If you know anyone that suffers from migraines or if you are unfortunate to suffer from them, you know migraine headaches are not like a common headache.
Migraines are painful, debilitating headaches which can be severe throbbing and usually unilateral (one sided). They affect 29.5 million Americans, and at least 17 percent of women and 6 percent of men have experienced migraines.
The pain from migraines is usually disabling and debilitating. Some patients experience an aura, a preceding symptom or a warning sign before the actual headache. Patients can experience visual phenomena. They may see flashing lights, jagged lines, or colors in their visual fields.
Others have experienced unusual smells, dizziness, odd noises, heaviness, and tingling. With severe headaches, patients can experience sensitivity to light (photophobia), to noise (phonophobia), nausea and sometimes vomiting.
Other unusual migraine phenomena can cause weakness on one side of the body (hemiplegic migraines), vision loss (ocular migraines) and sharp stabbing pains (ice-pick migraines). Patients often retreat into a dark room and sleep to alleviate the severe pain.
Migraines can be exacerbated by certain foods, including caffeine and MSG; sleep deprivation; weather changes; menstruation; certain odors; stress and other environmental factors. Headaches can last 30 minutes to 12 to 24 hours. In unusual cases, patients have suffered with headaches for up to three days.
Once a patient is diagnosed with migraines, treatment can and should be started immediately. Over the counter pain medications, narcotics, and other pain medications are not as effective as migraine medications. Overuse of pain medications can cause rebound headaches and can be very difficult to treat.
Treatment can be divided into preventive and acute treatments. Preventive treatment requires taking medication daily. The medication is used to decrease the frequency and the severity of the headaches and pain.
Preventive treatment should be started in patients who suffer more than three headaches a month. Preventive medications that your primary care provider may prescribe include anti-seizure (Topamax, Depakote, Lamictal), anti-depressants (amitriptyline) and anti-hypertensives (propanolol, verapamil).
Each patient will need to discuss with his or her primary care provider the side-effects and effectiveness of each medication. The most common acute treatment of migraines is triptans. Triptans are serotonin receptor agonist that help to treat and abort the acute headaches.
One needs to take the medication early in the development of headaches for it to be effective. Once patients have the full headaches, triptans may not be effective. Triptans come as pills, nasal sprays, and subcutaneous shots. There are about seven different triptans in the market.
There is a theoretical risk of coronary spasm in patients with heart disease and should be used cautiously under the care of a primary care provider.
Madhu Jasti is a neurologist with University of Maryland Baltimore Washington Medical Center.