Migraine

woman with migrain

Did You Know That…  Whoopi Goldberg suffers with migraine syndrome.  It seems not to have interfered with her success!  She’s an Academy Award winning actress, a producer, an author, and the just greatest ever comedienne.  She won a Golden Globe award, and her first nomination for an Oscar, for her leading-role performance in The Color Purple.  At one point she held the honor of being the most highly paid actress in history.  In all, she has won that Oscar, along with an Emmy, a Grammy, and a Tony.  She has a long medical history of migraine syndrome and has written about her medication use to get better control her headaches, including, at one point, medical marijuana.

Articles related to Migraine:

Stop That Headache!

Better medications for migraine have recently been released and more are in the pharmaceutical industry pipeline.  The newer ones prevent migraines altogether or greatly lessen their frequency and severity.  If, despite taking a preventative, you do get a migraine, there is the whole family of “triptans”.  Their development and approval, starting with sumatriptan (Imitrex) in 1991, was a revolution in migraine headache treatment.  There is something magical in blocking CGRP release (calcitonin gene-related peptide) by serotonin ( 5-HT) receptor activity at receptor types 5-HT1D and 5-HT1B.  CGRP makes the trigeminal nerve sensitive, thus, the headache, and blocking CGRP keeps the nerve sensitivity and pain from occurring.

Migraine Disorder is Not Just a Headache

Migraine Disorder is a headache disorder with recurrent headaches.  Everyone knows about “migraines” because the headaches are so severe.  However, mild or severe, a migraine is not just the headache.  A person’s whole chemistry and physiology changes.  There are gastric changes with nausea and maybe vomiting.  There are visual changes, sometimes resulting in an “aura”, sometimes before the headaches itself starts.  There are changes in energy level, motivation, and ability to think clearly.  When a person has a migraine headache, he/she has no desire to do anything.  The person wants to hide somewhere comfortable and wants “the world to go away”.  Some people who don’t get migraines view them as just “bad headaches”.  They are seriously mistaken.

More Migraine Details

Migraines can be mild migraines, or moderate migraines, but people talk about the really severe ones.  The pounding, pulsating pain usually affects only one side of your head and is made worse by movement or action.  During a migraine people want to stay still and be left alone.  These headaches can be as short as 2 hours or last as long as 72 hours.  Many people say they go to sleep with a migraine and wake the next morning feeling fine with no headache.  Others migraineurs are not so lucky.  As commented above, along with the headache comes nausea and maybe vomiting.  At times some sufferers feel a bit better once they can “lose the contents of their stomach.”  Also, one is often very sensitive to light (photophobia), and to noise (dysacusia), and sometimes to aromas and odors.  Sometimes even a good aroma, like cooking food, can seem awful and “turn one’s stomach”.  About 1 in 3 people who get migraines have some kind of warning that a headache is coming.  It’s sometimes a change in vision, the aura, or some other feeling that tells them that a headache is on the way.

As We Said Above – It’s Not Just a Headache

With the good medicines we have now people have noticed another thing about migraine headaches.  There is more to it than just the headache and other obvious symptoms.  After taking the right medication the headache, nausea, and other more obvious symptoms ease and eventually go away.  But the other less obvious symptoms such as no motivation, little energy, dragging tiredness stay around a bit longer.  When one is crushed by a headache and nauseated to near vomiting it’s hard to worry about or maybe even notice these other symptoms.  But people who get migraines have noticed that when the bigger problems are gone the smaller ones are easier to see.  Once the medication is fully effective the person feels just fine.

What Causes Migraine Headaches?

Family

For one, family, that is, the tendency to get migraines is genetically inherited.  About 2 out of 3 people who get migraines have family members who also get them. 

The World Around You

Many influences around in your environment can trigger a headache.  The list is long and it’s a different list for different people.  For some it’s food, as with the nitrates in hot dogs.  For others it’s alcohol or smoking.  Stress, being stressed out, is another pressure that can bring on a migraine, or being overly tired.  Skipping meals is often a problem that invites a migraine.  Weather changes, maybe barometric changes, as when sunny skies turn to clouds and rain, or the other way ’round, can bring on a headache.

Hormones Going Up and Down, Too

Before teenage years and the onset of menses, the percentage of boys who get migraines is a bit higher that the percentage of girls.  After puberty, about twice as many or 3 times as many women have migraine headaches as men.  Those sex hormones that start up in teenage years seem to have an effect.

How to Tell It’s Really a Migraine

The way in which a migraine starts and the way the pain and other symptoms develop over time are so typical of migraine syndrome that just this time course and symptom complex are a big part of knowing a headache is a real migraine.  If what you have does not fit the picture it might not be migraine syndrome or might be more complicated.  See your health care provider.  She might need to do tests or brain imaging to confirm that no other medical condition, such as sinus headaches, is the cause of the pain.  

Treating the Headache

A longer discussion of medications used to treat migraines or stop them from occurring is presented on our migraine disorder treatment page (https://www.neuroscirandd.com/migraine-treatment/).  In brief, really good medications are now available.  Your health care provider will likely have suggestions of medications you might try.  In the 30 to 90 minutes before the medication starts working many people get a bit of quick, temporary, though partial relief from a cold pack on the side of the head with the headache, and lying down quietly in a darkened room.  If you think there are triggers, like foods or missing meals or too little sleep, obviously avoid them if you can.

The Benefit of Migraine Syndrome If There Is One

There’s an old saying in medicine, a bit of medical philosophy.  If you want to live a long and healthy life, develop a minor medical condition at a young age, and then take care of that condition and yourself for the rest of your life.  Though you might feel like you want to die in the midst of the worst migraine, migraine syndrome is one of those minor medical conditions.  They don’t kill you.  Having them is awful, to be sure.  But they make you sensitive to your surroundings and yourself.  They make you aware of what is good for your health and what bad behaviors you need to avoid.  They make you examine more carefully what and when you eat and drink.  Maybe you’ll decide to cut back on alcoholic beverages.  Maybe you will want to smoke less.  Follow a better schedule, get regular exercise and sleep.  Stay away from too much stress and get away from stress if it envelops you.  And you’re motivated to see your medical care provider now and again for your headaches.  A good roadmap, indeed, for a long and healthy life.

Now for a bit of Medical History… It is thought that the ancient practice of chiseling a hole in someone’s skull, trepanation, was done to relieve the pain of migraine syndrome.  Evidence exists that trepanation was done as early as 9000 year ago.  A few of these people clearly survived.  Likely most did not.  During the 1600s the physician William Harvey still recommended trepanation for migraines.  Egyptian medical history going back to 3500 years ago describes what might have been migraine headaches.  Various ancient texts since then describe the headaches and other aspects of migraine syndrome, such as the visual aura before some headaches and sufferers feeling some relief after vomiting.  We still divide migraines into two main types, with and without aura, a terminology first used in the late 1800s.  The first real treatment, ergot from a fungus, was also discovered in the late 1800s.  Ergot was followed by methysergide from about 1960 to 1990, then sumatriptan, the first triptan, was developed.

Helpful links:

National Institutes of Health, National Institute of Neurological Disease and Stroke

https://www.ninds.nih.gov/Disorders/All-Disorders/Migraine-Information-Page

National Library of Medicine (United States), Medline Plus

https://medlineplus.gov/migraine.html

The Mayo Clinic

https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201

Migraine Research Foundation

https://migraineresearchfoundation.org/about-migraine/migraine-facts/