Migraine headaches are perhaps one of the most common reasons for emergency department visits and that we see at our pain management clinic here in Lakeland, Florida. A migraine begins when impulses from overactive nerve cells in the brain cause blood vessels to narrow and expand. These signals create a pulsing, or throbbing, sensation, usually on just one side of the head. Migraine headaches can be so severe that the pain is disabling.
Nausea, vomiting and extreme sensitivity to light and sound often accompany migraines. Often, warning symptoms, known as auras, may occur before or during a migraine headache. These can include flashes of light, blind spots, or tingling on one side of the face or in an arm or leg.
Migraine headaches typically last from 4 to 72 hours and vary in frequency from daily to fewer than one per year. According to the National Headache Foundation, more than 37 million Americans suffer from migraine headaches. A migraine affects three times as many women (18%) as men (6%). Migraines most often occur between the ages of 35 and 55, although they can affect other age groups. About 70% to 80% of people with migraines (sometimes called migraineurs) have a history of migraines in the family.
What Are Migraine Headaches?
A migraine headache is different from an acute headache in that it includes any combination of these symptoms:
- Moderate to severe pain (often described as pounding, throbbing pain).
- Sensitivity to light, noise, or odors.
- Blurred vision.
- Nausea or vomiting, upset stomach, abdominal pain.
- Loss of appetite.
- Sensations of being very warm or cold.
- Fever (although rare).
- Bright flashing lights, wavy or jagged lines, or blind spots (aura).
What Causes Migraine Headaches?
The exact cause of a migraine is not known; however, they seem to be a combination of changes in the brain and surrounding blood vessels, as well as family genes. Originally, scientists believed changes in the blood flow in the brain caused migraines. Now, experts believe family genes may be the cause.
Experts believe migraine triggers can be inherited. Some common triggers include:
- Stress (most common).
- Schedule changes.
- Exhaustion/lack of sleep.
- Sleep pattern changes.
- Weather changes (fronts, barometric pressure, strong winds, even altitude changes).
- Bright lights.
- Caffeine (too much or withdrawal).
- Certain foods and drinks (includes food additives like nitrates and monosodium glutamate).
- Skipping meals.
- Strong smells.
- Teeth grinding at night.
What are the Symptoms of a Migraine Headache?
Individual migraines range from moderate to severe in intensity, characterized by a throbbing or pounding feeling. Although frequently one-sided, the pain can occur anywhere on the head, neck, and face. Even all over. At their worst, migraines sufferers experience sensitivity to light, noise, and smells. Nausea is one of the most common symptoms which worsens with activity and can result in disability. Most migraine sufferers experience numbness, confusion, trouble speaking, vertigo (spinning dizziness), and other stroke-like symptoms.
Because migraine pain is in the face, it can often be mistaken for a sinus headache. A migraine may have other “sinus-like” symptoms, including watering eyes, nasal congestion, and a sense of facial pressure. Most patients who think they have a sinus headache may, in fact, be suffering from a migraine.
Migraines may progress through four stages: prodrome, aura, headache, and post-drome, though you may not experience all stages.
One or two days before a migraine, there is are subtle changes that warn of an upcoming migraine One or two days before a migraine, you may notice, including:
- Mood changes (depression to euphoria).
- Food cravings.
- Neck stiffness.
- Increased thirst and urination.
- Frequent yawning.
Most people experience migraines without aura; however, an aura can occur before or during a migraine. Auras are symptoms of the nervous system and are usually visual disturbances, usually flashes of light or wavy, zigzag vision.
Auras can also be the sensation of touch (sensory), movement (motor) or speech (verbal) disturbances. There may be muscles weakness.
These symptoms usually begin gradually and build over several minutes, lasting as much as an hour. Examples of migraine aura include:
- Visual phenomena (seeing various shapes, bright spots, or flashes of light).
- Vision loss.
- Pins and needles sensations in an arm or leg.
- Weakness or numbness in the face or one side of the body.
- Difficulty in speaking.
- Hearing noises or even music.
- Uncontrollable jerking or other movements.
- Sometimes, a migraine with aura may be associated with limb weakness.
If untreated a migraine can last from four to 72 hours. The frequency with which migraines occur varies with each individual. Migraines may be rare or strike several times a month. During a migraine, one may experience:
- Pain on one side or both sides of the head.
- Pain that feels throbbing or pulsing.
- Sensitivity to light, sounds, and sometimes smells and touch.
- Nausea and vomiting.
- Blurred vision.
- Lightheadedness, sometimes followed by fainting.
In the final phase or post-drome, following a migraine, the patient may feel drained and washed out. However, some report a feeling of elation. In the 24 hours following a migraine, some also experience:
- Sensitivity to light and sound.
How are Migraine Headaches Diagnosed?
Despite their dramatic symptoms, migraines almost never begin with an underlying problem that will show up in testing, even on brain MRIs. In fact, many experts do not recommend brain imaging at all, even in severe cases, as long as the patient’s symptoms are typical for migraines and a thorough neurological examination shows everything else to be normal.
Because of this, we classify migraines as “primary headaches,” one that has no known underlying cause. Thus, because the condition cannot be diagnosed by a scan or by a blood test, a “clinical” call is made by an experienced physician.
How are Migraine Headaches Treated?
Unfortunately, migraines can be difficult to treat. Because of this, some migraine headache sufferers self-medicate. Doing so can result in increasingly frequent headaches as a consequence of over using short-acting headache medications, known as a “medication over-use headache.”
Also, it is important to know that it is important to treat migraines as they are known to be associated with an increased risk of stroke, brain scarring (as seen on MRI scans), a heart defect called a patent foramen ovale (PFO), and other medical conditions.
Our pain management approach to migraines at Novus Spine and Pain Center is both abortive and preventive.
The goal of abortive therapy is to prevent a migraine attack or to stop it once it starts. Some medications can prevent a headache as it begins (prodrome stage) or once started; and taken as needed. Abortive treatment medications include those designed to target the chemical serotonin.
There are also drugs classified as “weak” narcotics that can help relieve almost any kind of pain. However, these are habit forming and are less desirable choices. These drugs are used as “backup” drugs for the occasions when a previously prescribed drug does not work.
If the patient suffers from more than one migraine headache per week, we use preventative treatment. The goal is to lessen the frequency and severity of the migraine attacks. Patients can take medication to prevent a migraine daily. Different drug classes have been used successfully as preventive therapies.
One treatment that has been found to help some migraine sufferers is an injection of Botulinum toxin (BOTOX ®) which has recently been approved by the U.S. FDA to treat a chronic migraine in adults. Injections are given at specific points in the head and neck muscles, and the effect lasts up to three months.
Are Migraine Headaches Hereditary?
As noted earlier, there is evidence migraines run in families. Four out of 5 people suffering from migraines have other family members who also suffer migraine headaches, too. Studies have found if one parent has a history of migraines, their child has a 50% chance of getting migraines. Should both parents have them, the chance of their children having migraines increases to 75%.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating pain and Migraine Headaches. By using a comprehensive approach and cutting edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.
Migraine Headaches Resources
Migraine Headaches (WebMD)
Guide to Migraine Headaches (WebMD)
How to head off the pain (Mayo Clinic)
Symptoms & Causes (Mayo Clinic)
Migraine Headaches (Johns Hopkins)
Migraine Headache (eMedicine Health.com)
Migraine Statistics (Migraine.com)