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  1. #1
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    Post 5 Questions About Migraine: Answered

    5 migraine questions answered
    Harvard Medical School, Healthbeat
    March 30, 2010

    Migraines are notorious for causing pain. But what triggers them? How can they be prevented? And what are the best treatments? Here are answers to five questions that will help clear up a few misunderstandings and provide some useful information along the way.

    1. What exactly is a migraine?
    The “classic” migraine is preceded by aura, which typically consists of strange visual disturbances — zigzagging lines, flashing lights, and, occasionally, temporary vision loss. Numbness and tingling affecting one side of the lips, tongue, face, and the hand on the same side may also occur. But only about a third of migraine sufferers experience aura, and fewer still with every attack.

    The migraine headache, with or without aura, often — but not always — produces pain that usually begins (and sometimes stays) on one side of the head. A migraine headache also often has a pulsating quality to it. Many people experience nausea, extreme sensitivity to light or sound, or both.

    It’s also possible to confuse other sorts of headaches with migraines. Migraines can cause nasal congestion and a runny nose, so they’re sometimes mistaken for sinus headaches. And the regular headache that most of us have experienced can have some of the features of a migrainous one, such as unilateral pain and nausea.

    In short, arriving at a definition and diagnosis for migraine is complicated. Yet a simple headache diary — keeping track of headaches and factors that might have provoked them — can be very helpful in making a diagnosis.

    2. What causes a migraine?
    One prevailing theory is that migraines are caused by rapid waves of brain cell activity crossing the cortex, the thin outer layer of brain tissue, followed by periods of no activity. The name for this phenomenon is cortical spreading depression.

    Cortical spreading depression makes sense as a cause of aura, but researchers have also linked it to headache. Proponents cite experimental evidence that suggests it sets off inflammatory and other processes that stimulate pain receptors on the trigeminal nerves. This “neurogenic” inflammation and the release of other factors make the receptors — and the parts of the brain that receive their signals — increasingly sensitive, so migraine becomes more likely.

    Some leading researchers have expressed doubt about whether migraines start with cortical spreading depression. Experimental drugs that inhibit cortical spreading depression have shown a preventive effect on aura, but not on migraine headache.

    So, say some researchers, migraines are best explained as beginning lower in the brain, in the brainstem, which controls basic functions, such as respiration and responses to pain, and modulates many others, including incoming sensory information. The theory is that if certain areas of the brainstem aren’t working properly or are easily excited, they’re capable of starting cascades of neurological events, including cortical spreading depression, that account for migraine’s multiple symptoms.

    3. What triggers a migraine?
    There are too many triggers to list them all here. Many migraine sufferers are sensitive to strong sensory inputs like bright lights, loud noises, and strong smells. Lack of sleep is a trigger, but so is sleeping too much, and waking up from a sound sleep because of a headache is a distinctive characteristic of migraine. Many women have menstrual migraines associated with a drop in estrogen levels. Alcohol and certain foods can start a migraine.

    One of the most common triggers, stress, is one of the hardest to control. Interestingly, migraines tend to start not during moments of great stress but later on, as people wind down.

    4. How can migraines be prevented?
    If you are prone to migraines, there are many steps to take to prevent or diminish the attacks:

    Identify triggers so you can avoid them. That can take some time and real detective work.
    Keep to a regular, stress-reducing schedule that includes a full night’s rest, balanced meals, and exercise.
    Wearing blue- or green-tinted glasses can help fend off an attack in people with light sensitivity.
    Try medications, such as beta blockers, tricyclic antidepressants, and anticonvulsants. All have side effects, so they should be taken at low doses and only if migraines are frequent.

    5. How can they be stopped?
    Migraine sufferers can cut an attack short with one of the triptan drugs, a class that includes eletriptan (Relpax), sumatriptan (Imitrex), and zolmitriptan (Zomig). The triptan drugs seem to work by inhibiting pain signaling in the brainstem. They also constrict blood vessels, so people with a history of cardiovascular disease (heart attack, stroke, uncontrolled hypertension) are usually advised not to take them.

    Pain relievers like ibuprofen (Advil, Motrin) and naproxen (Aleve) can halt a mild attack, but rebound headaches may develop if they’re taken too often. Rebound headache occurs after the body gets used to having a medication in its system; when it’s not there, headaches happen. Migraines can quickly snowball into more serious pain, so it’s important to treat the headache early, regardless of the medication

    More from Harvard Healthbeat (book purchase)
    Headaches: Relieving and preventing migraine and other headaches
    Steve

    Dum spiro spero....While I breathe, I hope

  2. #2

    Re: 5 Questions About Migraine: Answered

    A loved one of mine has serious headaches - thanks for sharing.

  3. #3
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    Re: 5 Questions About Migraine: Answered

    A loved one of mine has serious headaches
    Bluebird,

    Headaches, especially headaches that are debilitating should always be reported to the doctor for investigation. There are numerous causes for headache, some more serious than others so a competent diagnosis should be made. If the diagnosis is for migraine, it is a treatable disorder and no one should endure being disabled by this disorder. On the other hand, if the headaches are caused by stress and tension, they need to be treated in an entirely different way.

    For the sake of your loved one, urge then to be seen by a doctor.
    Steve

    Dum spiro spero....While I breathe, I hope

  4. #4

    Re: 5 Questions About Migraine: Answered

    I had read about the waves in the brain theory, and intuitively can connect those with aura as the waves hit the visual cortex, but I do not understand the relationship with pain. My lay understanding is that the brain does not have pain-registering nerve cells. But the head outside the brain does. So is there a relationship between the waves in the brain and the pain sensations when experiencing migraines?

    I have also read that the pain outside the brain may be caused by restricted blood flow or inefficient flow of oxygen and carbon dioxide. And elsewhere I have read that hyperventilation occurs under heightened anxiety, which reduces (not increases - per Buteyko) oxygen in the blood and constricts blood vessels. Presumably lactic acid would build up in muscle tissues and various metabolic processes would be hindered. Pain would not be a surprising reaction. How this all relates to muscles tension in the neck and head when under stresses, I am not sure, but in any event I note these bits in hopes of some reaction from those who may know more than I do.

  5. #5
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    Re: 5 Questions About Migraine: Answered

    I am a migraine sufferer... Usually it's hormonal (it's like clockwork; usually two days before and two days before the end of my cycle)... But I get them a lot more in the winter (could be lack of vitamin D during those darker Canadian winters) and when I am stressed, or when I lose sleep, or when I wait too long to eat something with protein/carbs...

    My doctor has explained about the blood vessels widening... Apparently there is a short window of time where blood vessels constrict and narrow just before they kick in and cause that cascade... So I take Zomig... I have to take the ones that dissolve in my mouth because sometimes I am too nauseated to take a pill with water (I will just vomit it up)... But my doctor suggested that I try taking advil first if I am not sure it is a migraine, because if I take something that constricts blood vessels and it's at the time my blood vessels are already narrower, that might not be a good thing. In fact, my understanding is that my sinus problems might actually cause my migraines, I didn't think it was the other way around... Interesting... So I usually take 400 mg of ibuprofen and 500 mg of tylenol sinus medication to see if that kicks down the pain, and if it doesn't I take a zomig.

    I get an extremely painful debilitating pain in my left eye. It sometimes is associated with neck pain. It's like my whole left side from upper shoulders, neck and just under my neck where my skull meets the spine is where the most pain occurs. Sometimes my migraine pain will lessen if I get a massage or get medication to rub onto my neck. But usually it's only temporary relief until I take my zomig. It feels like a stabbing and burning feeling behind my eye, like there is a hot knife back there slowing wiggling around. It makes it hard to think, talk, walk, work, and it makes everything seem brighter and louder. It muddles me up good. I could sleep for 5-10 hours after waking up. Even with the zomig, I may not feel the pain anymore, but I still feel groggy (possibly the medication? Or still the migraine symptoms)... I have only had an aura once that blocked my vision, interestingly in BOTH eyes... (I tried closing one eye but I could still see it in the other)... Most of the time I do not have auras, or perhaps I do see one or two little dots of light flickering around. I do wake up because of the pain sometimes. I get that numb feeling, almost like part of my face was frozen by going to the dentist. It's interesting that sometimes some pain or the tingling is where I feel my pressure points where my teeth meet one of my fillings (I had the filling filed down a bit and it's a lot better)... But also other parts of my face.

    If someone could explain the way the brain cascade causes pain to occur in behind my left eye all the time, I would be interested. If it's in my left eye, does that mean the right side of my brain is having the cascade? My understanding about the cascading is that the blood vessels cause issues with the brain's pain receptors... So if the brain cannot actually feel the pain, perhaps it 'projects' it into my eye (I am probably not using the correct terminology)? What I mean is perhaps the pain receptors that are affected by this cascade aren't in the brain but they are in my left eye.... Or behind my left eye in my sinus cavity?

  6. #6
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    Re: 5 Questions About Migraine: Answered

    JGJB,

    Everything you wrote describes classic migraine symptoms, including your triggers, the one sided headache and the pain behind one eye. I cannot speak to the cascading you talked about, but the use of a NSAID along with your Zomig (triptan) is the most effective way to treat your attack.

    You may want to ask your doctor for a prescription for Anaprox to taks along with your Zomig as the studies that were done to support the combined use of an anti-inflammatory with triptan were done using Anaprox. An over the counter alternative to Anaprox could be Aleve, because Aleve is similar but you would have to ask your doctor about the appropriate dose for you.

    My own experience with trying an NSAID, in your case Advil, to test the headache or to spare the Zomig has largely been counter productive, and instead of wasting precious time to get relief, I prefer to take the Zomig/Anaprox combination, wait around 45-50 minutes and get complete relief.

    Are you satisfied with the relief you get with Zomig (Rapimelts)?
    Steve

    Dum spiro spero....While I breathe, I hope

  7. #7
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    Re: 5 Questions About Migraine: Answered

    Actually, yes I am very satisfied with Zomig. I have tried a couple other types and they weren't bad, but I think I prefer Zomig... There is the very rare time when it doesn't work... If it doesn't work I just have to wait 2 hours and then I can take another one, and that will work if the first dose did not. But again, that rarely happens; usually the first dose kicks in and the pain is gone. I rarely feel relief from my tylenol/advil so I end up taking the zomig pill 99.999999% of the time... lol Sometimes, rarely, if I am actually coming down with a cold, I will take some kind of tylenol/sinus combination pill and it helps.

    Because I have a thyroid medication, if I wake up from a migraine and it's close to the time when I have to take my thyroid medication (it is synthroid because I am hypo-thyroid and need the extra hormone) I generally take my thyroid medication and then wait an hour before I take my migraine medication. I have tried taking everything at once and it makes me much more ill sometimes to the point of vomiting... I take Symbicort (for asthma) which is an anti-inflammatory and lung opener, and my thyroid pill, wait an hour and then take my migraine medication. If it's 3 am and I wake up with a migraine, I will take the migraine medication because after a few hours go by, it doesn't seem to cause a bad reaction when I have to get up at 5:30 or 6 am for work.

    I might be groggy and not quite be functioning top-knotch, but I will still go to work (call center/tech support) after Zomig, or during work if I feel one coming on I will take Zomig. It probably affects me with concentration and I might be a bit slower, but overall I don't want to miss work all the time because I only have 12 paid sick days. If I didn't have Zomig I would probably have to miss work because I wouldn't be any good at all.

    Interesting, thanks for the information. Next time I see my doctor, I'll ask about the Anaprox/Aleve...

  8. #8
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    Re: 5 Questions About Migraine: Answered

    I just have to wait 2 hours and then I can take another one,
    And as I am sure you probably already know, you must wait 2 hours before taking the second dose if relief has not ocurred from the first dose

    If the headache returns, the dose may be repeated after 2 hours. A dose should not be
    repeated, regardless of dosage form, within 2 hours. A total cumulative dose of 10 mg should
    not be exceeded in any 24 hour period.
    Astra-Zeneca Product monograph Zomig.

    Has your doctor or pharmacist reviewed your medications you are taking to avoid any potential drug/drug interaction with Zomig?
    Steve

    Dum spiro spero....While I breathe, I hope

  9. #9
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    Re: 5 Questions About Migraine: Answered

    Yep, my doctor knows about all my medications, but I suppose it couldn't hurt to review. 8) As a general rule, I try not to take or eat anything for an hour after I take my thyroid medication. It's a bit annoying that I have to get up earlier, but oh well. I would rather take my synthroid pill before I start my day than part way through the day and forget or something.

    Right, I know I have to wait 2 hours before I take another one of those if the first one didn't work... I don't eat them like popcorn or anything, they're bloody expensive! lol $100 for a package of 6 if I didn't have coverage. I think it's $60 with the employee coverage I have. So not exactly like buying penny candy! 8P

  10. #10
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    Re: 5 Questions About Migraine: Answered

    my doctor knows about all my medications
    Great! As an empowered patient, it's always a good idea to ask the doctor, when a prescription for a new medication is being given, to ask whether there is any concern about interaction with medications already being taken. It's not a bad idea to double check with the pharmacist when filling a prescription as well, because sometimes drug/drug or drug /food interactions are not well known or the pharmacist may know of other medications , either Rx or OTC you may be taking, and the pharmacist often has access to interaction checkers to make the determination.
    Steve

    Dum spiro spero....While I breathe, I hope

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