Migraine headaches are characterized by intense, throbbing pain, usually on one side of the head. It can be accompanied by nausea, vomiting, and sensitivity to light and sound. They are often much more than just a headache, and they can lead to disability in people who deal with them. Migraines are often presaged by an aura, or a feeling of impending pain that include seeing flashing lights, tingling in the extremities, or blind spots. They can last anywhere from a few hours to a few days, and usually are treated by medication and finding a dark place to lie down in.
Tammy had migraine headaches since she was a child. She could always tell when they were coming on because she would see wavy, electric lights in front of her eyes, and then she would have head splitting pain for almost a full day. In her childhood, it wasn’t so bad, but recently, it has gotten in the way of her daily activities. They seem to happen more and more frequently and leave her exhausted when they are over. She went to her doctor and got an arsenal of medications to take when the pain was bad, but she also got some medications to take to prevent the episodes. Since she has switched to this therapy, her migraines have decreased to once or twice per month.
At SoCal Pain Center, we often see patients who are suffering from migraine headaches, in addition to back pain and nerve pain. We can help you coordinate a medication plan to control your pain, prevent episodes, and live your life to the fullest. In addition, should you need counseling due to the chronic nature of your pain, we have on staff a psychologist who specializes in this area.
Biologically, migraines are thought to occur due to an imbalance of the neurotransmitter serotonin, activity in the lower brain stem, and activation of the trigeminal nerve. Although genetics do play a part, many migraines are triggered by environmental factors. For instance, hormonal fluctuations in women can sometimes bring on a migraine, and they tend to occur before or during the period when estrogen levels are at their lowest.
Some foods, such as alcohol, can cause a migraine, and stress is a well-known trigger for this condition. In some cases, noxious stimuli, such as bright lights, can create an aura and lead to a headache. Getting too much or too little sleep is a trigger in some people, and physical exertion, such as exercising, can cause a migraine to start and bloom. Finally, environmental factors, such as drops in atmospheric pressure, and certain medications are known triggers.
Migraines actually occur in multi-stage events, and each step has symptoms of its own. The first stage is the prodrome stage that occurs about two to three days before the attack. It includes constipation, depression, irritability, food cravings, and neck stiffness. The second stage is the aura stage, and it can occur 10 to 30 minutes before an attack. Not all migraine sufferers have auras, but they are characterized by seeing flashes of lights, loss of vision, trouble speaking, and tingling in an arm or leg that may feel like nerve impingement.
The third stage is the actual migraine attack, and it can last 4 to 72 hours. This can include pain on one side of the head, a pulsing or throbbing pain, and sensitivity to lights, sounds, and smells. Additional symptoms include nausea, vomiting, fainting, blurred vision, and diarrhea. Finally, the postdrome stage occurs after the attack, and it is characterized by fatigue, sluggishness, and a washed out feeling. However, rarely some people can feel euphoric. It can last for a few hours to a day.
Migraines are usually treated with medications, and these drugs are separated into abortive drugs that are taken when a migraine is current or imminent and preventative drugs that are taken routinely. Of the abortive drugs, over the counter pain relievers can be helpful for mild to moderate migraines, but they are not usually effective for severe pain. Triptans, such as Imitrex, are medications that help with the pain, nausea, and visual disturbances from migraines.
Ergot and caffeine related medications are often helpful for migraines that last longer than 72 hours. Anti-nausea medications can be used to treat symptoms during an attack, and narcotic pain relievers are also helpful in controlling pain. Finally, a steroid, such as dexamethasone, can help to relieve pain, but it is used only in stubborn migraines due to steroid toxicity.
Preventative drugs include the heart and blood pressure medications called beta blockers. Calcium channel blockers are also helpful in keeping migraines at bay. Some antidepressants, such as the tricyclic medications, can help prevent migraines, and anti-seizure drugs, such as gabapentin, are useful in this role, as well. Two uncommon drugs for migraines are a prescription strength antihistamine called cyproheptadine and Botox injections into the forehead and temple area every 12 weeks.
At the SoCal Pain Center, we are experts in treating chronic pain conditions, and migraines are one of the many conditions we treat. We have on staff a dedicated pain management doctor who can help to manage your medications, abortive and preventative, to provide you with the best chance of living pain free. Contact us today for a consultation.