Posts Tagged "migraine"

Last updated on October 18th, 2021 at 03:26 pm

CAN ALLERGIES CAUSE MIGRAINES, SINUS HEADACHES, AND JAW PAIN?

@Neuralgroover

 

Allergies and Sinus Headache

Do you have a bad headache along with sinus pressure, facial pressure, facial pain, sinus pain, nasal congestion, nasal drainage, postnasal drip, or sore throat? It must be a sinus headache, right? Sure, it’s possible if there is a true sinus infection going on. However, the majority of the time it isn’t.

 

Now if these symptoms are associated with fevers, nasty colored drainage, and other infectious symptoms, there could certainly be a sinus infection and sinus related headache. However, without these infectious types of symptoms (fever, nasty colored drainage, signs of infection), the most likely cause is actually migraine.

 

Yes, those several monthly headaches you get with sinus pressure and congestion are probably not recurrent sinus headaches or sinus infections. They are most likely migraine, especially if there is a recurrent pattern such as monthly occurrence. Allergies (and associated sinus symptoms) are not felt to be a common cause of headache, and most of the time those symptoms actually represent migraine. If your sinus headache has features including throbbing, pounding, pulsating pain, nausea, or sensitivity to light and sound, it easily fits criteria for migraine, and should be treated as such. However, a discussion with your doctor is always recommended to ensure there is not an associated sinus infection or other cause of the headache. Your doctor should always be the one making treatment recommendations based on their assessment.

 

With that said, it is still possible that allergies can cause headaches for some patients due to the inflammation involved. The second half of this blog towards the end will address the connection between allergies, headaches, and jaw pain.

 

Sinus Headache and Migraine Misdiagnosis and Mistreatment

The bottom line is that migraine is commonly misdiagnosed as a “sinus headache” by patients, physicians, and other medical professionals when there are sinus symptoms present. Unfortunately, what we end up seeing in the headache clinic are patients with a history of excess unnecessary antibiotics, sinus procedures, and minimal to no relief. By the time patients see us, they have often had sinus surgeries, which surprise, don’t help them. Improvement usually doesn’t begin until the headaches and sinus symptoms are treated as migraine.

 

Sometimes patients report their “sinus headaches” improve with these repeated courses of antibiotics, but this doesn’t confirm a sinus infection. Many antibiotics have anti-inflammatory effects, and it is often this effect on the headache that is being felt rather than an infection being treated. In addition, unnecessary excess antibiotics lead to antibiotic resistance. So, when you actually do need that antibiotic for an infection it may no longer be effective against that bacteria (and remember, most upper respiratory infections are viral, which antibiotics will have no effect on anyway). C-difficile (C-diff) infection (which can be deadly) is another complication of antibiotic use in some patients, so the less unnecessary gamble of antibiotic use the better.

 

There is a rare and controversial type of facial pain called mucosal contact point headache. This type of pain is typically localized to a smaller area in the face, rather than a headache elsewhere. So it is more of a facial pain than a headache. It is suspected to be caused by a severe nasal septal deviation where part of the nasal septum contacts the nasal mucosa across from it. or pressure on the nasal walls and headache. This has also been called rhinogenic headache.

 

How Does Migraine Cause Sinus Symptoms?

The reason for this common misdiagnosis of “sinus headache” is because the trigeminal nerve (cranial nerve 5) is the root cause and central to migraine, and it also innervates the sinuses, teeth, TMJ (temporomandibular joint) area, and the face. So if the migraine is activated and turned on, not only does the pain of the headache turn on, but so does the discomfort in the sinus areas, TMJ, teeth, along with sinus symptoms. The bottom line, if you get recurrent episodic headaches that have any throbby, pulsating or pounding pain, any nausea, or sensitivity to light and sound during a bad “sinus headache”, consider it migraine.

 

How Often is Migraine Misdiagnosed as Sinus Headache?                       

A study of almost 3,000 patients with self-diagnosed or doctor diagnosed sinus headaches showed that 88% of the patients actually had migraine according to ICHD3 criteria, not sinus headaches! The most common sinus symptoms reported in that study were sinus pressure (84%), sinus pain (82%), and nasal congestion (63%).

 

Another study called the American Migraine Study II showed similar results. This was a study involving 30,000 patients. About 50% of patients who were eventually diagnosed with migraine had been previously misdiagnosed, and the most common prior misdiagnosis was sinus headache.

 

Yet another study that looked at 100 patients with self-diagnosed sinus headaches. After a detailed history and exam, patients were given headache diagnoses based on the ICHD3 criteria. Of the 100 patients with self-diagnosed headache, 86% were diagnosed with a migraine related headache disorder, rather than a sinus related headache.

 

Is There a Connection Between Allergies and Jaw Pain?

Occasionally, Virtual Headache Specialist will allow guest bloggers to write an article on a migraine related topic, or collaborate with another website or company to further disperse useful medical knowledge. Sinus headache, allergies, jaw and facial pain are very relevant migraine associated topics. So, the second half of today’s blog topic in the section below was written by a guest author, whereas I wrote the section above. I hope the following article provides additional useful information on allergies, sinuses, and how they may relate to jaw and facial pain. The article below is a collaboration with the Zyrtec website given their allergy expertise on this topic.

 

While many people are aware of the fact that allergies can lead to headaches and sinus pain, they may be surprised to learn that allergies can also cause jaw pain. This can present as tender cheeks, pain radiating to your jaw and teeth, or even discomfort on the top of your head, and often feels worse when you lay down and better when you’re upright.

 

But why?

 

Basically, it’s all about the sinuses. We have four pairs of sinuses (frontal, ethmoid, maxillary, and sphenoid), and sinus pressure and pain in any of them can radiate all over your face — including your jaw. That’s why keeping your sinuses healthy by using a nasal spray, treating your allergies, and rinsing your sinuses with a saline rinse can be so helpful. Eating a healthy diet, exercising, and catching some solid zzz’s each night will also benefit your sinus health. Learn more ways to show your sinuses some love in this infographic.

 

Can Allergies Cause Jaw Pain?**

By Kristen Stewart

 

When you experience jaw pain, your mind may jump to reasons such as teeth grinding or toothaches. By going for the obvious, however, you may overlook something as simple as allergies causing your jaw pain. Keep reading to uncover how allergies can cause jaw pain. First, to help you determine if you may be suffering from allergies, here’s a quick primer on what allergies are, what causes them, and who’s most at risk of getting them.

 

IS IT ALLERGIES OR A COLD?

Allergies affect more than 50 million people in the United States each year, with many individuals suffering from allergic rhinitis. Also known as hay fever, its symptoms are as common as they are annoying — sneezing, runny nose, and itchy, watering eyes to name a few.1

 

While some symptoms overlap between allergies and a cold, you may notice some key differences. Colds are contagious and people often unwittingly infect others for two days before symptoms appear. A low-grade fever and aches and pains may accompany them. This common illness may also develop gradually over a couple days.2

 

On the other hand, viruses don’t cause allergies, so you can’t pass allergies on to anyone else. They occur when the body initially encounters a normally harmless substance and creates antibodies to it. When the body encounters the substance again, the existing antibodies tell the immune system to send chemicals such as histamine into the bloodstream to fight the invader. The immune response causes unpleasant allergy symptoms, and they often come on suddenly rather than gradually.3 Take our allergies versus cold quiz to find out which one you have.

 

ALLERGY CAUSES AND RISK FACTORS

Allergic rhinitis typically comes in two forms:  seasonal and perennial. As its name suggests, seasonal allergies strike at predicted times of the year, most often in the spring, summer, or early fall. The main culprits tend to be pollens from grassestrees, and weeds as well as mold spores transported through the air.

 

People with perennial allergies suffer all year. Triggers tend to be exposures encountered during everyday life such as animal dander, dust mites, cockroaches, or mold spores rather than outdoor greenery or conditions.4

 

While allergies are more likely to strike during childhood, they can develop at any time during a person’s lifetime. Reactions can vary from minor to severe.5

 

Unfortunately, you can’t control most of the risk factors for developing hay fever. People with existing allergies, asthma, or eczema are more likely to have hay fever. And if a parent, sibling or other blood relative has allergies or asthma, your chance of getting hay fever increases. But you can control one risk factor by spending less time exposed to allergens like animal dander or dust mites.

 

ALLERGIES, SINUSES, AND HOW THEY CAN CAUSE JAW PAIN

As any sufferer knows, allergies can wreak havoc on your body. In addition to the well-known sneezing, sniffling, and red watering eyes, you may experience postnasal drip, coughing, and fatigue.6 Allergies can also clog the sinuses. Because of that, they could be the source of your nagging jaw pain.7

 

You probably identify sinus problems with nasal pressure. But allergies can cause lower jaw pain as well as the feeling of general pressure, especially if maxillary sinuses are obstructed. Inflamed and swollen sinuses can affect a number of areas of the face and head and result in issues ranging from headaches and earaches to facial tenderness near the eyes and nose that radiates to the jaw.8

 

It’s possible that seasonal allergies could cause jaw pain in other ways, although more research is needed on the subject. Frequent sneezing and coughing force the mouth open which could lead to muscle tension and overuse strain and create issues with the jaw. Similarly, a stuffy nose may make you breathe through your mouth at night. If your jaw is strained open all night, it makes sense that you could wake up with jaw discomfort.9

 

And for people who have a temporomandibular joint disorder (diagnosed or not), it’s possible that allergies could exacerbate it and cause increased jaw pain. However, the sinuses are the key way allergies cause jaw pain.

 

THE SINUSES EXPLAINED

Many parts of the body get a lot of love. We try to eat right and exercise for our hearts and stay engaged with life mentally and socially to keep our minds sharp as we age. But people often neglect their sinuses. The sinuses may only become your focus of attention if a problem occurs. But it’s worth understanding more about your sinuses, and that’s especially true if you experience jaw pain, because sinus pressure and pain can radiate all over the face.

 

Sinuses are also called paranasal sinuses. They’re air-filled pockets or cavities in the skull and facial bones that connect to the nose through an opening known as an ostium.

Usually when we hear about cavities, it’s when we get bad news at the dentist’s office, but sinus cavities are our allies. Check out our 6 Things to Know About Sinuses page to learn about the remarkable role they play to keep us well and healthy.

 

Like many parts of the body, sinuses aren’t immune from issues. Allergic sinusitis typically comes with the usual allergy symptoms such as sneezing, nasal congestion, and itchy eyes, nose, and throat.10 Allergy headaches can also occur with facial discomfort in the sinus area. Pain can be located throughout the region or sometimes located on just one side.11

 

 

KEEPING SINUSES HEALTHY

The good news is you can take steps to keep your sinuses healthy, which may help alleviate and prevent jaw pain. One action you can take is to manage allergies to keep your symptoms under control. Allergies can cause inflammation of the nose and sinuses which in turn blocks mucus from draining and may lead to an infection.

 

In addition, consider using nasal saline sprays to keep your nose moist. This practice ensures the cilia will work at their optimum level to clear the airways and remove debris. You may also want to irrigate your sinuses with a saline sinus wash to add moisture and flush out dust, pollen, and other intruders. 12 13

 

Beware of irritants such as pollution and smoke. The chlorine found in chlorinated pools may also irritate and inflame your nasal passages and sinuses. If possible, opt to swim in saltwater pools or natural bodies of water to avoid excess exposure to chlorine.14

 

Maintaining good health overall can also help keep sinus issues at bay. Eat a healthy diet, exercise regularly, get enough sleep, and manage stress to boost the immune system and keep colds and flus at bay. Avoid taking antibiotics or steroids if possible as they disrupt the microbiota in the sinuses and may allow pathogens to proliferate.15Finally, it may sound obvious but don’t forget to wash your hands. Handwashing can play a large role in reducing illness and sinus issues.16

FIND THE RIGHT TREATMENT TO EASE YOUR JAW PAIN

If you have severe or long-lasting jaw pain, you may want to talk to a medical professional. But if you suffer from jaw discomfort and allergies, some simple precautions may help you smile — without pain — in no time.

________________________________________________________________________________________________________

Kristen Stewart is a freelance writer specializing in health and lifestyle topics. She lives in New Jersey with her husband, three kids and two very needy cats.

 

**The “Can Allergies Cause Jaw Pain?” section above originated on the Zyrtec website, was written by Kristen Stewart, and is being reshared here for an educational collaboration. The original version can be found here:

https://www.zyrtec.com/allergy-guide/understanding-allergies/symptoms/jaw-pain

 

[1]https://acaai.org/news/facts-statistics/allergies
[2]
https://www.zyrtec.com/allergy-guide/allergy-essentials/allergies-or-cold
[3]https://www.mayoclinic.org/diseases-conditions/hay-fever/symptoms-causes…
[4]
https://acaai.org/news/facts-statistics/allergies
[5]
https://www.mayoclinic.org/diseases-conditions/allergies/symptoms-causes…
[6]
https://www.mayoclinic.org/diseases-conditions/hay-fever/symptoms-causes…
[7]
https://acaai.org/allergies/symptoms/allergy-headaches
[8]
https://omfs.com.au/patient-information/news-updates/can-allergies-cause…
[9]
https://www.newsmile4u.com/blog/allergy-symptoms-can-hide-tmj/
[10]
https://www.cedars-sinai.edu/Patients/Health-Conditions/Allergic-Sinusit…
[11]
https://acaai.org/allergies/symptoms/allergy-headaches
[12]
https://blogs.bcm.edu/2014/06/25/ten-tips-to-avoid-sinus-infections/
[13]
https://medlineplus.gov/ency/patientinstructions/000801.htm
[14]
https://blogs.bcm.edu/2014/06/25/ten-tips-to-avoid-sinus-infections/
[15]
https://www.nature.com/articles/s41598-019-53975-9
[16]
https://www.cdc.gov/handwashing/why-handwashing.html

 

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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MIGRAINE AND HEADACHE DIETS.


Posted By on Sep 10, 2021

Last updated on October 14th, 2021 at 03:00 pm

MIGRAINE AND HEADACHE DIETS.

@Neuralgroover

The best migraine diet is…

 

Well first, there are many well established migraine triggers. The beverages and foods that we consume play a role in headaches and migraines for many patients. In fact, about 10% of headache and migraine sufferers can attribute at least a small part of their headaches to food and diet triggers. Often the trigger is a specific type of food or beverage. For example, in some studies (seen here and here) migraineurs reported their most common food triggers as chocolate (19-22%), cheese (9-18%), citrus fruit (11%), and alcohol (29-35%).

 

Certain types of diets may help reduce the likelihood and severity of headaches and migraines. Let’s take a look at some of the diets out there that may help with headaches and migraines.




How Does the Keto Diet Impact Headaches and Migraines?

The keto diet is unique in the sense that your body consumes more fat and protein while lowering the intake of carbohydrates. The idea is that your body is forced to burn fats rather than carbohydrates. Studies have shown that the keto diet was able to significantly reduce migraine frequency and abortive medication intake. It is thought that the keto diet can be particularly helpful for migraine sufferers on a twofold front:

  1. Ketone bodies produced by the liver can provide the brain with more energy than glucose.
  2. Additionally, ketones are thought to be anti-inflammatory. Since inflammation is a central piece of migraines, the keto diet can potentially help by reducing inflammation.

 

For those who are starting out fresh on the keto diet, there may be an occasional headache since the body is learning to burn fat instead of sugar. To avoid these headaches early on in the keto diet, the following suggestions will help:

  • Drink plenty of water.
  • Eat low-carb, water-rich vegetables.
  • Eat foods that are rich in electrolytes.
  • Avoid exercise on the opening days of your keto diet.

 

Can a Low-Histamine Diet Help With Headaches and Migraines?

Histamine can be a headache or a migraine trigger for certain individuals, even if they do not have allergies. The body makes a digestive enzyme called DAO (diamine oxidase) that processes histamine. About 25% of people have an issue with DAO production in their bodies. One study found that about 87% of people with migraines also had issues with DAO deficiencies. It was found that people who participated in a low-histamine diet had improved in their overall experiences with their migraines while a handful of people in the study had no migraines or headaches at all.

 

What can you eat on the low-histamine diet? You can eat fresh meat (especially chicken) and freshly caught fish. Some non-citrus fruits are low in histamine levels and include things like apples, raspberries, blueberries, melons, bananas, and kiwi. Eggs are also low in histamine. Gluten-free grains, such as rice and quinoa are also low in histamine. Fresh vegetables other than tomatoes, avocados, spinach, and eggplant are also low in histamine levels. Lastly, if you cook with oils, olive oil is low in histamine levels.

 

Elimination Diet, Headaches, and Migraines

From a dietary perspective, an elimination diet is any type of diet where you eliminate foods and beverages that you suspect your body does not tolerate well. On the elimination diet for headaches, there are some things that you might want to avoid:

  1. Caffeine and alcohol: These are known to dehydrate the body and cause headaches.
  2. Chocolate and cocoa: These are known to cause headaches. However, you may eat white chocolate.
  3. MSG: This is a flavor enhancing substance known to trigger headaches and migraines. If you want to avoid MSG, you can eat whole foods that have been flavored with natural herbs and spices. On food labels, it is often hidden as other names including glutamate, natural flavor, and partially hydrogenated vegetable protein.
  4. Processed meats: Anything like jerky, cold cuts, and lunch meats should be avoided. You can however eat fresh meats that you prepare yourself. Nitrates and nitrites are the migraine trigger culprits in these types of foods. 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 lunch meat for lunch, you may want to look into nitrate and nitrite-free lunch meat options.
  5. Dairy: You should avoid certain dairy foods like aged cheese, buttermilk, sour cream, and yogurt. However, you can eat things like cottage cheese, cream cheese, and American varieties of cheese.
  6. Nuts: Try substituting seeds for nuts.
  7. Fruits: Avoid citrus fruits altogether. You can eat things like apples, peaches, pears, etc.
  8. Some vegetables, like onions, pea pods, and sauerkraut should be avoided. You can eat most leafy green vegetables and water-rich vegetables.
  9. Condiments: You should avoid things like ketchup, mustard, vinegar-based condiments, etc.
  10. Baked goods: Be careful to make sure that anything you eat is gluten-free while you are on the elimination diet for headaches and migraines.
  11. Avoid any artificial sweeteners altogether, like NutraSweet.
  12. Avoid Fermented foods such as sauerkraut, soy products, and pickled foods because they contain tyramine which is a migraine trigger for many patients. Brewer’s yeast also contains a large amount of tyramine. A low tyramine diet can be very helpful for some patients with migraine.

 

Overall, your doctor may advise you to try the elimination diet for a trial period to see if the foods you are eating are contributing to your headaches and migraines. When attempting to figure out what foods to try eliminating, sometimes IgG food testing against food allergens can assist in determining specific foods which may be associated with high IgG levels in the blood (meaning your immune system is reacting against them).




Inflammatory Foods, Headaches, Migraine, and the Anti-Inflammatory Diet

Another way to fight off headaches and migraines is to avoid foods that are known to cause inflammation. For example, sugar and high fructose corn syrup are found in most processed foods and sweets. In some studies, these sweet substances were known to counteract the effects of omega-3 fatty acids, which can help reduce inflammation. Artificial trans fat, vegetable oils, and seed oils can also cause inflammation, leading to headaches and migraines. Refined carbohydrates, prepared meats, and other processed foods can also cause inflammation. In addition to causing headaches and migraines, foods that cause inflammation can cause a wide variety of other issues including high cholesterol, heart disease, obesity, and diabetes.

 

There are other variations of the anti-inflammatory diet which focus on omega fatty acids including the high omega 3/low omega 6 (H3/L6) and low omega 6 (L6) diets. The thinking is based on the fact that omega 3 is anti-inflammatory, whereas omega 6 is more inflammatory and can increase pain. Fast food is often loaded with omega 6 fatty acids, along with many other chemical additives which are often migraine triggers. So the goal is to eat foods with a higher ratio of omega 3 as compared with omega 6. In fact, a recent study showed that eating fish with healthy omega ratios can help prevent migraines.

 

Fish with a healthy omega ratio include tuna (canned in water), wild salmon, swordfish, mackerel, herring, sea bass, anchovies, sardines, cod, and bluefish. Fish with a less healthy omega ratio include farm raised fish and fish canned in oil. Vegetables with a healthy omega ratio include green leafy vegetables, and those with a less healthy omega ratio include beats, carrotos, chard, and parsley. Nuts and seeds with a healthier omega ratio include walnuts, flax and chia seeds. Those with a less healthy omega ratio include almonds, pecans, cashews, and pistachios. Oils with a healthier omega ratio ratio include olive oil and canola oil, while those with a less healthy omega ratio include highly processed oils such as corn, soy, safflower, and peanut oil.

 

Gluten Free Diet (Celiac Sprue)

Celiac sprue is caused by inflammation in the digestive tract, caused by exposure to gluten. Gluten is a protein found in many grains, including barley, wheat, and rye. Thus it is a common ingredient in foods such as pizza, pasta, bread, and cereal. Patients often complain of abdominal bloating and pain, diarrhea, and headache when they eat these foods. Some patients can less commonly have additional neurological symptoms besides headaches, including unsteadiness/imbalance (ataxia), and peripheral neuropathy. Unexplained iron deficiency is common, and liver function tests are sometimes abnormal. 70% of patients with true gluten sensitivity and celiac sprue have been shown to have improved symptoms within 2 weeks of doing a gluten free diet. Many patients get loosely diagnosed or self diagnosed as “celiac disease” or “gluten sensitive”. However, the gold standard diagnosis is made by small bowel biopsy, along with supporting bloodwork. So if there are suspicious symptoms as discussed here, a gluten free diet for 2-4 weeks may be a good consideration to try.

 

Low Fat Diet

Low fat diets have been reported to decrease headache and migraines in some patients. One study looked at patients eating no more than 20 grams of fat per day. It reported significant differences in migraine frequency which went from 6 days to 1 day per month on average, along with significant decreases in migraine severity, duration, and medication intake.

 

Finding What Works Right For You

The various diets discussed above all have one principle in mind, eliminating certain foods from your diet that can cause headaches and migraines. Many of the foods that are mentioned in the diets above that are to be avoided contain Tyramine. This is the substance produced when the amino acid tyrosine breaks down and can cause headaches.

 

Not only will the right diet help you mitigate the frequency and severity of headaches and migraines, but a proper diet can also help avoid certain types of chronic health conditions. Good diet is only part of the formula that will help you reduce headaches and migraines in your daily life. Your physician will also counsel you on good diet and exercise practices to help you with your headache and migraines.

 

In summary, the answer to which diet is the best migraine diet is… there isn’t one. Finding dietary influences on migraine and headache will vary widely between patients and what their migraine may be susceptible to or what it responds to. However, if there are clues to when you get migraines in relation to any of the dietary factors discussed above when you eat meals, it may be worth trying that particular diet or dietary modification for at least 4 weeks. Any dietary changes should always be discussed and approved of with your regular medical doctor first though, to make sure it is safe to try depending on your particular medical history.

 

Regardless of dietary factors, keep in mind that having migraine means that you are wired in a way that migraines can be triggered easier as compared to someone without migraines. You may be able to identify triggers, but many times there may not be a trigger and migraines can just happen because that is the nature of the disorder, unfortunately. So you still want to ensure that you have a good migraine abortive option for when they do happen. Abortive treatments are taken at the onset of the migraine with a goal of lessening the duration and severity of the migraine attack and associated symptoms. Some of these options include NSAIDs, ergots, triptans, neuromodulatory devices, the ditans (Reyvow (Lasmiditan)) and the gepants (Ubrelvy (Ubrogepant) and Nurtec ODT (orally dissolvable tablet) (Rimegepant)).

 

If the migraines are happening frequently enough, then a migraine preventive treatment should be considered. Preventive migraine treatments are used to lessen the frequency and/or severity of migraine attacks. Preventive treatments include a variety of daily pill medications, CGRP monoclonal antibodies (mAbs) (Aimovig (Erenumab), Emgality (Galcanezumab), Ajovy (Fremenazumab), Vyepti (Eptinezumab)), neuromodulation devices, Botox, Nurtec ODT every other day (1st and only dually approved migraine abortive and preventive), herbal and natural supplements and vitamins, yoga and meditation, and acupuncture and acupressure.




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 September 17th, 2021 at 04:53 am

VESTIBULAR MIGRAINE, MIGRAINE VERTIGO, DIZZINESS, AND LIGHTHEADEDNESS.

@Neuralgroover

Vestibular migraine has also been called migraine-associated vertigo/dizziness, migraine-related vestibulopathy and migrainous vertigo. Vestibular migraines are not as common as other headache and migraine conditions, but they impact about 3% of the population. They happen five times more often in women than they do in men. One of the common themes among vestibular migraine sufferers is that this condition is often found in their family history, and often, these people have a history of migraines. An early clue can be that they may have gotten easily car sick as a child, and they may still as an adult.

Dizziness, lightheadedness, and wooziness are very common symptoms associated with regular migraine attacks. Vestibular migraines cause severe dizziness, vertigo, imbalance, and disequilibrium in people with migraines. The severity of these symptoms in vestibular migraine are much more severe and pronounced as compared with the more commonly associated milder dizziness type of symptoms often seen with normal migraine attacks. In addition, with vestibular migraine, you might not always have a headache with the symptoms, which can make diagnosis even more tricky. So, let’s dissect the specifics and symptoms of vestibular migraine a bit more below…




What Types of Symptoms Might I Experience With a Vestibular Migraine?

As mentioned above, vestibular migraines don’t always coincide with a headache. They include dizziness that lasts for a few moments or more, nausea, vomiting, balance problems, sensitivity to motion when you move your body, disorientation, and sensitivity to light or sound. Vestibular migraines are connected to the inner ear, so a person experiencing this type of migraine will have significant issues with their balance and equilibrium during an attack.

 

The International Classification of Migraine 3rd Edition (ICHD3) has specific criteria that must be met to fit the diagnosis. Other causes of vestibular symptoms such as inner ear problems and other causes must have been tested for and excluded. The person must have a history of migraine without aura or migraine with aura. They must have at least 5 episodes of moderate to severe vestibular symptoms lasting between 5 minutes to 72 hours. Vestibular symptoms can include vertigo, spinning sensation, sensation of self-motion, disequilibrium, positional vertigo such as following a change in head position or head motion, dizziness with nausea, and visually induced vertigo triggered by a moving visual stimulus. At least half of these vestibular symptom episodes must be associated with 1 of the following 3 migrainous features:

1. Headache with at least 2 of the following 4 features:

  1. One sided location
  2. Pulsating, throbbing, or pounding pain
  3. Moderate to severe intensity
  4. Worsening by physical activity

2. Sensitivity to light (photophobia) and sound (phonophobia)

3. Visual aura

 

Approximately 1/3rd of patients can have vestibular symptoms lasting minutes, 1/3rd can last hours, and 1/3rd can last several days. A small fraction of patients have vestibular attacks which can last seconds only, but occur repeatedly during head motion, changes in head position, or visual stimulation. In these patients, episode duration is defined as the total period during which short attacks are recurring with these triggers. An even smaller fraction of patients can have attacks that can last several weeks to a month. Overall, attacks last 72 hours or less for the vast majority of patients.

 

What Causes Migraines With Vertigo?

The exact cause of vestibular migraines is not clearly understood. However, many researchers believe that there is overlap and erroneous connections between pain signals and vestibular signals that come in from the inner ear and the electrical migraine pathways. Some contributing factors to vestibular migraines include many of the commonly recognized migraine triggers such as lack of sleep, consumption of MSG and certain other foods, and dehydration.

 

How Long Does a Vestibular Migraine Last?

Vestibular migraines can last for a period as short as 5 minutes or up to 72 hours, as detailed above. Some patients have reported this type of migraine lasting for up to 4 weeks, with the intensity of the symptoms coming and going.

 

What Types of Treatments Will Help Alleviate Vestibular Migraines?

Different types of abortive therapies are available for vestibular migraines. Abortive migraine medications are medications taken at the onset of the migraine with a goal of lessening the duration and severity of the migraine attack and associated symptoms. Some of these options include NSAIDs, ergots, triptans, neuromodulatory devices, and the gepants (Ubrelvy (Ubrogepant) and Nurtec ODT (orally dissolvable tablet) (Rimegepant)). Triptans and abortives are particularly helpful if they are taken at the first sign of symptoms. Your doctor might prescribe something like Ativan, Valium or another vestibular suppressant to correct the balance on your inner ear, but these should preferably not be taken frequently or daily because they can form dependency and addiction.

 

Calcium blockers and beta blockers can also work to reduce the severity and intensity of your vestibular migraine, but there are many other migraine preventive options as well. Preventive migraine treatments are used to lessen the frequency and/or severity of migraine attacks. Preventive treatments include a variety of daily pill medications, CGRP monoclonal antibodies (mAbs) (Aimovig (Erenumab), Emgality (Galcanezumab), Ajovy (Fremenazumab), Vyepti (Eptinezumab)),  neuromodulation devices, Botox, Nurtec ODT every other day (1st and only dually approved migraine abortive and preventive),  herbal and natural supplements and vitamins, yoga and meditation, and acupuncture and acupressure.

 

Some of the typical migraine pill preventive medications include antiseizure, blood pressure, and antidepressant drugs. These traditional migraine medications can also be very helpful in treating more severe occurrences of vestibular migraines.




Could My Vestibular Migraine Be Something Else?

Vestibular migraines have symptoms that overlap with other medical conditions. In fact, at least 20% of vestibular migraine cases are misdiagnosed. A condition called Meniere’s disease causes dizziness. This disease, however, will often be accompanied by a stuffed ear sensation or ear ringing. Referral to an ENT doctor (ear nose and throat) to evaluate for inner ear disorders should always be part of the evaluation plan, along with possible neuroimaging with brain MRI or CT, and possibly some blood work. A brainstem stroke can also cause dizziness before more severe symptoms set in. MRIs and other medical tests can help rule conditions like these out. Therefore, vestibular migraine should always be a “diagnosis of exclusion”, meaning it can be considered only after other causes of dizziness and vertigo have been tested for and ruled out.

 

How Will My Doctor Manage My Vestibular Migraines?

In addition to some of the medications suggested above, there are ways to manage your vestibular migraines. Your doctor will probably do a full medical examination to understand any comorbidities and also see what medications you are currently taking. Dizziness is one of the most commonly reported side effects of many medications, so make sure to trace onset of symptoms back to any medication adjustments as well.

Depression, lack of sleep, and anxiety are some of the issues that may be exacerbated by your vestibular migraines. If these conditions are left untreated, the vestibular migraine will not get better. Depression and anxiety do not cause vestibular migraines, but the migraines can lead to anxiety and depression and these issues can all begin to feed into and fuel one another.

Another thing to keep in mind is that traditional medicinal approaches to headaches may not be the best approach to vestibular migraines for everyone. Vestibular migraines can sometimes be sensitive to Advil, Tylenol, and other NSAIDs. However, most patients will not respond as well to these over the counter medications and will need more migraine specific therapies. If you use triptans or NSAIDs daily or with a high frequency of more than 10 days per month on average, you may be more prone to rebound vestibular migraines. Vestibular physical therapy can also be helpful for some patients if they suffer from a high frequency of symptoms.

 

What Is the Outlook for Vestibular Migraines?

Overall, the outlook for Vestibular migraines is good. An NIH study found that vestibular migraines in a pool of patients from a period of 10 years decreased in about 56% of cases, increased in only about 30% of people, and stayed the same in about 16 percent of cases.




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 October 6th, 2021 at 06:02 pm

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. On food labels, it is often hidden as other names including glutamate, natural flavor, and partially hydrogenated vegetable protein. There is an MSG symptom complex reported by some patients which can include facial pressure, burning, headache, nausea, bronchospasm/wheezing, palpitations, and paresthesias (tingling/numbness).

 

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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