Health

That Pain in Your Head
If you're one of more than 28 million Americans who suffer from migraines, there are a variety of treatment options to help relieve your suffering.

by Kate Wicker

If you're like the 28 million Americans who suffer from migraines, this scenario is all too familiar. According to the National Headache Foundation, migraines are a disabling biological disease that affect work and school productivity in more than half of sufferers, costing the U.S. economy approximately $13 billion a year.

Lili Banan, a busy third-year medical student, knows first hand how migraines can adversely affect quality of life. "Migraines are debilitating. They're also unpredictable. You never know when you might have to put your life on hold and crawl into bed until the pain goes away," she says. "I've had to miss work. I've missed out on dancing and exercising because of migraines. They affect all the things you love to do."

Not your typical headache

Headaches are a common medical problem that most people experience at some point in their lives, but a migraine is in a league of its own. "A migraine is a very severe headache," says Dr. Michael Rivner, a neurologist at Medical College of Georgia Health System. "If you have any disorder that periodically keeps you out of school or work for any number of days, then that obviously is a significant illness that needs to be treated."

According to the founder and director of the Walton Headache Center, Dr. Marc Husid, migraine headaches are a specific syndrome with many associated symptoms. "There are many features, not all of which are present in every person or every attack," he says. "The three features most predictive of migraines include the presence of nausea, sensitivity to light and disability."

"Migraines are characterized by a pulsating quality," adds Rivner. "Often they occur on one side of the head. Sometimes the headache is on both sides; sometimes migraines switch sides."

A certain type of migraine known as a classic migraine may be preceded by a warning symptom known as an aura. "The aura can be flashing lights or it can be something more complicated like an actual weakness in an arm or leg," Rivner explains. Less than one-third of migraine sufferers experience auras.

Migraines often first surface in the teens and early 20s and there seems to be a genetic link as well. "There's often a family history of migraines," says Rivner.

Migraine Triggers

Although the exact cause of migraines is unknown, many doctors suspect that the expansion, or dilation, of the head's blood vessels causes the pain from migraines. There are also certain migraine triggers that vary from person to person. "There are a lot of aggravating factors. These can cause migraines in someone who is already susceptible to the headaches. Sometimes foods like chocolate or cheese can trigger migraines. Stress is another big one," says Rivner. "Stress usually makes anything in life that's bad worse."

Husid says other triggers include skipped or delayed meals, lack of sleep or irregular sleep hours, exposure to bright or flickering lights, and certain odors such as perfume, chemicals or cigarette smoke. In addition, women experience migraines three times more often than men.

Banan has learned to identify and avoid her own migraine triggers. "I've found that not getting enough sleep, not eating enough and eating foods with ginger seem to be my triggers. I have to make it a priority to eat and sleep well," she says.

Diagnosis And Treatment

Although there is no surefire cure for migraines, there are a number of treatment options available for sufferers. Husid stresses the importance of a collaborative effort between the patient and health professional. "We strongly believe that effective treatment begins with helping our patients gain an understanding of their diagnosis, the underlying brain events that produce symptoms and their triggers," he says.

Unfortunately, diagnosing migraines is sometimes difficult. "Many people who think they have sinus and/or tension headaches actually have migraines," Husid explains. "Migraines are mistakenly diagnosed as sinus because they are often triggered by changes in barometric pressure, because the pain is located over sinus areas and because 45 percent of migraine attacks include one or more sinus symptomsÑfor example, tearing or a runny or congested nose. Similarly, migraine is often misdiagnosed as a tension headache because it is triggered by stress and often starts as neck pain."

A comprehensive medical history, however, can rule out other types of headaches. "A thorough medical and headache history is key to accurate diagnosis and effective treatment," Husid says. If a migraine is suspected, a general physical, neurological exam and blood tests may help doctors arrive at a conclusive diagnosis. Additional tests such as CT or MRI scans may be performed as well.

Once a definitive diagnosis is made, a health professional works with the patient to develop an effective treatment plan. "We are very fortunate these days to have a number of effective medications for both the prevention and the acute treatment of headaches," says Husid.

Treatment of migraines depends on the frequency and severity of the attacks. For example, abortive medications such as triptans are useful in treating migraines once an attack begins, whereas prophylactic, or preventive, medications can help reduce the frequency and duration of migraines. These types of medications are taken daily to keep migraines at bay. "If someone is getting migraines three to four times per month, then we typically look at prophylactic treatment," says Rivner.

There are several types of medications that are used in the prevention of migraines, including beta-blockers, calcium channel blockers, antidepressants and antiepileptic medications. Most of these medications are equally effective, so it's important to evaluate the side effects and the individual patient in order to make the best recommendationÑyet another reason a complete medical history and examination are so critical.

A relatively new treatment for migraines is the use of botox injections. Botox, or botulinum toxin, is a big buzzword in the cosmetic world these days. Produced by bacteria, the substance has been touted as a wrinkle remover. But it turns out botox does more than eliminate crow's feetÑit helps alleviate migraine pain.

"We first realized its potential to treat migraines during the wrinkle trials. Some of the patients who were getting it for wrinkles said that they'd had headaches for years and years, and the headaches went away after getting botox," says Rivner. "We don't understand exactly why it works, but botox is often an effective treatment for migraines."

Use Your Head: Understanding the Different Types of Headaches While not everyone suffers from migraines, most people get headaches from time to time. In fact, headaches are one of the most common complaints physicians hear about from their patients. According to the National Headache Foundation (www.headaches.org), headaches can be divided into the following classifications: Tension-Type Headaches Nearly 80 percent of adults experience a tension-type headache during their lives. These headaches may result from stress or fatigue and are characterized by a dull, aching pain on both sides of the head. Chronic tension headaches are associated with depression or other emotional problems. Cluster Headaches Cluster headaches are not common. The pain is caused by blood vessel swelling in the head. These types of headaches start abruptly and generally last 30 to 45 minutes. However, the headaches recur throughout the day. Most sufferers get between one and four headaches per day in what is known as a cluster period. Organic Headaches This type of headache is not a disease itself but rather is a symptom of another condition. Organically-caused headaches may be an indication of a tumor, infection, high blood pressure, disease of the brain, eye, ear and nose, blood clots or other diseases. These conditions can be life-threatening, so prompt medical attention is recommended. But keep in mind, headaches generally are not caused by a serious condition. Sinus Headaches Sinuses are located in the forehead, each cheekbone and behind the bridge of your nose. When a sinus becomes infected, the inflammation causes localized pain, resulting in a sinus headache. Hormone Headaches Fluctuations in hormones may sometimes cause headache pain. Identifying the type of headache you're experiencing helps ensure proper treatment. If you're unsure how to classify your pain, try keeping a diary that notes the time and place the headache occurs, the duration, what relieved the pain, what you were doing when the pain surfaced and what you ate or drank 24 hours prior to the onset of the headache. Your notes will help your doctor make an accurate diagnosis and then develop an effective treatment plan. Finally, non-drug treatments can be combined with medications for an optimal treatment plan. Diet changes, ample sleep, relaxation techniques, biofeedback (which trains patients to gain some control over certain physiological conditions), massage, acupuncture and the simple application of heat or cold to the head all can help patients successfully ease migraine pain. Mild migraines can also be treated with over-the-counter pain medications and anti-nausea medicine for people who get nauseous. But Rivner warns that continuously popping pain pills isn't always the best way to tame migraine pain. "One of the problems with treating persistent migraines with pain medications instead of taking prophylactic medications is that you can get what's known as a rebound headache from being on all the analgesics," he says. "If you have recurring migraines, you really should see a doctor."

Reaching Out to Migraine Sufferers People who have never suffered from migraines may underestimate their severity. "It's often difficult for people who do not get headaches to understand just how debilitating migraine headaches can be," says Dr. Marc Husid, founder and director of the Walton Headache Center. But understanding and empathy will help migraine sufferers better cope with their pain. One way to learn about migraines is to attend a Walton/National Headache Foundation support group meeting on the third Thursday of every month from 6:30 to 7:30 p.m. "The meetings are free and open to all and can be very helpful to family members and friends, as well as to people with headaches," says Husid. For more information on the support group, call (706) 823-5252. Paying a visit to your doctor is also a good idea to make sure there's not an underlying condition causing your headaches. "Not all headaches are benign," says Rivner. "If you have a new onset of a severe headache, you should definitely check it out because it could be treatable or life-threatening." However, Rivner is quick to point out that throbbing head pain rarely indicates a serious condition such as a brain tumor. "Most people think that if you have a bad headache, then it must be a brain tumor, but that's not usually how brain tumors present." In fact, the primary reason to seek treatment is to manage your pain. "Most headaches are not life-threatening," Rivner adds, "but they certainly affect one's life." Coping with migraines isn't always easy, but they don't have to rob sufferers of their quality of life. "I'd encourage anyone who thinks they get migraines to seek treatment," says Banan. "A doctor can help you determine your best treatment options, so you can get back to doing things you love."