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Neurological Education: Migraine Headaches

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There are various causes of headaches. The major cause is due to primary headache disorders such as migraines and tension-type headaches. Very rarely are headaches a sign of a serious medical issue. Whatever the cause may be, a headache disorder can become very burdensome for patients who deal daily with the threat of a possible debilitating headache. Dr. Jochims will proficiently evaluate your particular case and, through conservative management, will work with you to tailor a treatment plan specific to your needs.

Migraines

Estimates show that about 30 million Americans suffer from migraines, with women being three more times likely to be affected than men. Migraines can come at any age, including during childhood, but are most often experienced between the ages of 15 and 55. About 10% of children suffer from migraines, but they often go undiagnosed because the disease process in children can present in an atypical pattern.

Migraines occur when the blood vessels on the surface of the brain swell. This causes a pain signal to be sent to the brain stem, which processes this signal, and the pain is then felt by the body. Migraine pain is typically felt behind the eyes or temple area, but is also sometimes felt in the face, sinuses, jaw or neck area. It’s usually described as a throbbing or pulsating pain. Often the pain only affects one side of the head, but can affect both sides. Migraines are also often associated with nausea or vomiting, sensitivity to sensation (light, sound, odor). Exertion can make the headache worse. Migraines can last anywhere from four to 72 hours.

There are four distinct phases of a migraine that you may or may not recognize in your own experience. The first and fourth stages are similar, with periods of tiredness, fatigue and general illness. You may just not feel like yourself. The second phase is referred to as an aura, which typically presents as a visual disturbance up to an hour before pain is experienced. It may be experienced as seeing dots, flashing lights, wavy lines or blind spots. It may also present as general confusion, tingling in arms or face and difficulty speaking. The third stage is mild to severe head pain; often, associated nausea is also experienced. During this stage, you may be sensitive to light, sound and odors.

Diagnosis

Migraines often go undiagnosed or are misdiagnosed if they are not properly evaluated by a trained professional. Nearly half of all migraine sufferers are never diagnosed. Many patients struggle through the daily threat of pain without seeking advice from a trained specialist.

Diagnosis is made by obtaining a details of the patient’s past and present medical history as well as a complete social history (patient’s daily activities, etc.). Even the most minute detail can make a difference in finding the key to diagnosis. It’s important to make special observances regarding your headaches. What do they feel like? When do they occur? Why do they occur? What is going on when they begin? Is there anything that makes them better/worse? It’s advisable to begin recording these details in a headache diary and to bring it with you to every appointment in order to better assist your doctor in evaluating you case. Often, tests such as CT scan and MRI will not be necessary in diagnosing your migraines.

Treatment

Many factors can contribute to the occurrence of migraines. Subsequently, many factors may contribute to their treatment. There are three general areas of treatment for migraines: preventive, acute and complementary. It’s the goal of Neurological Wellness Clinic to maximize preventive and complementary approaches in an effort to minimize the need for use of acute treatment methods.

As a preventive approach, your doctor may prescribe medication, or a combination of medications, to be taken on a regular basis in an attempt to stop migraines from occurring altogether. The doctor might also prescribe counseling, physical therapy or biofeedback to assist a medicinal treatment plan. These preventive measures may be used in combination with complementary treatment methods.

In the case where acute therapy is needed, the treatment chosen is most often a medication. There are some over-the-counter medications (NSAIDs and ibuprofen) that patients can use to help control their symptoms. The doctor may also deem it necessary to prescribe a medication to be taken as soon as onset of symptoms is noticed. And, used sparingly, on a last-resort basis, there are narcotic analgesics.

As with all pain medications, it’s very important for patients to be aware of the potential for abuse. When in pain, it’s easy to justify taking “just one more” pill, but it’s important to recognize that continual overuse of medication is not only dangerous for your health, but in the case of a headache patient may cause an increase in frequency and severity of headaches to occur. This is called an analgesic or rebound headache.

References: www.migraineresearchfoundation.org | www.americanmigrainefoundation.org

What Can You Do?

Medical treatment for headache disorders can often be assisted by the patient in their daily actions. For prevention of headaches, it’s important to evaluate your lifestyle and identify areas for improvement. Regular exercise and regular, consistent rest are vital components of preserving a healthy lifestyle. Maintaining a healthy diet, including drinking lots of fluids, might also help prevent symptoms. Identify triggers for your headaches and avoid interaction with these as much as possible. Some possible triggers are include:

  • Certain foods, such as aged cheeses, sausages, chocolate, fermented food, MSG
  • Use of alcohol
  • Chemicals, such as nicotine, gasoline, glue, household cleaners, perfumes, paint
  • Certain emotions such as stress
  • Disruption in your regular schedule such as skipping a meal or disruption in your sleep pattern
  • Hormones – Many women, especially migraine sufferers, notice symptoms tend to occur at a certain point in their menstrual cycle
  • Change in environment, such as when traveling or a move to a new home
  • Change in weather

When interaction with certain triggers is inevitable, try to develop ways to combat these interactions. Take extra care with your health. Drink plenty of fluids; get extra rest. Minimize interaction as much as possible. When a headache is occurring, preventive measures will not help the emergent need to reduce your pain. But there are some things you can do in an acute situation to help decrease your symptoms. If you take medication at the onset of a headache, try to take the medication at the first sign of symptoms – the earlier the better! During a headache, use a cold compress, lie down in a dark quiet room and drink fluids (suck on ice if nausea makes it difficult to drink). Try using relaxation techniques such as deep breathing, visualization of a peaceful and serene scene, progressive relaxation or massaging the muscles of your head and neck.

Image of woman suffering with migraine headache.

Migraine Headaches

Estimates show that about 30 million Americans suffer from migraines.

Migraines often go undiagnosed or are misdiagnosed if not properly evaluated by a trained professional.

Identify Headache Triggers

For prevention of headaches, it’’s important to evaluate your lifestyle and identify areas for improvement.

Identify triggers for your headaches and avoid interaction with these as much as possible. When interaction with certain triggers is inevitable, try to develop ways to combat these interactions.

Take care of your health – drink plenty of fluids and get extra rest.

Dr Jochism

Dr. Sean Jochims, Neurologist

Dr. Sean Jochims graduated medical school with the prestigious Rick Wartgow Award for dedication to medicine. He also received Excellence in Teaching Awards as chief resident in neurology at the Medical College of Wisconsin.

Education
  • Medical School: Medical College of Wisconsin
  • Internship/Internal Medicine: Northwestern University
  • Clinical Neurophysiology Fellowship: Rush Presbyterian/St. Luke’s Medical Center, Chicago
  • Participant at Atlanta School of Sleep Medicine
Board Certifications
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