandins, serotonin, and other inflammatory substances that cause the pulsation to be painful. What Triggers a Migraine? Many migraines seem to be triggered by external factors. Possible triggers include:
Migraines and Co-Existing Conditions There are some medical conditions that are more commonly associated with migraines, including:
Are Migraines Hereditary? Yes, migraines have a tendency to run in families. Four out of 5 migraine sufferers have a family history of migraines. If one parent has a history of migraines, the child has a 50% chance of developing migraines, and if both parents have a history of migraines, the risk jumps to 75%. What Are the Symptoms of Migraines?
The symptoms of migraine headaches can occur in various combinations and include:
Most migraines last about 4 hours although severe ones can last up to a week. The frequency of migraines varies widely among individuals. It is common for a migraine sufferer to get 2-4 headaches per month. Some people, however, may get headaches every few days, while others only get a migraine once or twice a year. Types of Migraines Symptoms that signal the onset of a migraine are used to describe two types of migraine.
An "aura" is a physiological warning sign that a migraine is about to begin. Migraines with auras occur in about 20%-30% of migraine sufferers. An aura can occur one hour before the attack of pain and last from 15 to 60 minutes. The symptoms always last less than one hour. Visual auras include:
There are also auras that can affect the other senses. These auras can be described simply as having a "funny feeling," or the person may not be able to describe the aura. Other auras may include ringing in the ears (tinnitis), or having changes in smell (such as strange odors), taste or touch. Rare migraine conditions include these types of neurological auras: Hemiplegic migraine. Temporary paralysis (hemiplegia) or nerve or sensory changes on one side of the body (such as muscle weakness). The onset of the headache may be associated with temporary numbness, dizziness, or vision changes. Retinal migraine. Temporary, partial or complete loss of vision in one eye, along with a dull ache behind the eye that may spread to the rest of the head. Basilar artery migraine. Dizziness, confusion or loss of balance can precede the headache. The headache pain may affect the back of the head. These symptoms usually occur suddenly and can be associated with the inability to speak properly, ringing in the ears, and vomiting. This type of migraine is strongly related to hormonal changes and primarily affects young adult women. Status migrainosus. A rare and severe type of migraine that can last 72-hours or longer. The pain and nausea are so intense that people who have this type of headache often need to be hospitalized. Certain medications, or medication withdrawal, can cause this type migraine syndrome. Ophthalmoplegic migraine. Pain around the eye, including paralysis in the muscles surrounding the eye. This is an emergency medical condition, as the symptoms can also be caused by pressure on the nerves behind the eye or an aneurysm. Other symptoms of ophthalmoplegic migraines include droopy eyelid, double vision, or other vision changes. Fortunately, this is a rare form of migraine. Migraines without auras are more common, occurring in 80%-85% of migraine sufferers. Several hours before the onset of the headache, the person can experience vague symptoms, including:
How Are Migraines Treated? There is no cure for migraines. However, there are many medications are available to treat or even prevent some migraines. Some people may also reduce the frequency of migraines by identifying and avoiding triggers that lead to the migraine such as drinking red wine or getting too little sleep (see the triggers above).
All of these treatments should be used under the direction of a headache specialist or doctor familiar with migraine treatments. As with any medication, it is important to carefully follow the label instructions and your doctor's advice. Can Migraines Be Prevented? Yes. You can reduce the frequency of your migraine attacks by identifying and then avoiding migraine triggers. You can keep track of your headache patterns and identify headache triggers by using a headache diary. Recalling what was eaten prior to an attack may help you identify those foods that cause your migraines and make the necessary dietary changes to avoid these triggers in the future. Stress management and coping techniques, along with relaxation training can help prevent or reduce the severity of the migraine attacks. Women who often get migraines around their menstrual period can take preventive therapy when they know their period is coming. Migraine sufferers also seem to have fewer attacks when they eat on a regular schedule and get adequate rest. Regular exercise -- in moderation -- can also help prevent migraines. Headache types
Hormones and Headaches It has been estimated that 70% of migraine sufferers are female. Of these female migraine sufferers, 60%-70% report a menstrual relationship to their migraine attacks. What Is the Relationship Between Hormones and Headaches? Headaches in women, particularly migraines, have been related to changes in the levels of the female hormone estrogen during a woman's menstrual cycle. Estrogen levels drop immediately before the start of the menstrual flow. Premenstrual migraines regularly occur during or after the time when the female hormones, estrogen and progesterone, decrease to their lowest levels. Migraine attacks typically disappear during pregnancy. In one study, 64% of women who described a menstrual link to their headaches noted that their headaches disappeared during pregnancy. However, some women have reported the initial onset of migraines during the first trimester of pregnancy, with disappearance of their headaches after the third month of pregnancy. What Triggers Migraines in Women? Birth control pills as well as hormone replacement therapy during menopause have been recognized as migraine triggers in some women. As early as 1966, investigators noted that migraines can become more severe in women taking birth control pills, especially those containing high doses of estrogen. The frequency of side effects, such as headache, decreased in those who took birth control pills containing lower doses of estrogen and did not occur in those who took birth control pills containing progesterone. What Are the Treatment Options for Menstrual Migraines? The medications of choice to stop a menstrual migraine are non-steroidal anti-inflammatory medications (NSAIDs). The NSAIDs most often used for menstrual migraines include:
NSAID treatment should be started two to three days before the menstrual period starts and continue til the period ends. Because the therapy is of short duration, the risk of gastrointestinal side effects is limited. For people who have severe menstrual migraines or who want to continue taking their birth control pills, doctors recommend taking a NSAID, starting on the l9th day of the cycle and continuing through the second day of the next cycle. Other medications that may be used are given by prescription only. They include:
These drugs should also be started two to three days pre-menses, and continued throughout the menstrual flow. Because fluid retention is often associated with menses, diuretics have been used to prevent menstrual migraine. Some doctors may recommend limiting salt-intake immediately before the start of menses. Lupron is a medication that affects hormone levels and is used only when all other treatment methods have been tried and have been unsuccessful. What Are the Treatment Options for Menopausal Migraines? For people who need to continue post-menopausal estrogen supplements, the lowest dose of these agents should be used, on an uninterrupted basis. Instead of seven days off the drug, you should take it on a daily basis. By maintaining a steady dose of estrogen, the headaches may be prevented. An estrogen patch (such as Estraderm) may also be effective in stabilizing the levels of estrogen. What Are the Treatment Options for Migraines During Pregnancy? During pregnancy, no treatment is recommended to treat migraines. Medication therapy used to treat migraines can affect the uterus and can cross the placenta and affect the baby, so these medications should be strictly avoided during pregnancy. A mild pain-reliever can be used, such as Tylenol. It is important that pregnant women suffering from headaches discuss the safety of headache medications with their obstetricians and headache specialists before taking anything.
Transformed Migraines
Transformed migraines are chronic, daily headaches with a vascular quality (meaning that they are throbbing in nature.) Most people who experience transformed migraines have a history of migraines, usually beginning in childhood or early adolescence. The onset of daily transformed migraine headaches generally occurs in people during their 20's and 30's. Many people with a previous history of migraine will suddenly report the headaches are less severe but are more frequent, until they begin occurring daily. This change may be caused by the daily use of pain relievers. Some people with transformed migraines report having severe episodes accompanied by nausea and vomiting, much like migraines. Often, it is difficult to differentiate between tension headaches and transformed migraines. Because transformed migraines are difficult to diagnose, many people may be treated inappropriately. Treatment is further complicated because of the chronic nature of headache. Many people with transformed headaches have the tendency to overuse pain-relievers, both prescription and over-the-counter, using these drugs daily with or without having a headache. This puts the person at risk for building up a tolerance to the drugs. Additionally, taking large amounts of pain-relievers containing caffeine can experience withdrawal headaches. In many cases, people suffering from transformed migraines have other health problems such as hypertension and depression which complicate treatment. Seeking care by an experienced, multidisciplinary health care team to coordinate treatment is essential to finding relief. Rebound Headaches  When the occasional headache strikes, most of us head for the medicine cabinet or local pharmacy and take an over-the-counter pain medication, such as acetaminophen (Tylenol), ibuprofen (Motrin), aspirin, or pain-relieving medications containing caffeine. While over-the-counter pain-relievers are helpful in improving headache pain, they must be taken with caution because they could actually make your headaches worse if they aren't taken correctly. The overuse or misuse of pain relievers -- exceeding labeling instructions (such as taking the medications 3 or more days per week) or not following your doctor's advice -- can cause you to "rebound" into another headache. When the pain medication wears off, you may experience a withdrawal reaction, prompting you to take more medication, which only leads to another headache and the desire to take more medication. And so the cycle continues until you start to suffer from chronic daily headaches with more severe headache pain and more frequent headaches. Pain-reliever overuse appears to interfere with the brain centers that regulate the flow of pain messages to the nerves, worsening headache pain. This rebound syndrome is especially dangerous if your medication contains caffeine, which is often included in many pain-relievers to speed up the action of the other ingredients. While it can be beneficial, caffeine in medications, combined with consuming caffeine (coffee, tea, soft drinks or chocolate) from other sources, makes you more vulnerable to a rebound headache. In addition to the rebound headache, over-use of pain-relievers can lead to addiction, more intense pain when the medication wears off, and possible serious side-effects. Who Gets Rebound Headaches? Any person with a history of tension headaches, migraines, or transformed migraines can be affected by rebound headaches if he or she overuses certain medications. What Pain-Relievers Are Responsible for Causing Rebound Headaches? Many commonly used immediate relief medications, when taken in large enough amounts, can cause rebound headaches. Medications once thought of as "safe" are turning up as the likeliest culprits. These include:
While small amounts of these medications per week may be safe (and effective) -- at some point, the continued medication use can lead to the development of low grade headaches that just will not go away. Taking larger or more frequent doses of the offending immediate relief medication is not recommended. This not only exposes the person to a higher level of the medication's harmful ingredients, but it can make the headache worse and continue indefinitely. Are There Treatments for Rebound Headaches? Usually, discontinuing the medication or gradually tapering the medication dose will lead to more easily controlled headaches. You will probably be asked to record your headache symptoms, noting the frequency and duration of headaches. Some people may need to be "detoxified" under more carefully monitored medical conditions. People taking large doses of sedative hypnotics, sedative-containing combination headache pills or narcotics such as codeine or oxycodone may need to be admitted to the hospital so they can be detoxified and recover under supervision. Unfortunately, for many chronic daily headache sufferers, detoxification for the first several weeks leads to increasing headaches. Supervision and treatment by a headache specialist are therefore very important. Eventually, the headaches disappear and resume their previous intermittent nature. Can Rebound Headaches Be Prevented? Yes. You can prevent rebound headaches by using pain-relieving medications on a limited basis, only when necessary. Do not use them more than once or twice a week, unless instructed otherwise by your doctor. Also, avoid caffeine-containing products while taking a pain-relieving medication, especially medication that already contains caffeine.
Cluster Headaches
Cluster headaches are one of the most severe types of headache. It can be 100 times more intense than a migraine attack. Who Gets Cluster Headaches? Cluster headaches are the least common type of headaches, affecting less than 1 in 1,000 people. Cluster headaches are a young person's disease: the headaches typically start before age 30. Cluster headaches are more common in men, but more women are starting to be diagnosed with this problem. The male to female ratio is 2-3:1. What Causes Cluster Headaches? The true biochemical cause of cluster headaches is unknown. However, the headaches occur when a nerve pathway in the base of the brain (the trigeminal-autonomic reflex pathway) is activated. The trigeminal nerve is the main nerve of the face responsible for sensations (such as heat or pain.)
When activated, the trigeminal nerve causes the eye pain associated with cluster headaches. The trigeminal nerve also stimulates another group of nerves that causes the eye tearing and redness, nasal congestion and discharge associated with cluster attacks. The activation of the trigeminal nerve appears to come from a deeper part of the brain called the hypothalamus. The hypothalamus is home to our "internal biologic clock" which regulates our sleep and wake cycles on a 24-hour schedule. Recent imaging studies have shown activation or stimulation of the hypothalamus during a cluster attack. Cluster headaches usually are not caused by an underlying brain condition such as a tumor or aneurysm. What Triggers Cluster Headaches? The season is the most common trigger for cluster headaches, which often occur in the spring or autumn. Due to their seasonal nature, cluster headaches are often mistakenly associated with allergies or business stress. The seasonal nature of cluster headaches most likely results from stimulation or activation of the hypothalamus Cluster headaches are also common in people who smoke and drink alcohol frequently. During a cluster period, the sufferer is more sensitive to the action of alcohol and nicotine, and minimal amounts of alcohol can trigger the headaches. During headache-free periods the person can consume alcohol without provoking a headache. What Are the Symptoms of a Cluster Headache? Cluster headaches generally reach their full force within five or ten minutes after onset. The attacks are usually very similar, varying only slightly from one attack to another.
Most cluster sufferers (80%-90%) have episodic cluster headaches that occur in periods lasting seven days to one year, separated by pain-free episodes lasting 14 days or more. In about 20% of people with cluster headaches, the attacks may be chronic, meaning there are less than 14 headache-free days per year. Chronic cluster headaches vary from episodic cluster headaches, as they are continuous without remission periods. Cluster headaches are not typically associated with nausea or vomiting. It is possible for someone with cluster headaches to also suffer from migraines. Is There Any Way to Tell That a Cluster Headache Is Coming? Although the pain of a cluster headache starts suddenly, there may be a few subtle signs of the oncoming headache. Some signs include:
How Are Cluster Headaches Treated?
All of these treatments should be used under the direction of a doctor familiar with treating cluster headaches. As with any medication, it is important to carefully follow the label instructions and your doctor's advice. Sinus Headache Sinuses are air-filled cavities (spaces) located in your forehead, cheekbones, and behind the bridge of your nose. The sinuses produce a thin mucus that drains out of the channels of the nose. When a sinus becomes inflamed, usually as the result of an allergic reaction, a tumor, or an infection, the inflammation will prevent the outflow of mucus and cause a pain similar to that of a headache. What Are the Symptoms of Sinus Headaches? Sinus headaches are associated with a deep and constant pain in the cheekbones, forehead or bridge of the nose. The pain usually intensifies with sudden head movement or straining. The pain is usually accompanied by other sinus symptoms, such as nasal discharge, feeling of fullness in the ears, fever, and facial swelling.
Whether your headache symptoms can actually be attributed to the sinuses will need to be determined by your doctor. If your headache is truly caused by a sinus blockage, such as an infection, you will likely have a fever. CT scans or MRI along with a physical examination are usually conducted to determine if there is a blockage in your sinuses. How Are Sinus Headaches Treated? Treatment of sinus headaches is usually directed toward symptom relief and treating the infection. Treatment might include antibiotics for the infection, as well as a short period of antihistamines (such as Benadryl) or decongestants (such as Sudafed) to treat the symptoms. If you take decongestants, but do not have a true sinus headache, the medication could make your headache worse. Be sure to see your doctor before taking any medications. Other medications to treat sinus infections include pain-relievers and vasoconstrictors (to decrease nasal congestion). If the pain continues after using pain-relievers, corticosteroids may be prescribed to further decrease the inflammation. When an allergen is causing the sinus flare-ups, preventive allergy therapy is often needed. Decongestant medications can be used to relieve headaches associated with sinus infections. Decongestants help relieve headache symptoms because they constrict blood vessels that cause headache pain. However, decongestant use can be habit-forming. If your headaches seem to be relieved by decongestants but you do not have a sinus infection, you may actually have a migraine or tension headaches which require specific treatment. Can Allergies Cause Headaches? It is a misconception that allergies cause headaches. However, allergies can cause sinus congestion, which can lead to headache pain. If you have allergies, the treatment for your allergy will not relieve your headache pain. The two conditions generally must be treated separately. See your doctor to ensure proper treatment A child's headache 
Kids get headaches, too! Many adults with headaches started having them as kids -- in fact, 20% of adult headache sufferers say their headaches started before age 10, and 50% report their headaches started before age 20. How Common Are Headaches in Children and Adolescents? Headaches are very common in children and adolescents. In one study, 56% of boys and 74% of girls between the ages of 12 and 17 reported having had a headache within the past month. By age 15, 5% of all children and adolescents have had migraines and 15% have had tension headaches. Many parents worry that their child's headache is the sign of a brain tumor or serious medical condition, but most headaches in children and adolescents are not the result of a serious illness. What Types of Headaches Do Children and Adolescents Get? Children get the same types of headaches adults do, including: tension headaches, migraines, and sinus headaches. What Causes Headaches in Children and Adolescents? Children get headaches for many of the same reasons adults get headaches. But, most headaches in children are usually due to an illness, infection, cold or fever. Other conditions that can cause headaches include sinusitis (inflammation of the sinuses), pharyngitis (inflammation or infection of the throat) or otitis (ear infection). The exact causes of migraines are unknown, although they are related to changes in the brain as well as to genetic causes. For many years, scientists believed that migraines were linked to the expanding (dilation) and constriction (narrowing) of blood vessels on the brain's surface. However, it is now believed that migraines are caused by inherited abnormalities in certain areas of the brain. Most children and adolescents (90%) who have migraines have other family members with migraines. When both parents have a history of migraines, there is a 70% chance that the child will also develop migraines. If only one parent has a history of migraines, the risk drops to 25%-50%. Children and adolescents with migraines may also inherit the tendency to be affected by certain migraine triggers, such as fatigue, bright lights, and changes in weather. Some migraine triggers can be identified such as stress, anxiety, depression, a change in routine or sleep pattern, bright light, loud noises or certain foods, food additives and beverages Too much physical activity or too much sun can trigger a migraine in some children or adolescents. Common causes of tension headaches include striving for academic excellence as well as emotional stress related to family, school or friends. Other causes of tension headaches include eyestrain and neck or back strain due to poor posture. Depression may also be a reason your child is having headaches. When tension headaches worsen over time and occur along with other neurological symptoms such as loss of vision, or speech problems or muscle weakeness, they can be the sign of a more serious problem, such as:
If you suspect any of the above listed conditions, take your child to his or her doctor for evaluation. How Are Headaches Evaluated and Diagnosed in Children and Adolescents? The good news for pediatric and adolescent headache sufferers is that once a correct headache diagnosis is made, an effective treatment plan can be started.
If your child has headache symptoms, the first step is to take your child to his or her doctor. The doctor will perform a complete physical examination and a headache evaluation. During the headache evaluation, your child's headache history and description of the headaches will be evaluated. You and your child will be asked to describe the headache symptoms and characteristics as completely as possible. A headache evaluation may include a CT scan or MRI if a structural disorder of the central nervous system is suspected. Both of these tests produce cross-sectional images of the brain that can reveal abnormal areas or problems. If your child's headache symptoms become worse or become more frequent despite treatment, ask your child's doctor for a referral to a specialist. Children should be referred to a pediatric neurologist, and adolescents should be referred to a headache specialist. Your child's doctor should be able to provide the names of headache specialists.. How Are Headaches Treated in Children and Adolescents? Your doctor may recommend different types of treatment to try. You should establish a reasonable time frame with the doctor to evaluate your child's headache symptoms. The proper treatment will depend on several factors, including the type and frequency of the headache, its cause and the age of the child. Treatment may include education, stress management,biofeedback and medications.
What Happens After My Child Starts Treatment? When your child's doctor starts a treatment program, keep track of the results by using a headache diary, and record how the treatment program is working. Keep your child's scheduled follow-up appointments so your child's doctor can monitor your child's progress and make changes in the treatment program as needed. Do Children Outgrow Headaches? Headaches may improve as your child gets older. The headaches may disappear and then return later in life. By junior high school, many boys who have migraines outgrow them, but in girls, migraine frequency increases because of hormonal changes. Migraines are three times more likely to occur in adolescent girls than in boys. When to worry about children's headaches
Fortunately, less than 2% of pediatric and adolescent headaches are the result of a serious disease or physical problem. But, you should still be aware of signs that may indicate a more serious illness is behind your child's headaches. A more serious problem should be considered when your child has any of the following:
Also, you should take your child to the doctor if he or she has headaches with:
I hope some of what you have read has been
helpful to you and I wish you "Health and Happiness
Always".........Till next time, stay safe and healthy.
Sandy~
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The
term "cluster headache" refers to a type of headache that recurs
over a period of time. People who have cluster headaches experience
an episode one to three times per day during a period of time (the
cluster period), which may last from 2 weeks to 3 months. The
headaches may disappear completely (go into "remission") for months
or years, only to recur. A cluster headache typically awakens a
person from sleep 1 to 2 hours after going to bed. These nocturnal
attacks can be more severe than the daytime attacks. Attacks appear
to be linked to the circadian (or "biological") clock. Most people
with cluster headaches will develop cluster periods at the same time
each year -- either in the spring or fall or the winter or summer.
