WHAT IS A CHRONIC MIGRAINE?
Chronic Migraine is a complex neurological disease that includes symptoms such as sensitivity to light and sound, nausea and severe head pain. To be considered chronic, a person has to have 15 or more headache days per month. While 36 million Americans experience migraine, only four million have been diagnosed as chronic.
- Prodrome – Up to 72 hours before an attack, a migraine patient may experience warning signs that an attack will occur. Severe exhaustion or hyperactivity, difficulty concentrating, food cravings, sleepiness, and neck pain can occur during this phase.
- Aura – Aura symptoms occur immediately before the head pain occurs. The most commonly known aura is a visual disturbance, which can involve a temporary blind spot, blurred vision, eye pain, tunnel vision, or seeing stars or zigzag lines. This typically lasts for 20-60 minutes. Other types of aura warning signs may include vertigo, tinnitus (ringing in the ears) and even temporary paralysis on one side of the body.
- Headache – Pain during this phase is often described as throbbing, pulsating, or stabbing. Other symptoms experienced include nausea, sensitivity to light and sound, chills, fatigue, numbness, tingling, weakness, or sweating. The pain may be felt behind the eye, in the neck and shoulders, and in the temples.
- Postdrome -Occurs after the intense pain has subsided. One can feel sluggish, exhausted, depressed, and confused for hours or even days after the initial attack.
Vision disturbances, or aura, are considered a “warning sign” that a migraine is coming. The aura occurs in both eyes and may involve any or all of the following:
- A temporary blind spot
- Blurred vision
- Eye pain
- Seeing stars or zigzag lines
- Tunnel vision
Other warning signs include yawning, difficulty concentrating, nausea, and trouble finding the right words.
Not every person with migraines has an aura. Those who do usually develop one about 10 – 15 minutes before the headache. However, an aura may occur just a few minutes to 24 hours beforehand. A headache may not always follow an aura.
Migraine headaches can be dull or severe. The pain may be felt behind the eye or in the back of the head and neck. For many patients, the headaches start on the same side each time. The headaches usually:
- Feel throbbing, pounding, or pulsating
- Are worse on one side of the head
- Start as a dull ache and get worse within minutes to hours
- Last 6 – 48 hours
Other symptoms that may occur with the headache include:
- Increased urination
- Loss of appetite
- Nausea and vomiting
- Numbness, tingling, or weakness
- Problems concentrating, trouble finding words
- Sensitivity to light or sound
Symptoms may linger even after the migraine has gone away. Patients with migraine sometimes call this a migraine “hangover.” Symptoms can include:
- Feeling mentally dull, like your thinking is not clear or sharp
- Increased need for sleep
- Neck pain
Causes and Risk Factors
Preventative Treatment Options
There is no cure for migraine disease … yet! The goal is to treat attacks right away and to prevent future attacks by avoiding triggers and making positive life changes. Your doctor may prescribe preventative medications taken on a daily basis to potentially stop migraine attacks. Preventative Medications may include: Antidepressants such as amitriptyline or venlafaxine, blood pressure medicines such as beta blockers (propranolol, metoprolol) or calcium channel blockers (verapamil), anti-seizure medicines such as valproic acid, gabapentin, and topiramate. Botulinum toxin type A (Botox) injections may also help reduce chronic migraine attacks.
Four pharmaceutical companies are in various stages of FDA approval for medicines that would help prevent migraine attacks. This would be the very first drug specifically designed to prevent migraine. All formulations target the Calcitonin-Gene Related Peptide (known as CGRP) receptors in the brain. Scientists have discovered that levels of CGRP increase during migraine attacks. The CGRP monoclonal antibodies aim to regulate CGRP output and prevent attacks.The earliest these drugs will be available to consumers is late 2018.
Treating an Attack with Abortive Medications
Medications used at the onset of an attack are called abortives. Abortive medications should be taken at the first sign of a migraine attack. Over-the-counter pain medications such as acetaminophen, ibuprofen, or aspirin are effective for a population of migraine patients, however frequent use can cause stomach irritation and even damage the liver.
Prescription medications are used to abort an attack and include triptans, such as Imitrex, or ergotamines such as the DHE . Other abortives include anti-nausea medications such as zofran or phenergan, anti-inflammatory drugs such as ketorolac or NSAIDS and steroids.
Many migraine patients seek complementary and alternative medicines (CAM)
- Natural supplements such as feverfew, CoQ10, magnesium, herbal treatments, vitamins, and minerals can be discussed with your doctor.
- Mind-body medicine – meditation, yoga, acupuncture, tai chi, hypnotherapy, and biofeedback.
- Manipulative and body-based practices – chiropractic spinal manipulation, acupuncture, and massage therapy
- Eastern medicine – Traditional Chinese medicine, Homeopathy, and Naturopathy.
All patients should check with their healthcare provider before starting any treatment or type of therapy.
Diet & Nutrition
Some of the most common foods, beverages, and additives that may be associated with headaches include:
Aged cheese, which includes tyramine. Tyramine is formed from the breakdown of protein as foods age. These cheeses can contain high amounts of tyramine; brie, gorgonzola, cheddar, muenster, feta, mozzarella, swiss, parmesan and other highly processed cheeses.
Alcohol: Red wine includes titrates and histamines that can induce a migraine attack. Darker liquors are often culprits as well. Many clear alcoholic beverages such as vodka, gin, and white rum can sometimes be tolerated. Overall, alcohol can lead to dehydration, a common trigger.
Processed Foods Containing Additives
- Hot dogs
- Luncheon meats and deli-style meats
- Other cured or processed meat
- MSG (monosodium glutamate). MSG is a food additive/flavor enhancer found in soy sauce, meat tenderizer, Asian foods, and a variety of packaged foods.
Additional Potential Food Triggers
- Nuts and seeds
- Beans such as fava, broad, garbanzo, lima, pinto
- Chicken livers and other organ meats
- Smoked or dried fish
- Sourdough bread, fresh baked yeast goods (donuts, cakes, homemade breads, and rolls)
- Certain fresh fruits, especially citrus fruits
- Dried fruits (figs, raisins, dates)
- Soups made from meat extracts or bouillon (not homemade broth)
- Cultured dairy products, sour cream, buttermilk, yogurt
- Caffeine found in chocolate and cocoa; beverages such as coffee, tea and colas; also found in certain medications
- Aspartame and other artificial sweeteners
- Food containing artificial dyes
What Are the Symptoms of Food Additive-Induced Headaches? Most headache symptoms begin within 20-25 minutes after consuming food additives. They include:
- Pressure in the chest
- Tightening and pressure in the face
- Burning sensation in the chest, neck, or shoulders
- Facial flushing
- Headache pain across the front or sides of the head
- Abdominal discomfort
Talk to Your Doctor
For people who take monoamine oxidase (MAO) inhibitor medications to treat their headaches, it is especially important to avoid all foods containing tyramine, including aged cheeses, red wine, alcoholic beverages, and some processed meats, as these foods can trigger severe high blood pressure.
It can also be helpful to keep a food diary to pinpoint potential food triggers.
Alliance for Headache Disorders Advocacy: allianceforheadacheadvocacy.org
American Headache and Migraine Association (AHMA): ahma.memberclicks.net
American Headache Society: americanheadachesociety.org
American Interventional Headache Society: interventionalheadache.net
American Migraine Foundation: americanmigrainefoundation.org
Association of Migraine Disorders: migrainedisorders.org
Migraine Research Foundation: migraineresearchfoundation.org
National Headache Foundation: headaches.org
National Institute of Neurological Disorders and Stroke (NINDS) – Migraine Information: ninds.nih.gov/Disorders/All-Disorders/Migraine-Information-Page
The National Migraine Association: migraines.org
World Headache Alliance: w-h-a.org
Headache and Migraine News: headacheandmigrainenews.com
Headache on the Hill: allianceforheadacheadvocacy.org/headache-on-the-hill
Migraine Again: migraineagain.com
Migraine Connect: migraineconnect.com
Migraine World Summit: migraineworldsummit.com
My Migraine Connection: healthcentral.com/migraine
Miles for Migraine: milesformigraine.org
Runnin’ for Research: runnin4research.org
The Daily Headache: thedailyheadache.com
The Daily Migraine: thedailymigraine.com
The Gluten Free Chef Blog: theglutenfreechefblog.com
Golden Graine: goldengraine.com
Making of a Brave Man: instagram.com/makingofabraveman
Migraine Chick: migrainechickie.blogspot.com
My Broken Brain: facebook.com/groups/384285098435674
Chronic Migraine Awareness: facebook.com/ChronicMigraineAwareness
Headache Tracking Tools, Online Diaries and Assessments
Migraine 4 Kids: migraine4kids.org.uk
Miles for Migraine Youth Camps: milesformigraine.org/youth-camps
Children’s Hospital of Philadelphia (CHOP) Pediatric Headache Program: chop.edu/centers-programs/pediatric-headache-program
Cleveland Clinic Pediatric Headaches: my.clevelandclinic.org/health/articles/pediatric-headaches