Headaches, Part 2: MIGRAINES

In part I of this series, I mentioned that headaches might be just an annoyance to some, but a dangerous sign of a serious medical issue to others. They can be caused simply by tension and stress, a case of the flu, or by something as life-threatening as a stroke. 

Last time, we talked about tension headaches and other basics, but there are various different types of headaches. One that can really make you miserable is the “migraine”.

MIGRAINES

A migraine is a disorder that affects nearly 15% of the world’s population and is characterized by repetitive episodes of moderate to severe headaches. In general, it’s more common in women than men, starting as a teenager or young adult and reaching a peak in the late thirties or early forties.

The exact cause of migraines is a matter of some debate. They are thought by some to be related to spasms in the blood vessels. Others believe environmental factors are to blame, and still others consider it some misfiring of nerve cells. There may be some genetic aspect as well, as they seem to run in families. 

There are four phases to a migraine, although not everyone experiences all of them:

1)      The “prodrome”, which occurs hours or days before the headache

2)      The “aura”, which immediately precedes the headache

3)      The “pain phase” (the actual headache)

4)      The “postdrome”, the effects experienced following the end of a migraine attack

THE PRODROME

Prodromal symptoms occur in the majority of migraine sufferers. They represent essentially a “premonition” that there’s a migraine in your future. Prodromes can start anywhere from two hours to two days before the actual headache and include all sorts of symptoms, including:

·       Mood swings

·       Fatigue

·       Stiff necks

·       GI irregularity

·       Increased sensitivity to noise or smells

·       Food cravings

AURAS

A prodrome may be followed by an “aura”. An aura is an unusual sensory effect that usually precedes a headache but is not uncommonly part of the headache itself. Symptoms can be strange visual phenomena (the most common), unusual sensations, and other irregularities. Many people experience their own set.

THE ACTUAL HEADACHE

The actual migraine headache (the “pain phase”) can last two to 72 hours and has certain signs and symptoms. They are usually:

•                     One-sided

•                     Throbbing in nature

•                     Nausea inducing, sometimes causing vomiting and other GI symptoms

•                     Pain-inducing when looking at light sources

•                     Causative of visual changes such as blurring, lights, and color phenomena

•                     Made worse by physical activity

There are, of course, variations to the above and different persons will experience different symptoms. For example, in a significant minority of cases, the pain is on both sides of the head or involves the neck. In others, dizziness and confusion are part of the symptom complex.

THE POSTDROME

After the headache has subsided, a lot of people report soreness in the area and a foggy feeling similar to a hangover for a time, as well as weakness and other symptoms.

TREATMENT

As you might expect, initial treatment for a mild migraine simply involves bedrest in a dark, quiet room and Ibuprofen (Advil) or acetaminophen (Tylenol). If that fails, consider a combination of acetaminophen, aspirin, and caffeine, each of which has known beneficial effects.

Some older medications like ergotamine, sometimes combined with caffeine (Cafergot) are still prescribed for migraines. Some come in nasal sprays. Some of these meds can cause spasms of the coronary arteries, so if you have a high risk of heart attack, they may not be for you.

Another family of drugs that work to relieve migraines are in the “triptan” family, the most popular being sumatriptan (Imitrex). These are effective against both pain and nausea in the majority of patients and are often given when simpler treatments fail. Taken in combination with Naproxen (Aleve), they are even stronger in their effectiveness.

Some medications are thought to have a preventive effect against migraines, including valproate, metoprolol, topiramate, and others.

In the next part of this series on headaches, we’ll talk about natural treatments for migraines and discuss sinus headaches as well.

Joe Alton MDAbove you’ll see original cartoon images from our early work on medical disaster preparedness. For current images and content in our award-winning Third Edition of the Survival Medicine Handbook, just click the link!