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Strategies for dealing with migraines

Chemical IndustryMedicinePharmaceutical IndustryMercy Medical Center (Baltimore, Maryland)

The many people who suffer from migraine headaches often seek quiet, dark places to ride them out. But there are effective means of preventing them, shortening their duration and even stopping them. There are established medications and lifestyle changes sufferers can employ, and even some new ones to try, says Dr. Michael Sellman, chief of neurology at Mercy Medical Center in Baltimore.

How common are migraines, and who usually suffers from them?

Migraine headaches are the most frequent neurology problem that I see in my office. Migraine headaches typically begin in adolescence or young adult life. They can be genetic in nature and inherited from the mother or father. Women get migraine headaches three times more often than men. It is estimated that 15 percent of all women get migraine headaches and 5 percent of all men as well.

Do you need to see a doctor to diagnose them?

You do not necessarily need to see a doctor to diagnose migraine headaches. It is reasonable to see a doctor to confirm this diagnosis and make sure the headache disorder is not due to some other cause. I would, however, suggest someone see a doctor if the headaches do not respond to treatment or have any unusual features.

What causes them and can they be prevented?

There are multiple causes of migraine headache. About 15 percent of migraines occur shortly before a woman's menstrual cycle. Certain foods have been implicated to trigger a migraine. These include chocolate, strong cheese, onions, oranges and tomatoes. Red wine and sometimes beer frequently precipitate a migraine attack. Rapid changes in barometric pressure (impending rainstorm) can trigger a migraine headache.

Migraine headaches can be prevented in part by a healthy lifestyle. Patients should be encouraged to eat small, frequent meals to avoid hunger. Personal stress should be reduced as much as possible. Lack of sleep can cause a headache disorder to worsen. A frequently underappreciated cause can be too much sleep. Therefore, do not sleep 10 hours on a weekend if headaches are a problem.

Medication to prevent migraines works very well for the majority of patients. These medications need to be prescribed by a physician. A physical examination is necessary before a prescription could be given and follow-up monitoring for complications is necessary. A newer treatment that is having some success in preventing migraine is botox injections.

If one begins, is there a way to shorten its duration?

The key to abortive treatment is to fight the headache immediately in the early stages. By the time the headache becomes full-blown, it is too late. Practical over-the-counter treatments that work in some patients is to drink a strong cup of coffee and take a tablet or two of aspirin. There are numerous prescription medications that can effectively reduce a migraine headache as well.

Are there complications from the migraines or medications to look out for?

The complications of migraines are infrequent but do happen. The most devastating is that of stroke. Young women with frequent migraines are sometimes advised not to take birth control pills because they are at increased risk for stroke.

The side effects of medications to look out for should be discussed by the prescribing physician. I think it is a good idea for patients to ask this important question to their doctor when receiving a prescription.

The most common side effect of over-the-counter medication comes from taking too much aspirin. Patients can bleed or get an ulcer. They also can get "rebound" headaches because the aspirin loses its effectiveness. The patient then gets a bad headache because he did not take an aspirin.

meredith.cohn@baltsun.com

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