A migraine headache can cause intense throbbing or a pulsing sensation in one area of the head. It is commonly accompanied by nausea, vomiting, and extreme sensitivity to light and sound.
Migraine attacks can cause significant pain for hours (>4hrs) to days and be so severe that all you can think about is finding a dark, quiet place to lie down.
Some migraines are preceded or accompanied by sensory warning symptoms (aura). Auras are nervous system symptoms that typically include: visual disturbances (flashes of light) touching sensations (sensory), movement (motor) or speech (verbal) disturbances. Less commonly, an aura may be associated with limb weakness (hemiplegic migraine). Most people experience migraine headaches without aura. Each of these symptoms are usually gradual and builds up in intensity over several minutes then commonly lasts 20 to 60 minutes.
While the exact cause of a migraine remains unclear it is noted that genetics and environmental factors can play a strong role. During a migraine; there are changes in the brainstem, the major pain pathways, as well as imbalances in the brain’s hormones (such as serotonin). In 90% of patients with a migraine there is a family history of migraines in at least one other relative. Migraines can occur in both men and women however it tends to me more common in women. A migraine typically presents itself before the age of 40.
What is a chronic migraine?
Defined as a headache that occurs 15 or more days a month and >8 migraines a month with the headache/migraine lasting 4 hours or longer for at least 3 consecutive months in people with current or prior diagnosis of migraine.
Symptoms that may be more serious than a migraine:
You should seek out immediate medical attention if you have any of these symptoms:
- An abrupt, severe headache
- Headache accompanied with fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or trouble speaking
- Headache after a head injury
- A chronic headache that is worse after coughing, exertion, straining or a sudden movement
- New headache pain if you’re older than 50
Common triggers for migraines:
- Hormone fluctuations for women
- Certain foods- commonly salt, cheese, processed foods, skipping meals, food additives such as monosodium glutamate
- Drinks: caffeine, alcohol- more commonly wine
- Stress- home life or work
- Sensory stimuli- bright lights, sun exposure, excessively loud noise, smells including smoke exposure, perfume or pain thinners
- Changes in sleep patterns
- Changes in weather- barometric fluctuations
- Medications- oral contraception, vasodilators (ie. Nitroglycerin)
Diagnosis and work up:
While most often headaches and migraines are diagnosed by your provider with the information you have provided some times additional testing is needed to rule out other possible causes. These tests can include:
- Blood tests. Your doctor may order blood tests to test for blood vessel problems, infections in your spinal cord or brain, and toxins in your system.
- Computerized tomography (CT) scan. A CT scan uses a series of X-rays to create detailed cross-sectional images of your brain. This helps to diagnose tumors, infections, brain damage, bleeding in your brain and other possible medical problems that may be causing your headaches.
- Magnetic resonance imaging (MRI). An MRI uses a powerful magnetic field and radio waves to produce detailed images of your brain and blood vessels.
MRI scans helps diagnose tumors, strokes, bleeding in your brain, infections, and other brain and nervous system (neurological) conditions.
- Spinal tap (lumbar puncture). To rule out a possible underlying infection or bleeding in your brain
Treatment options include:
- Abortive medications- triptans, OTC or Prescription pain medications; Ergots
- Preventive medications- Beta blockers, antidepressants (Amitriptyline, Effexor), Anti-epileptics (Topamax, Valproic acid)
- Onabotulinumtoxin A (Botox) injection
- Lifestyle changes
Is Botox an option for me?
You are a good candidate for Botox injections as a form of treatment for your chronic migraines if you:
- Previously diagnosed with migraines
- Have tried and failed abortive (ie. Imitrex) and preventive (ie. Topamax, Propanolol) medications
- Experience >8 migraines/month and >15 headache days/month for the past consecutive 3 months
- Headaches/migraines without treatment last more than 4 hours
Ashlie Teixeira-Smith, MSN, APRN is now treating patients with Chronic Migraine’s. For more information please contact us at (775) 323-2080.