Headache Disorders


Last updated on June 15th, 2021 at 11:26 am

WHAT CAUSES HEADACHES EVERY DAY?

@Neuralgroover

If you experience headaches every day, you likely have a condition known as chronic daily headache. Generally speaking, the difference between episodic and chronic headaches is the frequency. Episodic headaches happen “sometimes,” while chronic headaches happen “all of the time.” To be exact, chronic daily headaches occur for 15 days or more per month for longer than than three months. Episodic headaches happen less than 15 days per month. Acute headaches refer to a flare up, or exacerbation, of the headache regardless of if the headache disorder is in an episodic or chronic daily headache frequency. Depending on the specific type of headache disorder, the acute headache attacks can last a number of minutes, up to days or weeks.

The true causes of many types of headaches are not known and involve many variables. Most chronic daily headaches are from primary headache disorders, meaning there is not something specific or bad causing the headache (such as a head injury or brain tumor). The 4 most common types of primary headache disorders causing chronic daily headache are chronic tension type headache, chronic migraine, new daily persistent headache (NDPH), and hemicrania continua, in that order. Chronic migraine and chronic tension type headaches are often being fueled by medication overuse headache (rebound headache). Some chronic daily headaches are the result of an underlying condition, such as head injury, brain tumor, etc. These are called secondary headaches, because they are being caused by something else. This is why any type of headache requires a visit with your doctor for a more detailed history and examination.

Sometimes, there are certain symptoms that accompany frequent daily headaches, and these associated symptoms help determine the specific headache type. These can include: head pain that evolves from one or both sides of the head or radiates from one point; nausea or vomiting; sweating; sensitivity to light or sounds; stuffy or runny noses if the headache is sinusoidal in nature; redness or tearing of the eyes.

What Is Causing Me To Have Headaches Every Day?

There are a wide variety of potential causes for chronic daily headaches, which is why any headaches, especially daily headaches, require an evaluation with your doctor. The general cause of chronic daily headaches often tend to be a mixture of factors such as: tightness of muscles in the neck, shoulders, and head; trigeminal nerve issues; hormonal changes; environmental factors, medication overuse headache, also known as rebound headache (such as excess over the counter pain medications), excess caffeine (or caffeine withdrawal headache) and genetics. However, many other conditions and diseases may also be causing your chronic daily headaches, a few of which are mentioned below. There are a wide array of medical conditions that can also contribute to headaches, and this is why it is important to see your doctor about any type of headache problems.

Anemia

Some other medical conditions, like anemia, can also cause frequent daily headaches. Anemia is a condition where your blood cells have difficulty transporting oxygen throughout your body. This can be the result of an iron deficiency, lack of Vitamin B, and folic acids. There is also a condition called sickle cell anemia where your red blood cells are not formed correctly and cannot carry adequate levels of oxygen. Typically speaking, more severe cases of anemia will result in chronic daily headaches.

Chronic Disease

Chronic daily headaches are also associated with certain types of chronic disease like fibromyalgia, lupus, and diabetes. Typically, these diseases are accompanied by other symptoms. Lupus, for example, comes with joint pain and skin lesions. Diabetics tend to get headaches when their blood sugar levels are low. Fibromyalgia patients typically have a lot of musculoskeletal pain throughout the neck and shoulders, and this can also influence headaches.

Lack of Sleep

Sometimes, exhaustion over a long period of time can cause headaches to persist. Insomnia is a common trigger for daily headaches. People who suffer from sleep apnea often will experience frequent daily headaches in the morning. Sleep apnea sufferers receive less oxygen to their brain than regular sleepers. Untreated and undiagnosed sleep apnea can result in frequent morning headaches and lead to other issues like heart conditions,higher blood pressure, excessive daytime fatigue, memory and cognitive complaints. Heavy snoring is often a clue, and when a bed partner notices the patient seems to stop breathing at times or gasps for air during sleep, this is almost certain sleep apnea. The medical term is obstructive sleep apnea because during certain stages of sleep, the muscles in the neck and throat relax and collapse, causing obstruction to the airways.

Stress and Frequent Daily Headaches

Stress is another issue that can cause frequent daily headaches. According to Excedrin’s website, if your stress increases by 10 percent, you are likely to experience 6.3% more days per month where you have a headache. If you suffer from migraines, you will have them 4.3% more often. Eliminating stress will potentially help reduce your chronic headache frequency and could potentially eliminate them altogether. Stress is one of the biggest migraine triggers.

Chronic Sinusitis

If you have chronic sinusitis, you may have headaches that accompany it. This is caused by infection, nasal polyps, and swelling of the lining in your sinuses. The most common way to deal with chronic sinusitis is nasal corticosteroids, saline irrigation, or oral/injected nasal corticosteroids. In some cases, aspirin sensitivity can cause sinusitis, but these instances are pretty rare. Occasionally, surgery may be necessary to clear out sinuses. However, it is important to remember that many times sinus symptoms in the setting of headache are actually migraine. The reason is because migraine originates in the trigeminal nerves. The trigeminal nerves also innervate all of the sinuses and teeth. So, when the migraine is triggered by the trigeminal nerves, many times the sinuses are also activated. The result is headache with sinus symptoms, which is most often misdiagnosed and mistreated as “sinus headache”.

Allergies

An unknown allergy may be an uncommoncause of your headaches too. This can be related to excess histamine release along with significant sinus inflammation, fluid buildup, and blockage. If you have an allergic reaction that leads to a chronic headache condition, you will likely have a headache that is located very close to your sinuses.

COVID-19 Long-Haul Headaches

In some people who have been diagnosed with COVID-19, the COVID-19 headache that accompanies it in some individuals can last for several months or longer. Along with the headache, some patients also develop many other associated persistent symptoms called long COVID syndrome. This headache is usually a whole-head, severe-pressure, persisting type of headache, although the pain and locations can vary widely. They can also have migraine features and many times presents as New Daily Persistent Headache (NDPH). There are a wide variety of treatment options as discussed here.

Trigeminal Nerve Issues

The trigeminal nerve is The reason for this is because the trigeminal nerve innervates many structures including the face, sinuses, teeth, TMJ areas, and everything inside the skull including the arteries in the brain. Some people have chronic daily facial pains which they refer to as chronic daily headache, so let’s touch on that too. More severe trigeminal nerve problems can cause severe facial pains, such as trigeminal neuralgia. Trigeminal neuralgia tends to occur in older patients (over 50) and more often in women. However, it can certainly occur across all age groups and not uncommonly in men as well. This condition can impact men, too. Simple tasks such as brushing your teeth, putting on makeup, or any other interaction with your face can produce a short bout of excruciating pain, and in some instances, longer cases of pain, and even daily continuous levels of varying facial pain. This condition often occurs because of aging, could be related to multiple sclerosis (particularly in younger patients), or other issues, like a tumor or aneurysm compressing on the trigeminal nerve. To deal with this type of headache, your doctor might prescribe an antiseizure or antidepressant medication (certain ones work well on pain pathways such as irritated nerves), and in some cases surgery depending upon your condition.

 

Treating Headaches That Happen Every Day

If you get a headache every day, you will likely need to be treated for the condition that is causing your headache, such as diabetes, elevated blood pressure, or other medical conditions that may become uncovered as the headache is evaluated. However, there are certain things that you can do to help reduce chronic daily headaches, like drink plenty of water, avoid caffeine, stay away from alcohol, certain types of foods, and other common headache triggers. Reducing stress is also going to help reduce chronic daily headaches. Eliminating medication overuse headache (rebound headache) is a key factor necessary for headache improvement to occur, if present.

Certain headache preventive treatments and medications may include beta blockers, tryglycric antidepressants, anti-seizure medications, and NSAIDs can help deal with chronic daily headaches. In some instances, Botox can help deal with chronic daily headaches if they are chronic migraine.

 

Seek Help For Your Chronic Daily Headaches

In the United States, while there are not many of them, there are health professionals dedicated to the pursuit of headache medicine. There are around 720 doctors who are UCNS-certified headache specialists, and have taken an interest in treating headache disorders. There may be one of these health professionals in your state who can help you deal with your headache.

IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

 

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

 

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

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Last updated on June 1st, 2021 at 10:24 pm

TMJ DISORDER AND TMJ ASSOCIATED HEADACHE AND FACIAL PAIN.

@Neuralgroover

The temporomandibular joint (TMJ) is the joint that connects the jawbone and the skull. This is one of the most powerful joints in the human body, as it can apply 162 pounds per square inch when a person bites. It is important to realize that the TMJ is a synovial joint. In other words, it is a joint composed of a capsule filled with synovial fluid. Similar to a knee joint (but on a much smaller scale), the synovial fluid keeps the joint lubricated and healthy. However, this can also be the source of various types of dysfunction. There is a condition called TMJ disorder that can contribute to facial pain and headaches. TMJ disorder is fairly common, impacting about 12% of Americans at any given time. Women get TMJ disorder more often than men; in fact, for every male TMJ sufferer, there are 9 female TMJ sufferers.

TMJ disorder tends to be higher among younger people, while women using estrogen or contraceptives tend to experience TMJ disorder more frequently.

 

What Is TMJ Disorder and What Causes It?

Loosely put, TMJ disorder is any type of pain and restricted movement that impacts the jaw joint and surrounding muscles. There are several different causes of TMJ, including

  • Injury to the tooth or jaw
  • Grinding or clenching of the teeth
  • Poor posture
  • Stress
  • Other issues

In some instances, even chewing gum can aggravate an outbreak of TMJ. TMJ disorder can lead to headaches and facial pain.

 

TMJ Disorder and Headaches

When TMJ sufferers have a headache, they often report a headache that is like a tension headache in nature. TMJ associated headaches often recur in one or more regions of the head and face and are accompanied by several different symptoms:

  • Tight face and jaw muscles
  • Face or jaw pain
  • Clicking noises in the jaw when chewing
  • Overall restricted movement of the jaw
  • Changes in how the teeth fit together when biting down

It is important to keep in mind that TMJ discomfort can also be a manifestation of migraine headache attacks. Migraines can also cause referred pain to the TMJ areas, neck, shoulders, sinus areas, and face. So if the TMJ discomfort happens primarily when someone has a migraine type headache or symptoms, it could also just be a referred pain syndrome rather than a true TMJ disorder.

 

Is There a Positive Outlook for TMJ Headaches?

TMJ headaches are incredibly uncomfortable, but there is generally a very good outlook for TMJ headaches. Your doctor may suggest a wide variety of treatments to alleviate the pain and often lifestyle changes and other treatments may be required to eliminate and address TMJ disorder. Treatments aimed at alleviating TMJ disorder itself are generally very successful in reducing the frequency of these types of headaches. Let’s take a look at some of the treatments that are available for TMJ headaches.

Very rarely are TMJ disorders serious and long lasting. In these rare situations, diagnosis and treatment must be sought quickly to manage and resolve the condition. Chronic, severe TMJ disorder is very rare, however, tendons, muscles, and cartilage over time can become damaged leading to arthritis. The good news is that most cases of TMJ disorder go away within about two weeks if the jaw is given the necessary time to rest and the root cause, such as stress, is removed.

Occasionally, TMJ disorder will go away on its own. Self-limiting cases are common and being aware of grinding and clenching can help alleviate TMJ over time if it’s not a severe case.

Lifestyle Changes to Address TMJ Associated Headaches and Facial Pain

Some behaviors may cause and trigger flare ups of TMJ disorder, as well as associated headaches and facial pain. Some people may experience this disorder from the type of food that they eat, the stress in their life, and certain jaw movements that they have learned as habits over the years. Some small lifestyle changes can help with TMJ disorder and associated headaches and pain, including:

  • Avoiding foods that are hard or require a great deal of chewing
  • Reducing the stress factors in one’s life to prevent jaw clenching and teeth grinding, which are coping behaviors aimed at dealing with stress.
  • Learning jaw exercises to strengthen the jaw muscles themselves and avoiding things like gum chewing and wide yawning, which can irritate the jaw joint.

Over-The-Counter Solutions for TMJ Associated Headaches and Facial Pain

For the short-term, certain medications may help alleviate the headaches and facial pain caused by TMJ disorders. These include NSAIDS, such as aspirin, ibuprofen, and naproxen. These can help eliminate a headache as an abortive treatment. Additionally, icing your jaw can also help relieve the pain associated with a TMJ headache. Jaw exercises can help with muscle relaxation and pain symptoms. Muscle relaxers are often prescribed in conjunction with NSAIDs in an attempt to lessen the muscle spasm and clenching of the muscles surrounding the TMJ.

Long-Term Treatments for TMJ Associated Headaches and Facial Pain

There are a wide variety of different treatments for TMJ disorder, which can help relieve headaches and facial pain. These include physical therapy, Botox, surgery, and other types of treatments.

Sometimes, there are certain exercises that may help address TMJ associated headaches and facial pain. Patients can learn various exercises, like chin tucks, upward tongue, forward jaw, and resisted closing movements. These help with TMJ pain relief. Generally speaking, these exercises provide a very good therapeutic outlook for patients.

Some patients may also benefit from alternative treatments like acupuncture and massage. Consulting with a medical professional is advised to make sure that any exercises are learned correctly.

Splints and Mouthguards For TMJ Disorder

Splints and mouthguards are a treatment that may help alleviate TMJ associated pain and headaches. These do not directly treat the pain itself, but can help prevent clenching and grinding of the teeth. Some dentists may fit these for patients after a consultation with a health professional. Seeing a TMJ specialist for these types of treatments is recommended to ensure precision of the device, because if it is off even slightly, the pain can intensify. The idea behind splints and mouthguards are that they prevent the grinding and biting that typically occurs during sleep, allowing the jaw to rest. Sometimes, a dentist will work on a long-term bite placement solution, which is often a frequently successful treatment for TMJ disorder.

Other Treatments for TMJ Disorder and Associated Headaches and Facial Pain

There are other techniques to help with TMJ disorder that are surgical and alternative in nature. A TMJ arthroscopy is a minimally invasive surgery that allows the surgeon to remove inflamed tissue and align the jaw correctly.

Another treatment that may also work is Transcutaneous Electrical Nerve Stimulation. This provides an electrical pulse that creates muscle contractions so that your jaw muscles will massage themselves. This helps relieve pain and stiffness, simultaneously improving your overall jaw mobility.

 

IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

 

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

 

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

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Last updated on May 28th, 2021 at 01:36 am

ACUPUNCTURE, ACUPRESSURE, PRESSURE POINTS AND DAITH PIERCING FOR MIGRAINE, HEADACHE, AND PAIN.

@Neuralgroover

Acupuncture is an alternative medical therapy that involves thin needles being inserted into the body. Acupressure is a therapy, often used in conjunction with acupuncture, where the practitioner applies pressure to certain points of the body. These two therapies are used for a wide variety of different therapeutic purposes, but can be specifically used to address headaches and migraines with the advice of a headache specialist.

 

Acupuncture for Headaches, Migraines, and Pain

Acupuncture is a technique that is derived from ancient Eastern/Chinese medicine. It consists of inserting thin solid needles into specific acupuncture points in order to maintain the flow and balance of Qi (pronounced “chee”) in the body. Qi is another term for life force or life energy. Balancing Qi is felt to activate the body’s natural healing abilities, and achieve homeostasis (natural state of balance in physiological and organ systems and functions). It is believed that acupuncture achieves homeostasis when Qi is able to flow smoothly and unobstructed through a system of channels called meridians. This normal flow of Qi and restoring homeostasis is felt to aid in the treatment of a variety of ailments. Acupuncture affects the limbic and para-limbic networks in the brain, stimulates the nervous system, and improves communication between nerves and influences neurotransmitter actions.

Acupuncture can be specifically beneficial for headaches, migraines, and pain. In fact, the World Health Organization has endorsed acupuncture for headaches, migraines, and pain since 1979. Some research has been done to investigate the efficacy of acupuncture for headaches and migraines, and in that research, it was found that those who participated in acupuncture for headaches and migraines reported a 50% reduction in frequency of their symptoms.

Sometimes, traditional medicine is not successful in easing headache and migraine pain in sufferers and they are eager to explore other methods of treatment, like acupuncture. This therapy was developed in ancient China. According to the practice, there are fourteen points along the body called meridians. If the energy at these points in the body is disturbed, various types of pain or illness can happen. Acupuncture works by piercing these areas of the body with a thin needle.

 

How Does Acupuncture Work For Headaches, Migraines, and Pain?

It is not well understood how acupuncture specifically eases headaches and migraine pain, but it is believed that the pathways of the brain that are responsible for turning pain off are activated. Generally speaking, acupuncture is very straightforward and simple. The acupuncturist will place needles at certain points in the patient’s back and neck, the areas that are believed to be responsible for slowing pain transmission. Sometimes, a head massage will also be given while the needles are placed. An acupuncture session generally takes about an hour and the patient will have a weekly session over a duration of two weeks.

 

What Does the Medical Community Say About Acupuncture For Headaches, Migraines, and Pain?

Over the years, various medical professionals have said mixed things about acupuncture. However, a recent study by the NIH supports acupuncture as a very viable treatment for headaches, migraines, and pain. The study concludes that:

  • Acupuncture should be a first-line option for the treatment of headache and migraines.
  • It is at least as effective as preventative medications that are often prescribed for headaches and migraines.
  • In comparison to some of the medications that are on the market, acupuncture potentially has longer lasting effects, is safe, affordable, and can potentially reduce drug intake with side effects.

 

There was another publication which analyzed 15 systematic reviews of the effectiveness and safety of acupuncture in migraine treatment. This analysis concluded that acupuncture is more effective and safer than medication or sham (placebo) acupuncture in headache severity and frequency in various headache types including migraine and tension type headache.

 

Acupuncture can be safe and effective and you should consult with your healthcare practitioner on its employment and potential benefits. It should be considered as a complement and adjunct treatment to standard migraine treatments.

Acupressure for Headaches, Migraines, and Pain

Acupressure is very similar to acupuncture; however, acupressure does not involve needles. For some people who suffer from headaches and migraines, pressure can be applied to specific points on the body to relieve pain. An acupressure practitioner will use their fingers, palms, and elbows, as well as specialized devices to apply pressure to certain points on the body.

Acupressure may help alleviate some of the symptoms associated with migraines and headaches; however, more research is needed. A recent 2017 study by the National Institute of Health indicated that acupressure, at the very least, had the potential to reduce nausea associated with chronic migraines.

 

The Pressure Points For Headaches, Migraines, and Pain

Since acupressure and acupuncture are very similar and are often used in conjunction, the points where needles and pressure are applied (the meridians) are often the same. Here are some of the points along the body where the practitioner will apply the needle or pressure.

Ear Pressure Points

Ear pressure points, in addition to helping with migraine and headache pain, have the potential to help relieve chronic pain. Some of the points used along the ear include:

  • Ear Gate: This is the point where your ear connects with your temple.
  • Ear Apex: This is the very top of your ear.
  • Daith: The daith is near your cartilage above the opening to your ear canal.

Very little research has been done about these pressure points, but some people have reported that stimulation of the daith may lead to a reduction in headache severity and frequency. The daith piercing is done on the innermost cartilage fold near the entry of the ear canal. From a first-hand perspective, I see an extensive amount of patients in our headache center who have gotten one or two daith piercings. From my personal observations, the vast majority report no benefit at all. I have seen a few that said it did help, although they usually report this benefit wears off after a few months when I see them back in the office. I have also seen some patients whose headaches got worse and/or developed ear and nerve pain from the piercing. This certainly doesn’t mean that there is no benefit to it, but it needs to be studied more objectively. It may require a precision piercing in exactly the right pressure point spot for it to help, but this is not clear. Pain patients in clinical trials have a notoriously high placebo responder rate as well. This could also be a factor of why some tend to improve briefly and then the effect wears off.

 

Hand and Foot Pressure Points

Various pressure points on the hands and feet can also potentially reduce headaches and migraines. There is a point between your thumb and index finger where, if pressure is applied, can potentially alleviate headache pain. On your feet, points between your first and second toe and fourth and fifth toe, if pressure is applied, can reduce anxiety, reduce migraines, and decrease pain in the jaw and face.

Upper Body Pressure Points

The upper body also has several different pressure points. For example, a point between your eyebrows can potentially reduce stress. Acupuncture and acupressure applied to the points where your nose reaches your eyebrows can reduce headache and migraine frequency. The point where your neck reaches the base of your skull has the potential to reduce migraines and fatigue. Lastly, your shoulder well has the potential to release pain, headaches, and a stiff neck.

 

Are Acupuncture and Acupressure Viable Treatments for Headaches, Migraines, and Pain?

The research for headaches and migraine relief is always ongoing. The World Health Organization has endorsed acupuncture since 1979 and acupressure is very closely related and used in conjunction with acupuncture. Generally speaking, acupressure and acupuncture is at least as effective as preventative medications and therapies for headaches and migraines and may potentially have longer lasting beneficial effects without the side effects of medication. As with any therapy, acupuncture and acupressure should be explored as a possible treatment after consultation with your primary care physician or headache specialist.

 

IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

 

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

 

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

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Last updated on May 28th, 2021 at 01:33 am

LONG COVID, POST-COVID SYNDROME, POST-VIRAL SYNDROME, MECFS, PWME, AND POST-COVID HEADACHE EXPLAINED AND TREATED.

@Neuralgroover

Background

Long Covid, post-Covid syndrome, long Covid syndrome, long Covid-19, post Covid-19 syndrome, long haul Covid, and long tail Covid are some of the emerging terms for what appears to be a chronic constellation of symptoms following Covid-19 infection in some patients.

 

What are long Covid symptoms, and what is long Covid syndrome?

Here is how I want you to visualize long Covid syndrome, or any chronic post-viral syndrome. Close your eyes and imagine your body in its usual shape and form, but with no tissue or anything else except for its vast nervous system and network of nerves throughout every fraction of a millimeter of your body. Imagine this extensive network of nerves as if they are bare metal electrical wires plugged into their source of electricity, the brain, which normally regulates all of these various electrical circuits in the body. Now imagine a bucket of water dumped onto this vast connection of live electrical wires. This immediately causes short circuiting of the electricity running through the nerves, along with smoke, and a smoldering, crackling, buzzing, electrical fire (hopefully you’re getting a good visual there). This is how you can think of post-Covid syndrome, except it isn’t a bucket of water dumped onto the body’s electrical connections, but rather Covid-19 with the same end results of a nervous system meltdown.

 

So essentially, think of long Covid syndrome as having gotten stuck in an extensive variety of short circuits and nervous system dysregulation because the normal regulating circuits from the brain have been injured and disrupted. The resulting long Covid symptoms are widely variable but most often include headaches, excess fatigue, exercise intolerance, shortness of breath, muscle pains, chest pain, breathlessness, muscle weakness, dizziness, imbalance, disequilibrium, tremors, cognitive fog, tinnitus, brain fog, cognitive dysfunction of memory, concentration, and attention, sleep disturbances, dysautonomia, POTS, dizziness or passing out when standing (orthostatic intolerance), temperature dysregulation, tachycardia (racing heart) with mild activity, night sweats, persistent low grade fever, depression, anxiety, gastroparesis (the gut not transporting food through the digestive tract as efficiently), and other gastrointestinal symptoms such as diarrhea and constipation.

 

Now keep in mind, this scenario is not specific for only Covid-19. This is a syndrome well known by neurologists and seen not too uncommonly, normally called a chronic post-viral syndrome. Awareness has just become higher given the Covid-19 pandemic and amount of people infected with resultant chronic post-viral syndrome. It usually begins around the time of a nonspecific mild viral illness which you wouldn’t expect to cause any significant complications such as an upper respiratory infection, diarrheal illness, or a vague flu-like illness. Covid-19 is just another virus which can also trigger this same syndrome, just as many other viruses have done historically for centuries.

 

Many of the long Covid symptoms and other chronic post-viral syndromes have symptoms which overlap with myalgic encephalomyelitis chronic fatigue syndrome (MECFS). Another term for patients with these symptoms is people with myalgic encephalomyelitis (PWME) which is commonly seen discussed on social media outlets. Patients with these disorders often report some nonspecific viral symptoms such as the common cold, runny nose, cough, or diarrhea preceding the onset of their MECFS symptoms. So, a similar mechanism causing MECFS, long-Covid syndrome, and other chronic post-viral syndromes is suspected. Many of these syndromes are also consistent with fibromyalgia syndrome, which shares many similar characteristics. All of these terms should be considered a diagnosis of exclusion, meaning other possible causes should be excluded first. Comprehensive evaluations should include cardiac (heart), pulmonary (lung), autoimmune and rheumatologic (such as lupus, multiple sclerosis, etc.), neurocognitive, sleep medicine, physical therapy, ongoing infections, medication side effects, or other metabolic disturbances depending on what constellation of symptoms the patient is dealing with.

What Causes long Covid syndrome?

Generally, the cause of post-Covid syndrome, similar to other chronic post-viral syndromes, has been suspected to have an immune reaction as the underlying cause of it. The way it works is that your immune system first develops antibodies against a piece of the virus which it encounters, typically a protein. Well, that piece of the virus that your immune system forms antibodies to are meant to attack and neutralize any viruses that enter your body with a similar protein so you don’t get sick from it again. The thinking is that the antibodies formed may have a similar appearance to something in your own body’s cells (such as the myelin on nerve cells or other nervous system tissue). So your immune system then erroneously attacks your own cells as well. What follows is a wide constellation of symptoms, depending on which cells and area of the body are affected. Besides this persistent immune activation and reaction, other theories of possible long-Covid syndrome causes include persistent viral replication, metabolic dysfunction, residual cellular injury from the initial viral infection, and unmasking of underlying diseases which were just under the surface and pushed over the edge by the Covid-19 infection.

 

What is the treatment for long Covid syndrome?

Treatment for Long-Covid Syndrome is the same as other chronic post-viral syndromes, as well as MECFS symptoms. Unfortunately, this treatment is typically symptomatic, meaning treating the specific individualized symptoms such as insomnia, headache, pain, etc., rather than one unifying treatment. It is important to not automatically consider these patients as “functional”, or that they are embellishing their symptoms. Many of them were highly functioning professionals suddenly stopped in their tracks with this disruptive constellation of symptoms and no one can explain exactly why to them. Thus, anxiety and depression secondary to these symptoms and associated frustration should also be considered. Some patients have reported that their long-Covid symptoms improved after receiving the Covid-19 vaccination, but this has certainly not been a consistency for everyone. Treatment involves a trial and error process of trying different medications, depending on what symptoms are being targeted. For neurological symptoms and headaches, think of it as trying to find something to help “reset” or “reboot” the system electrically. Optimizing nutrition is also important.

 

How do you treat Covid-19 headache?

Coronavirus (Covid-19) headache is discussed in much greater detail here in terms of background, symptoms, and treatments. If this is an issue for you, I would suggest that you read that article for a better overall understanding. However, to summarize, there are a few different varieties of Covid-19 headache. Patients that have a history of migraine commonly have a flare up of their migraines related to the Covid-19 infection itself. Similarly, it has been common to see migraines flare up with the Covid-19 vaccine as well. These migraine flare ups are typically temporary and may last a few days to a week or so for some. There is also a milder nonspecific tension type headache (achy pressure tightness) that some patients get with either the Covid-19 infection, or the Coronavirus vaccine, and it is also typically a temporary headache which may last a few days at most. Then, there are the unfortunate group of patients that develop New Daily Persistent Headache (NDPH) after Covid-19 infection, and much more rarely after the Covid-19 vaccine itself. This is a much more persistent headache which begins as a daily persistent headache from the onset, and lasts for more than 3 months. It is notoriously a very resistant form of headache to many treatments. However, improvement is still possible with the combination of time and trial and error treatments until the most effective treatment is found, which can be widely variable between patients.

 

IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

 

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

 

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

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Last updated on May 28th, 2021 at 01:24 am

COMMON FOODS, ADDITIVES, AND OTHER MIGRAINE TRIGGERS.

@Neuralgroover

While the exact cause of migraines remains unknown, the neurovascular theory of migraine is currently most accurate. Regardless of exact mechanism, there are many different triggers that can bring them on. Certain types of foods, beverages, and food additives can trigger migraines. In addition to these triggers, things like excess light, visual stimuli, and noise can also trigger migraines. Let’s take a look at some of the common different triggers that can bring on a migraine.

 

Foods and Beverages That Can Trigger Migraines

Certain types of foods and lack of eating can cause migraines. As many as 60% of people report that food can trigger migraines. When people report having a migraine to their primary care physician or headache specialist, they often report alcohol, caffeine, and chocolate as being a common trigger for their migraine. Sometimes, foods that we associate as being healthy can also bring on migraines. For example, aged cheeses, fermented foods, and certain types of cured meats can bring on a migraine. Fermented foods, while being great for promoting gut health, contain an amino acid called tyramine, which can trigger migraines. Tyramine is also a common trigger found in aged cheeses.

Beverages containing certain additives such as artificial sweeteners can also cause migraines. For example, diet soda contains both caffeine and aspartame. In certain cases of people who have clinical depression, aspartame can worsen migraine symptoms. Alcohol is also a common migraine trigger. In particular, red wine and white wine may trigger migraines in individuals. Red wine triggers migraines in about 19.5% of people with migraine while white wine may trigger migraines in about 10.5% of people with migraine.

While many people drink coffee, tea, and energy drinks, these beverages are known to bring on migraines and headaches. An additional migraine trigger for these beverages is caffeine withdrawal. Also, over-the-counter medications for headaches and migraines could potentially contain caffeine, which may in some cases make a migraine worse. In general, caffeine can be a double edged sword. Caffeine does have some mild pain relieving properties, and it also causes mild constriction (narrowing) of dilated arteries. Both of these factors can be helpful for some patients with migraine. However, when caffeine is not in the system, headaches can be triggered as a result (caffeine withdrawal headache). A common example of this is in patients that wake in the morning with a headache that improves when they drink their morning coffee. This occurs because as they are sleeping, the caffeine is eliminated from the body. So when they wake, they are in caffeine withdrawal. Thus, why the headache gets better once they get their morning coffee flowing.

Other types of food additives can also trigger migraines. For example, MSG is a very common food additive that may cause migraines. Some studies have found that MSG may bring on a migraine or headache in the face area. Nitrates and nitrites are also common migraine triggers. These are vasodilating agents found in many foods, especially preserved and processed meats such as lunch meats, sausage, smoked foods, pork, bacon, salami, pastrami, hot dogs, corned beef, ham, and, bratwurst. So if you have a child that is getting a lot of headaches and migraines, and eats lunchmeat for lunch, you may want to look into nitrate and nitrite-free lunch meat options.

 

Dehydration and Migraines

People who suffer from migraine report that dehydration is a common trigger. Even the slightest notion of dehydration can fast track the onset of a migraine, causing dizziness, confusion, and the other classic symptoms of a migraine. In some cases, people who drink water after the onset of migraine might notice a decrease in the severity of their symptoms.

 

Lack of Sleep and Migraines

People who do not sleep enough often tend to experience migraines with more frequency and severity. When a person doesn’t sleep enough, the body tends to produce more of a certain type of protein that can cause migraines and pain. Also, during a regular sleep cycle, the body tends to have more REM sleep cycles, which can regulate certain processes in the body. One of the most common things migraine sufferers experience during sleep deprivation is that rest or sleep will often mitigate the severity of their migraine. Getting good sleep plays a big role in not only influencing migraine and headache, but a wide variety of other normal body functions. During the deep restorative stages of sleep, your body is replenishing it’s many neurotransmitters in the brain. Neurotransmitters influence mood, concentration, energy, attention, memory, and a variety of neurologic functions. So, if you are not getting those deep stages of sleep, you become deficient in neurotransmitters, and the result is often worsening headaches, migraines, anxiety, depression, fatigue, poor memory, concentration, and focus. For example, the most common cause of anxiety and depression is serotonin deficiency in the brain. For this reason, many antidepressants work by replacing serotonin levels. Thus, good sleep may be able to bypass the need for replacement by these medications for some patients, in addition to improving headache frequency. The optimal amount of sleep is generally considered to be 8 hours of uninterrupted sleep, which is often easier said than done for many people with today’s hectic schedules.

Light, Smell, and Sound Sensitivity Can Also Trigger Migraines

Migraine is a disorder of neurological overactivity and oversensitivity. The neurological wiring in patients with migraine is set at a much lower threshold for triggering a migraine, as compared to someone without migraine. Sometimes, elements in our environment can also be attributed to the onset of migraines. Direct sunlight can be a primary trigger for migraines. Driving by a white picket fence alternating with bright light in between, fluorescent office lighting (which almost universally drives people with migraine insane), flashing strobe lights, or looking at the sun reflecting off a shiny surface are commonly reported visual triggers. While the outdoors and exercise are great for health, wearing a cap or sunglasses and finding a shady area may help alleviate the onset of migraine. Sometimes, direct sunlight can make an existing migraine worse, especially if the migraine was triggered by sleep deprivation, dehydration, or skipping a meal.

Prolonged loud sound can also trigger migraines in some individuals. For example, loud concert music and high decibel noises can trigger a migraine. In addition, some noises can become more bothersome or disturbing for someone experiencing a migraine, such as chewing noises, clocks ticking, and doors opening and closing.

Smells can also be associated with the onset of migraines. About 50% of people report heightened sensitivity to smells when they have a migraine attack. The most common scent trigger for a migraine comes from perfumes, which may be associated with aerosols and additives in the perfume itself. The smell of tobacco and certain types of foods are also common triggers and agitators of migraines that are associated with scent. Although oversensitivity to smell (osmophobia) is not listed in the ICHD3 criteria for migraine diagnosis, it is very specific for migraine and often an easy clue for the diagnosis.

 

Changes In the Weather and Migraines

Seasonal and weather changes may also have an impact on the onset of migraines. Here are some of the types of changes in weather that may agitate migraine sufferers:

  • Changes in barometric pressure
  • Extreme changes in temperature where it becomes suddenly hot or suddenly cold, such as during season changes
  • Storms, especially where there is thunder and lightning
  • Dry and dusty weather

Another common trigger for migraines that is largely environmental is smoke. People who suffer from migraines report smoke as being a frequent migraine trigger and will avoid camping, barbecues, and other outdoor activities where there is smoke.

Why do changes in the weather cause migraines? People who already suffer from migraines and headaches tend to have a greater sensitivity to environmental changes. It is also common that people who have migraines triggered by environmental sensitivity do not discuss these triggers with their doctor.

 

Hormonal factors

Migraine occurs in 20% of women (1 in 5), and 6% of men (1 in 16). There is a reason for that difference, and it relates to hormonal differences. Before puberty, migraines actually occur more commonly in boys. However, once menarche (menstrual cycles) begins for girls, they take over in migraine frequency from that point on. Menstrual migraine is typically triggered by the drop in estrogen prior to a menstrual cycle. Menstrual migraine and its treatments are discussed in much greater detail here. Perimenopause (entering menopause, menopause, and exiting menopause) is also a common time of life where migraines can become much more frequent and severe for women, due to hormonal fluctuations. Interestingly, during pregnancy migraines improve for many women, and it is not uncommon that they report having no migraines at all during pregnancy (because the drop in estrogen is not occurring every month). Migraines often return shortly after pregnancy ends, and can initially seem more severe. Some women may not notice much improvement during pregnancy, while some can get worse.

 

Stress

Stress is one of the most common migraine triggers, which is unfortunately typically hard to avoid. For some patients, it is the opposite. They may get stress let-down migraines. For example, they get a migraine every time they are dealing with less stress, such as when they go on vacation, or every weekend when they don’t have to get up and go to work. These are particularly cruel types of migraine triggers! There can be other variables involved in migraine triggers in these scenarios too though. For example, if they sleep in longer than normal on the weekend, that can be a trigger for some patients since migraine is often influenced by sleep patterns. The weekend migraine could also relate to caffeine withdrawal if they sleep in and don’t get their normal weekday caffeine as early on the weekend compared to the weekdays.

 

Allergies and Migraines

Migraines and sinus headaches from allergies both have very common symptoms. Generally speaking, a migraine from an allergy will be more intense than a sinus headache and display the classic migraine symptoms such as nausea, throbbing pain, sensitivity to light, and a lengthy headache (up to 3 days and frequently recurring).

People with allergies are ten times more likely to develop migraines than people without allergies. The most common reason for migraines from an allergy is due to histamine release, your body’s overreaction to external and internal triggers that are driving your allergies.

Allergy shots and triptans are common ways to treat allergy-related migraines once they have started. Medications like beta-blockers may prevent allergy-related migraines before they happen.

 

IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

 

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

 

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

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Last updated on April 30th, 2021 at 11:13 pm

MIGRAINE HEADACHES EXPLAINED.

@Neuralgroover

Migraines are a very intense type of headache that are often accompanied by other symptoms, including nausea, vomiting, sensitivity to light and sound, as well as neurological symptoms such as visual disturbances, numbness or tingling, speech disturbances (slurred speech, difficulty getting words out), weakness, vertigo, cognitive dysfunction or “cognitive fog”, among other things. Migraines tend to be more prevalent in women than in men, with a 3:1 ratio. A common risk factor for migraines often involves family history, but not for everyone.  People who suffer from migraines report intense feelings of pain, including a pulsating/throbbing sensation. This often occurs on 1 side of the head, but can also involve both sides. Exercise and activity during a migraine will often make it worse. Migraine is usually associated with nausea, and/or sensitivity to light (photophobia) and sound (phonophobia)  Migraines often come in different phases, which are called prodrome, aura, the headache phase, and postodome, but not everyone gets all 4 phases:

  • The prodromal phase of a migraine often marks the beginning of a migraine attack and can happen over a period of a few hours ranging to a few days. Some of the symptoms include irritability and depression; food cravings; yawning and tiredness; and fatigue or muscle stiffness. Some patients report their prodrome as just a difficult to describe feeling that they recognize as an early warning sign of an impending migraine. Not every migraine attack includes the prodromal phase.
  • The aura phase of a migraine doesn’t necessarily always happen in every migraine attack, and only about 25% of patients with migraine get aura. Historically, those that get aura are called “classical migraine”, whereas “common migraine” refers to the more common variety of migraine which isn’t associated with aura. A large number of people who have migraines report that during the aura phase, they experience loss of sight, numbness, and other symptoms. Visual aura (loss of vision, jagged lines, flashing, colors, shapes, wavy lines, kaleidoscope, shimmering, expanding blind spot, etc.) are the most common aura. This is followed by numbness and tingling on 1 side (especially face and arm), and then dysphasia (trouble speaking; slurred speech, getting words out). There are also less common types of aura such as hemiplegic migraine aura (1-sided weakness), and brainstem aura (previously called “basilar migraine”; slurred speech, vertigo, tinnitus, double vision, hearing impairment, decreased level of consciousness, ataxia/imbalance). The aura phase should last between 5-60 minutes per ICHD3 criteria. Hemiplegic migraine can be associated with 1-sided weakness which can last up to 3 days. If the other types of aura last longer than 60 minutes, it is called prolonged or atypical aura, and usually warrants a brain CT or MRI, although it is not too uncommon to see. .
  • The headache phase of a migraine is often the longest and most intense period of a migraine. Symptoms include intensive throbbing, nausea, giddiness, irritability, stiffness, and soreness. According to ICHD3 criteria, an untreated or unsuccessfully treated migraine attack should last 4-72 hours. A headache lasting longer than 72 hours (3 days) is called status migrainosus. It is not uncommon for a refractory migraine to last days and sometimes weeks for some patients.
  • The postdrome phase is the drawing down of a migraine attack. It can last for up to 48 hours and some of the lingering symptoms remain from the other phases of a migraine attack. Patients often report feeling wiped out, fatigued, and sore as if they were “hit by a bus”.

 

According to the American Migraine Foundation, more than 36 million people suffer from migraines (although now estimated to be closer to 39 million), but only one out of three people actually talk to their doctors about their pain.

Statistics About Migraines and Their Prevalence

According to several different sources, migraines are one of the most common types of illness in the world. More specifically, it is ranked as the 3rd most prevalent illness in the world. It is estimated that migraine affects about 39 million Americans, and 1 billion worldwide. For example, 1 in 4 households in the United States have an individual that suffers from migraine attacks. Migraines impact 18-20% of women (1 in 5) and 6% of men (1 in 16) in the United States and they are also fairly common in children.

Migraines are also a common cause for an emergency room visit. In fact, there are more than 1.2 million emergency room visits each year in the United States for someone who is suffering from an acute migraine attack. Patients with migraine have a greater than 1.5 fold increase in office visits, and a greater than 2 fold increase in ER visits and hospital admissions. Migraines can also diminish the quality of life for the people who suffer from them. More than 4 million adults suffer from chronic migraine pain, which is an individual who is experiencing more than 15 days of migraine pain each month. Approximately 3% of patients will transform from episodic migraine to chronic migraine each year. Overall, it is estimated that 3-5% of patients in the United States have chronic migraine. Also, 20% of people who suffer from chronic migraines are disabled. Disability due to migraine peaks between the ages of 15-49 years old, which are peak employment years. Thus, migraine now accounts for the 2nd leading cause of years lived with disability following low back pain! Migraine also accounts for 50% of all neurologic disability. All of this puts a very high price tag on migraine, with an estimated 36 billion dollars spent in migraine costs in the United States each year.

 

Migraines in Children

Migraines are commonly undiagnosed in children. They are more commonplace in adolescent children, but 10% of school-age children suffer from migraines. Half of all migraine sufferers have their first migraine attack before they turn twelve and if a child has one parent who suffers from migraines, they have a 50% chance of developing migraines during their lifetime. Also, boys under the age of twelve tend to have migraines more often than girls, but that trend reverses in adolescence, typically with onset of menarche (which also highlights the hormonal influence on migraine).

 

What Causes Migraines?

There are a number of reasons that people suffer from migraines, but the true cause of them is not fully understood. Genetics and environmental factors play a role. In fact, around ⅔ of migraine cases run in families. Migraines also tend to happen in people who are prone to stress, bipolar disorder, and depression. There are also some common triggers for migraines, including:

  • Drinks, such as alcohol and caffeinated beverages.
  • Work stress or stress at home.
  • Bright lights or strong smells.
  • Drastic changes in one’s sleep cycle.
  • Bouts of overexertion.
  • Changes in the weather or other barometric pressure changes
  • Certain foods and food additives such as MSG, nitrates, aspartame, and other substances such as artificial sweeteners.

 

Migraine Theories:

1) Vascular theory; “vascular headache” (outdated):

a) Lack of blood flow (ischemia) caused by vasoconstriction (narrowing) of the intracranial arteries (arteries inside the brain) caused migraine aura.

b) The vasoconstriction was then followed by rebound vasodilation (dilation) of the arteries. This dilation activated pain receptors on the arteries, and this was the cause of the pulsating headache.

c) This theory has since been disproven and outdated. Studies have also shown that the physical pulsations of the arteries did not correlate to the pulsating sensations of the headache pain.

2) Neurovascular theory (current):

a) Migraine is a neurogenic process with secondary changes in cerebral perfusion (related to neuronal dysfunction and hypometabolism during an attack). In other words, migraine is an electrical neurological event in the brain, not an event triggered by blood flow changes. This electrical event influences changes in brain metabolism such as hypometabolism and hypermetabolism. When the neurons are in a hypometabolism state, they have less oxygen and glucose requirement since they are not as active, and thus there is a lack of blood flow (not due to vasoconstriction of the brain arteries). This can be followed by hypermetabolism in which there is an increase in oxygen and glucose requirements and thus, increase in blood flow (so not necessarily simply rebound vasodilation).

 

b) Migraine aura is a good illustration of this phenomenon. Migraine aura is caused by an electrical wave spreading across the cortex of the brain moving at about 3 mm per minute (not by vasoconstriction as per the older vascular theory). At the front of this spreading electrical wave it causes hypermetabolism and an increase in blood flow. This hypermetabolism causes the “positive” migraine aura features (colors, flashing lights, kaleidoscope, shapes, zig-zags, tingling sensory changes, etc.). Following this electrical wave there is “neuronal depression” and hypometabolism, associated with a decrease in blood flow. This hypometabolism causes the “negative” migraine aura features (loss of vision, black spots, numbness, etc.). Depending on where this wave spreads, you may get different aura symptoms; visual aura as it spreads across the occipital (visual) cortex, sensory/numbness/tingling as it spreads across the parietal (sensory) cortex, dysphasia (trouble speaking, slurred speech) as it spreads across the frontotemporal (speech) cortex, one sided weakness in hemiplegic migraine as it spreads across the frontal (motor) cortex, brainstem symptoms such as vertigo, tinnitus, double vision, hearing loss, imbalance, decreased level of consciousness, slurred speech (previously called basilar migraine, now called migraine with brainstem aura) as it spreads across the brainstem.

 

c) The electrical event of migraine not only causes the changes in metabolism as described above, but the trigeminal nerves are also activated. Think of migraine as an electrical switch that gets turned on in the brainstem. It then turns on and activates the trigeminal nerves. The trigeminal nerves innervate all of the arteries in the brain and through the meninges surrounding the brain. When activated, the trigeminal nerves release a variety of inflammatory proteins (such as CGRP) and neuropeptides. The result of this is 3-fold:

1st, these inflammatory peptides cause neurogenic inflammation around the brain. Think of it like a sterile (non-infectious) meningitis. So, when you’re having a migraine, exercise and activity, moving around, bouncing in a car, etc. often worsen the pain.

2nd, it causes cerebral vasodilation in the brain and meninges. The dilation itself does not cause the pain, but rather it triggers the trigeminal nerves which innervate the arteries, and this sends signals back to the brain that something is going on, which in turn causes more release of inflammatory proteins and causes the migraine to worsen. This is the basis of why it is called the neurovascular theory of migraine.

3rd, it enhances and exaggerates the transmission of pain from the trigeminal nerves, into the brainstem, and into the cortex of the brain where the pain is recognized.

 

At baseline, a patient with migraine who is not having a headache always has a state of neuronal hyperexcitability in the cerebral cortex, especially in the occipital cortex (which is why the majority of aura symptoms tend to be visual aura). So, they have a much lower threshold to a migraine being activated and triggered as compared to someone without migraine. In other words, the neurological system in a patient with migraine can be thought of as always being in a hyperactive, hypersensitive, overdrive state with the “volume turned way up” compared to a person without migraine. Thus, I tell my patients the goal of preventive treatment is to “turn the volume down” and increase the threshold of migraine being triggered so easily.

 

What Are Some Common Treatments for Migraines?

There are two categories of treatment for any type of headache, including migraines. Migraines can be treated through abortive or preventive means. Abortive treatment for any type of headache includes medications such as aspirin, which treats the headache while it’s happening. Preventative treatments are intended to keep a headache or migraine from happening so frequently. Here are some of the different types of treatments for migraines.

 

Abortive Treatment for Migraines

The goal of migraine abortive treatments is to stop individual migraine attacks at onset so the migraine does not reach full severity, ends quickly, and your function is restored and maintained rather than having to go lay down and miss the whole day in bed.  Over-the-counter pain relievers for migraines, such as aspirin or ibuprofen, are fairly commonplace. Some more aggressive abortive treatments include prescription medications like triptans (such as Maxalt) that block pain pathways within the brain. Some people may also receive anti-nausea drugs and opioid prescriptions to deal with more intense migraine symptoms. The migraine specific abortive/acute (as needed) treatments include triptansgepants (Ubrelvy, Nurtec), ditans (Reyvow) or neuromodulatory devices.

Preventative Treatments for Migraines

Medications that lower blood pressure, antidepressants, anti-seizure drugs, CGRP monoclonal antibodies, and even botox are some of the common preventative treatments for migraines. The classification of the preventive medicine typically has nothing to do with its purpose when it is used for migraine. For example, there are specific anti-blood pressure medicines that are good for migraine prevention. However, they do not work for migraine because of blood pressure changes, but rather they affect the electrical pathways of migraine. The same scenario goes for the antidepressant/anti-anxiety and anti-seizure categories. The medicines selected within each of these preventive categories are very specific and based on clinical trials and evidence. In other words, not all medicines within a specific medication class (such as all antidepressants) have evidence for migraine prevention, but rather very specific ones within that class. Medications that are designed to lower blood pressure can sometimes prevent migraines with aura and without aura. Certain types of antidepressants can help prevent migraines, but have some undesirable side effects in some individuals. Anti-seizure drugs, such as Topamax, can reduce the frequency of migraines in some individuals. The preventive migraine treatments should be used until the migraine and headache frequency is significantly improved consistently for several months. As mentioned above, this can be done with a variety of medications which may also include the CGRP monoclonal antibody (mAb) treatments (Aimovig, Ajovy, Emgality, Vyepti), Botox, natural supplements, herbals and vitamins, or neuromodulatory devices.

Alternative Treatments for Migraines

Some other types of treatment for migraines include acupuncture, cognitive behavioral therapy, supplements, essential oils, yoga, meditation, and other techniques designed to enhance relaxation. For some individuals, exercise can decrease the frequency of migraines. In fact, some studies have shown that a routine exercise program can be just as effective as some of the prescription preventive medications used for migraine. Neuromodulatory devices that are FDA cleared for migraine prevention are also available and include sTMS (SAVI, SpringTMS, sTMS mini),  eTNS (CEFALY), and nVNS (GAMMACORE), all of which are discussed in much greater detail here. There are also nutraceuticals and supplements which have good evidence for migraine prevention.

 

Finding Help For Migraines

Migraines remain a poorly understood medical condition, but there are treatments available. Only 4% of people suffering from migraines work with a headache specialist or a pain specialist. It is estimated that preventative treatment could benefit around 25% of people who suffer from severe migraines.

If you suspect that your headaches are migraines, you should see your doctor. Furthermore, any type of headache warrants at least one visit with your doctor to make sure there are no concerns by medical history or examination for any other worrisome causes of your headaches. They may refer you to a neurologist or other type of headache specialist. Oftentimes, a wide variety of tests may be given, including CT scans and MRIs, to see what is contributing to the cause of the migraine. The good news is that migraines can be successfully managed for the majority of patients, and that many people live with them thanks to the treatments that they receive.

 

IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

 

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

 

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

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