Migraine: not just another headache!

By Joseph Kandel, M.D.

Migraine: not just another headache!What is a Migraine?
This is a severe type of headache, often accompanied with warnings such as visual sensations, flashes of lights, numbness or tingling, nausea, vomiting, and sensitivity to noise and too light. They can often last between four hours and 72 hours, and frequently involves one side of the head or the other. When a patient has all of these symptoms, it is easy to make the diagnosis. If there is a strong motor or sensory component, It can easily be confused for a stroke-like event.

Is a migraine disorder inherited?
Actually, it is common for patients with migraine headaches to have family members who have these headaches. 80% of migraine sufferers will have a family history. If a single parent has migraines, the odds are 50% that the child will have the migraine disorder. If both parents of migraines, the chances rise to 75%.

If it is not a migraine, what else
could it be?
There are many types of headache pain disorders, and just because there is a pain in your head, it does not mean you suffer from a migraine disorder. Sinus headaches involved pains around the sinuses, cheekbones, forehead, and the bridge of your nose. Often signs of sinus pressure and infection can be found with these type of headaches. Hormone headaches are associated in women who are having fluctuations in their hormone levels; birth control medication, menstrual cycles, pregnancy, and menopause can all factor into this. Tension headaches, also called stress headaches, are the most common in young adults; they can involve the muscles in and around the head and are uncomfortable, but rarely rise to the level of migraine pain. Cluster headaches are a vascular type of headaches, almost always occurring in men, with a pain intensity of a 10/10. The pain is often so severe that individuals may consider suicide. More recently, cervicogenic headaches have been noted to be a major source of headache problems. There are many pain generators in the cervical spine, and these can trigger headaches.

How can I get diagnosed?
To correctly diagnose your type of headache, you must see a physician. But not just any physician; you must see a physician who specializes in treating headache disorders. Most of the time it will be a neurologist who has a keen interest in migraine and other types of headaches. The history is always extremely important, and the physical exam can lead to a direction to help your physician diagnose your specific type of headache. For example, if there are tender spots all along the cervical spine, and testing reveals pain on examining the neck muscles, then you might have cervicogenic headaches or an underlying cervical spine disorder. Diagnostic testing is often helpful, including MRI or CT of the brain and cervical spine, as well as EEG (particularly if you’ve had any fainting episodes with your headache disorder).

How will my headache be treated?
Once the specific type of headache has been identified, your treatment will be directed by your migraine or headache specialist. Keeping a headache diary is going to be essential, particularly in finding triggers or activities that will produce or aggravate headaches. Dietary changes, avoiding certain foods that are known to be triggers may be suggested. Avoiding gluten or dairy products may also be suggested. Stress management, relaxation therapy, and mindfulness may also be offered as treatment options. Breathing exercises may be recommended. On occasion, biofeedback and counseling may be suggested.

What are my medication options?
There are truly too many options to name them all; however, they do fall into two categories, preventative and abortive.

Typically, preventive medications include heart medicine such as beta blockers (propranolol) or calcium channel blockers (verapamil), anti-seizure medicines (Topamax), antidepressants (Pamelor) to name a few. Botox is injectable therapy that has been tremendously successful and migraine headache prevention.

Abortive medications could include the wide variety of triptans (Imitrex, Maxalt, Relpax, etc.),
Anti-inflammatories (motrin, advil, excedrin migraine) as well as newer formulations such as Cambia (a powder that dissolves rapidly in water and has a quick onset of action!); In addition, medications to help with nausea (phenergan, zofran) are often quite helpful.

What else can I do about my
Find your triggers, change your lifestyle. Avoiding things that bring on migraines will be essential; The best migraine is the one you don’t get! Following proper body mechanics and proper workplace ergonomics at all times, increasing hydration, avoiding excessive stress, exercising daily, and integrating a healthy balance to your life will pay off with many more headache free days!

For more information about migraines, cervicogenic headaches, neck and back pains and muscle spasm, contact:

Joseph Kandel, M.D. & Associates

To see the expert therapy team at Neurology Office, call to make an appointment with Dr. Kandel 239-231-1414 (Naples) or 239-231-1415 (Ft. Myers) or check out the web site: www.NeurologyOffice.com

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