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June is Migraine Awareness Month. Those who suffer from the debilitating headaches know that they can be difficult to treat. Dr. Sharisse Stephenson provides more information that could potentially help sufferers. Here is some info below:

 WHAT’S THE DIFFERENCE BETWEEN A HEADACHE & MIGRAINE? WHAT ARE THE MAIN SYMPTOMS?

There are many different types of headaches. There is actually an International Classification system which describes the different types of headaches.  Migraine is one of the most common types of headaches.  Migraines can often occur on one side of the head, the pain may be moderate or severe in intensity.  Nausea, vomiting, light and noise sensitivity are common associated symptoms.  Activity can aggravate the pain. 

 WHEN IS A HEADACHE NOT JUST A HEADACHE? HOW DO YOU KNOW WHEN TO SEEK CARE?

 An important distinction that we make as neurologists is the difference between primary versus secondary headaches. Primary headaches are headaches without an underlying bad cause such as migraines or tension headaches. The headaches can still be debilitating and lead to disability but there is not an underlying bad cause for the headache such as stroke or tumor.

Secondary headaches occur as a result of an underlying cause.  If you or someone has a severe, new headache or “the worst headache of your life”, that is an indication to call 911 and go to the nearest emergency department.  This can be a sign of a serious and potentially fatal problem called subarachnoid hemorrhage which occurs when an aneurysm ruptures in the brain.

If you do not have a history of headaches and develop a new headache especially accompanied with other symptoms such as fever, weakness, numbness, difficulty speaking, neck stiffness, you should go to the emergency department as this can be a sign of something more serious such as stroke or meningitis.  Even if you have a known history of headaches or migraines, you should seek care if you have frequent headaches, severe pain, or headaches that are difficult to stop as we have many treatment options to get headaches and migraines under better control.

DOES STRESS PLAY A ROLE IN HEADACHES OR MIGRAINES?

Stress plays a significant role in migraines. Stress can increase the frequency and severity of migraines.  Stress can contribute into the role of developing chronic migraines and increase migraine-related disability.

 DOES THE WEATHER AFFECT HEADACHES OR MIGRAINES?

Some people who have migraines appear to be more sensitive to changes in the weather. Weather-related triggers include:

  • Bright sunlight
  • Extreme heat or cold
  • Sun glare
  • High humidity
  • Dry air
  • Windy or stormy weather
  • Barometric pressure changes

For some people, weather changes may cause imbalances in brain chemicals, including serotonin, which can prompt a migraine. Weather-related triggers also may worsen a headache caused by other triggers.

 WHAT TREATMENT OPTIONS ARE AVAILABLE TO GET RELIEF FOR A MIGRAINE OR HEADACHE?

There are many treatment options for migraines. Triptans are a common class of medication that can help stop a migraine in progress.  A common triptan that some people may be familiar with is imitrex or sumatriptan.  For patients with frequent migraines, we use different preventative options to reduce the frequency of migraines such as oral medications, botox injections and a new class of monthly injectable medications called CGRP antagonists.

 DOES HORMONAL IMBALANCE PLAY A ROLE IN MIGRAINES?

Hormones play an important role in migraines. Women are more affected from migraines compared to men.  Some women may experience more headaches associated with their menstrual cycles or even experience specific menstrual migraines.  Migraines can worsen in response to some hormonal medications.  Migraines can also worsen during the peri-menopausal stage as a result of a change in estrogen levels.

HOW CAN MIGRAINE HEADACHES AFFECT A PERSON’S LIFE AND WHAT CHANGES SHOULD THEY MAKE?

Migraine is the third most common disease on the planet, affecting more than 36 million Americans. One in every four households in the U.S. has at least one person living with migraine, and often more than one person since migraine is genetically linked. The evidence shows that migraine reduces family, social, and recreational activities.  Migraines can cost missed days of work or lead to chronic disability preventing full time work.  It is important to get treatment if migraines are impacting your life.  It is important to address any underlying medical issues such as high blood pressure, insomnia, sleep apnea, stress, obesity which can affect headaches.

ARE THERE SOME LIFESTYLE CHANGES THAT MIGHT HELP PREVENT HEADACHES, SUCH AS DIET, EXERCISE OR MEDITATION?

Lifestyle changes can greatly improve migraines. Studies have shown that a regular exercise routine can reduce migraine frequency.  Weight loss can also help migraines and treat underlying medical issues such has high blood pressure and sleep apnea which can cause headaches. Stress management techniques such as guided relaxation and meditation can help improve migraine control. I encourage all of my patients with migraines to do a guided relaxation or meditation program at least 10 minutes per day. Adequate sleep and a regular sleep schedule are also important for migraine control.

 HOW DO  DEPRESSION AND MENTAL HEALTH ISSUES INCREASE SEVERITY AND FREQUENCY OF MIGRAINES?

A: Depression is one of the most common psychiatric conditions in patients with migraine.  Depression can play a role in increasing severity and frequency of migraines and the development of chronic migraines which occurs when a person suffers from 15 or more days of headache per month. Controlling anxiety of patients with migraine is associated with improved quality of life, adherence to a migraine treatment plan, and effectiveness of migraine treatment.

ARE MIGRAINES CURABLE?

Migraines can resolve in some people.  There are many treatment options to help improve migraines.

WHAT ARE YOUR THOUGHTS ON THE FDA APPROVED WEARABLE DEVICE FOR MIGRAINE PAIN. HOW DOES IT WORK?

The Nerivio Migra is a neuromodulating device recently approved for migraines. It is worn on the arm and controlled by a smart phone device to send electrical impulses to help modulate migraines. This is just one of several neuromodulating devices that have been FDA approved for migraine. There is Gammacore which is a device that stimulates the vagus nerve. The Cefaly device looks like a headband and sends electrical stimulation to the supra orbital nerve.  There is now a model that stimulates the occipital nerve. The single pulse transcranial magnetic stimulator sends a magnetic pulse to the head to help with migraines. These neuromodulating devices have been shown to improve migraines.

 WHAT’S THE DIFFERENCE BETWEEN A SINUS HEADACHE AND A MIGRAINE?

Sinus headache is now considered an outdated term because a lot of headaches described as “sinus headaches” may really be related to a primary headache disorder such as migraine or tension headache. A true sinus headache is pain that results from disorder of the nasal or sinus passages. However, patients may state they have sinus headaches but the headaches are truly migraines.  A true sinus headache may have some pain but should not have any of the other symptoms associated with migraine and should resolve with treatment of the sinus issue.

 CAN CERTAIN FOODS OR BEVERAGES TRIGGER A MIGRAINE?

Yes, certain foods and beverages can trigger migraines.  Even moderate alcohol use can trigger headaches in patients with migraines. Excessive caffeine and caffeine withdrawal can trigger migraines. MSG can trigger migraines.  Some patients can try elimination diets to find their own personal diet triggers.

WILL A MIGRAINE INCREASE RISK OF A STROKE OR HEART ATTACK?

Migraine with aura can increase the risk of stroke especially in women on oral contraceptives.  Certain underlying medical issues can increase headaches such as high blood pressure and sleep apnea and also increase the risk of stroke and coronary artery disease.

Dr. Stephenson answers your ‘Text Tom’ questions on the next page:

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