Symptoms of migraines can be debilitating and cause the sufferer to miss work, end up removed from family activities and isolated to dark, quiet rooms away from painful stimuli.
Dr. Elizabeth Minto is a neurologist at the University of South Alabama Physician’s Group and teaches neurology also. Minto graduated from USA, UAB, and Vanderbilt before making the trip home to work for the local community.
Her interests include migraines because of the many cases of them she sees in her practice.
So what does a migraine mean?
“A headache is a symptom and there are hundreds of causes,” she said at a Med School Cafe lecture on Thursday. A doctor’s job is to determine the headache type based on history and an exam.
A migraine headache is 2.5 times more common in females than males, and is rooted in family history. “You’re born with a tendency to have them or you aren’t,” said Minto.
Migraines make their appearance as young as age 8, and appear to varying degree and frequency until they lessen or resolve, typically around age 50.
For a headache to be a migraine, it must meet certain criteria. Among the criteria is pulsation, throbbing, moderate to severe pain, aggravation by physical exertion and a longevity of 4-72 hours. Nausea and vomiting may also coincide with the pain. Photophobia and phonophobia, better known as sensitivity to light and sound, are also common symptoms.
What do you do?
Literally, it translates to “half of the head.” That’s a misnomer though, as many migraine headaches are bilateral.
The best way to treat a migraine is early, before it magnifies. “If you wait too long to take the medicine, the horse is out of the barn,” said Minto.
Some of the symptoms that warn migraine sufferers of an oncoming headache include irritability, food cravings, and fatigue. Your body warns you that something is off.
Some people even see shapes of light, in what’s called an aura phase.
Two medicinal families are most commonly used to treat migraines, including ergotamine and triptans. Minto recommends triptans, “all of them,” she said.
Triptans are the first line of treatment, but it may take some experimentation to find the right drug that works for each patient.
Minto gave the advice to avoid butalbital, a drug that might be prescribed by urgent care facilities.
An over-the-counter option is Excedrin Migraine, which Minto says she recommends frequently because of its low cost and availability. “I tell people to take two,” she said.
Medication overuse can happen, and actually cause more headaches. As the body adjusts to powerful drugs, it can become used to them and expect them. In order to get the drugs, the body reacts by causing a headache, much like withdrawal symptoms from a myriad of pain medications.
Thus, for those having migraines more than 2 times a week, Minto recommends a preventative medication that is taken daily.
In order to facilitate the best treatment, it’s best to recognize the triggers and the frequency.
What can cause them?
Triggers include, wine, cheese, hormonal imbalance, head trauma, sleep deprivation and even the weather or perfume.
Maintaining a healthy diet and not skipping meals is helpful, as well as 40 minutes of exercise three times a week. Minto also recommended drinking less than two caffeinated drinks a day. “And one venti Starbucks coffee counts as two,” she said.
If you’re a migraine sufferer and take birth control, opt for progesterone medications instead of estrogen medications.
Are you sure it isn’t my sinuses?
A common misconception about migraines is that they’re just sinus headaches. Sinus pressure and even a congested nose can be a result of a migraine.
Approximately 85 percent of migraines were misdiagnosed as sinus headaches at one time. So when you go to an urgent care or a general practitioner that doesn’t recognize the signs of a migraine, the steroid shot you get will easy symptoms of a migraine, but those antibiotics are needless.
In addition to medication, psychological services can be helpful to manage migraines. “Migraines are often co-morbid with depression and anxiety, that anyone with chronic pain has,” she said.
Communication is key
Keeping track of medication and frequency of attacks is crucial, said Minto, and with new technology, it’s easier than ever before.
An application called “iHeadache” can be downloaded on any smart phone and will help record all necessary information. That way, you can bring that information directly to your doctor.
Managing migraines requires “trial and error” said Minto. “See a neurologist.”