Headache and Migraine

In the United States, nearly 40 million people live with a headache disorder (source- headaches.org). The term “headache” describes the onset of pain felt in the head, face or neck. There are two main types of headaches: primary and secondary.

Primary headaches account for 90% of all headaches. Examples of primary headaches include migraine, tension-type headaches, cluster headaches, trigeminal autonomic cephalalgias (TACs) and others. A secondary headache occurs as the result of medication misuse, an underlying medical condition, or a brain injury such as aneurysm, brain tumor, concussion or stroke.

Types of Headache Disorders Diagnosing Headache/Migraine Treatment Options

Migraine

A migraine is a common neurological disease that is often described as an intense pulsing or throbbing pain in one area of the head, usually lasting from 4 to 72 hours if left untreated. Other symptoms of this debilitating disorder may include nausea or vomiting and sensitivity to light and sound. A migraine usually worsens with physical activity.

Migraines affect more than 10% of people worldwide and are three times more common in women than men. About one-third of migraine sufferers can predict the onset of a migraine because it is preceded by visual disturbances called an “aura,” which may appear as flashing lights, zigzag lines or a temporary loss of vision.

Four Phases of Migraine

1. Prodrome phase: This pre-headache phase is the first sign of a migraine attack. A few days prior to the attack, you may experience changes in mood or irritability, fatigue, sensitivity to light or sounds and stiffness in the neck and shoulders.
2. Aura phase: Some people may experience visual disturbances, or aura, before or during a migraine attack. Aura does not occur with every migraine attack. Symptoms of an aura include temporary vision loss or blurred vision, flashing lights or bright spots and numbness or tingling in the face and head. These symptoms usually last between five minutes and one hour.
3. Headache or Attack phase: A migraine attack is the throbbing pain felt on either one side of your head or throughout both sides of your head. The length of this active phase varies among different people and may last for several hours or up to 3 days. In addition to pain, you may experience other symptoms such as nausea and vomiting, sensitivity to light, sound and smell and sleeplessness.
4. Postdrome or Resolution phase: After a migraine attack, you may feel drained of energy, have difficulty concentrating or feel exhausted and fatigued. Even though the attack phase is over, you should avoid triggers that could lead to another migraine.

Tension Headache

Tension-type headaches are the most common types of headaches. Although the exact cause can be difficult to identify, high levels of stress, lack of sleep, increased work pressure and lack of physical activity are known to increase the frequency.

Cluster Headache

Cluster headaches are among the most painful types of headaches. They are rare, affecting about 1 in 1,000 people. Cluster headaches are known by more than 10 different names, including histamine headache, migrainous neuralgia and Horton’s headache.

This type of headache is characterized by frequent attacks that may last for weeks or months. These “cluster periods” generally occur in the spring or fall, often beginning during sleep and lasting between 15 minutes and 3 hours. Some patients do not have cluster periods, and instead have attacks year-round.

Cluster headache sufferers awake with intense, burning or stabbing pain on one side of the head, usually around the eye. Other characteristics of cluster headache include:

• Drooping of the eyelid on the affected side
• Swelling under or around the eye
• Watering and redness of one eye
• Swelling of one side of the face
• A red, flushed face
• A runny nostril on the same side as the head pain

The exact cause of cluster headaches is unknown; however, the condition tends to run in families. Experts have identified a connection to certain molecular pathways and areas of the brain. While cluster headaches are not life threatening, they are chronic and painful enough to interfere with daily life and work. (I have reworked the existing content on the site) keep current video.

Medication-Overuse Headache (Rebound Headache)

A medication-overuse headache, also referred to as a rebound headache, is caused by frequent or excessive use of over-the-counter pain medication or migraine prescription medication. If these medications are used too often, they can actually cause future headaches, instead of relieving pain.

Trigeminal Autonomic Cephalalgias (TACs)

Trigeminal autonomic cephalalgia (TAC) is a severe type of primary headache that usually creates pain on one side of the head. Cluster headaches are an example of TAC. In addition to pain, TACs can produce other symptoms, including watering eyes or excessive tearing, red eyes caused by infection or injury to blood vessels or a runny nose.

If you suffer from migraines, the specialized physicians affiliated with Memorial Hermann Mischer Neurosciences can diagnose your condition and develop a treatment plan to ease your symptoms. Making a diagnosis begins with learning more about your medical history, family history and symptoms and having a physical and neurological examination. Based on your initial evaluation, neuroimaging like magnetic resonance imaging (MRI) or computerized tomography (CT scan) may be recommended.

Tracking your headache symptoms can be an important part of a migraine diagnosis. Understanding your symptoms and looking for a pattern is not only beneficial to you, but it helps your health care provider better understand what may be triggering your attacks. Headache sufferers are encouraged to track their attacks by keeping a journal. This will give the provider important information and assist in creating a successful treatment program.

If you experience new symptoms like weakness or numbness in arms, facial droop or changes in headache patterns, you should contact your physician right away.

Treatment for headaches and migraines has two goals: prevention and symptom relief.

Preventing migraines often involves medication and lifestyle changes, such as exercise and relaxation techniques. Biofeedback is another treatment option that can reduce the frequency and severity of migraine attacks. For women, hormone therapy may help prevent migraine attacks that are linked to their menstrual cycles.

Several types of medications, such as Sumatriptan, ergotamine drugs, ibuprofen or aspirin, are successful in relieving migraine symptoms.

With the proper combination of medications for prevention and treatment of migraine attacks, most people can overcome much of the discomfort caused by the disorder. Work with your doctor to decide which treatments to try, taking into account your own individual migraine history. The pattern, duration and triggers associated with your migraine attacks will help determine what may work for you.

Pre-Emptive Strikes Against Migraine: How to Stop a Headache in its Tracks

Migraines can be debilitating and can disrupt your everyday life. There are ways, however, to prevent migraines. If you are experiencing frequent attacks (twice a month or more), or if migraines are interfering with your ability to function, preventive treatment options are available.

Medication

There are both over-the-counter and prescription medication options to prevent migraines. Currently, the Food and Drug Administration (FDA) has approved five medications specifically for the prevention of migraines, but other “off-label” medicines (approved by the FDA for other conditions) have also been effective in stopping the onset of migraines.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Commonly called fenfenoprofen, ibuprofen, ketoprofen, naproxen and naproxen sodium, these over-the-counter pain relievers have been shown to be successful in preventing migraines.

Triptans

This class of prescription medication can relieve migraines by increasing levels of serotonin, which constricts blood vessels and lessens pain. For menstruation-related migraines, frovatriptan, naratriptan and zolmitriptan seem to be particularly helpful.

Beta blockers

Though more commonly used to combat high blood pressure, beta blockers, specifically propranolol and timolol, are approved by the FDA for the prevention of episodic migraines.

Antidepressants

These prescription medications, including venlafaxine and amitriptyline, have a positive impact on neurotransmitters and are also helpful for preventing episodic migraines.

Antiepileptic drugs

Similar to antidepressants, antiepileptic drugs enhance the impact of neurotransmitters, which relieves head pain. Within this class of drugs, topiramate and divalproex sodium are specifically approved by the FDA for migraine prevention.

Botulinum toxin type A (also known as Botox®)

This is the only medication approved by the FDA for the prevention of chronic migraines, defined as migraines that occur 15 or more days each month. Botox® weakens muscles and blocks nerve signals at the site of injection, and is only recommended if oral medications have been unsuccessful.

Other Treatment Options

Occipital nerve block

The greater and lesser occipital nerves run along the back and top of your head. An occipital nerve block is a procedure that involves injecting pain-relieving medicine into these nerves to help relieve migraines.

Calcitonin gene-related peptide (CGRP) antagonists

There have been several advancements in migraine treatments and prevention in recent years. Scientists have discovered that the calcitonin gene-related peptide (CGRP), a protein that causes inflammation in the brain, is a cause of migraine.

New medications contain monoclonal antibodies, which target either the CGRP gene or the gene receptor. Two medications are currently available: Ubrelvy ® and Nurtec ®. Both are oral CGRP receptor antagonists and are used in the treatment of acute migraines.

Neuromodulation

Neuromodulation treatment is performed with a device that uses electrical currents to increase or decrease the activity in the brain. Some devices treat migraine attacks that have already started, while others work to prevent migraine attacks.

Patient Toolkit: Living with Migraine 

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