Making Life Better for Migraine Patients

January 24, 2009

For the world’s 300 million migraine sufferers,knowledge and action can boost everyday quality of life.

While some headaches can be very painful, there are unique characteristics that distinguish migraines from non-migraine headaches, including:
  • Pain concentrated on only one side of your head;
  • Pain so intense that it’s almost impossible to do even simple tasks;
  • Fleeting pain (pain that comes and goes);
  • Severe nausea or vomiting;
  • Pain from simple body movement;
  • Painful reaction to a flash of light or loud noise.

Understanding Migraines

Dr. Paisarn Vachatimanont To gain a better understanding of migraine headaches and how patients can better cope with the debilitating condition, Better Health talked to Dr. Paisarn Vachatimanont, a neurologist specializing in treating migraine headaches.

“Migraine headaches have a distinct focus in the temple area,” Dr. Paisarn explains. “The pain may be felt on one or both sides of the head, and in some cases the pain may shift from one side to the other. More specifically, the area around the eye sockets is usually where the pain is most intense, with a throbbing or pulsating sensation that can also cause nausea and vomiting.” The duration of a migraine headache can vary greatly from one patient to another; some migraines have been known to last as long as 72 hours.

Migraine is a brain-related condition, but its precise cause or causes are still not known. Some experts believe that migraines result from a malfunction in the brain stem, while others support the theory that a chemical imbalance in the brain causes blood vessels to become over-sensitive to certain kinds of stimulation.
“There is much debate in the medical community about how blood vessels can become so sensitive to certain kinds of stimulation,” Dr. Paisarn notes. “I support the theory that a genetic component is involved. There are some interesting parallels with the way asthma patients suffer, as they are known to show a high sensitivity to certain types of stimulation that trigger an asthma attack. People who don’t have asthma have no adverse reaction when faced with the same stimulation.”

Migraine sufferers typically range from 25 to 45 years of age (though there have been reports of children as young as five having migraines). More importantly, about three out of four migraine patients are female, which helps explain the connection between hormones and migraines.

Migraine Triggers

Factors that can trigger the onset of a migraine are numerous and can vary greatly from one patient to the next. Many patients report having migraines triggered by exposure to heat or a flash of light, after insufficient sleep, or after consuming chocolate or a glass of red wine. Contraceptive pills are believed to trigger migraines in some women.

There are six main types of migraine triggers:
  • Hormone changes in women: During and after menstruation, during pregnancy, and while taking oral contraceptives;
  • Food: Cheese, red wine, chocolate, monosodium glutamate, tea, coffee, and artificial sweeteners;
  • Sensory stimuli: A flash of sunlight, loud noise, cigarette smoke and other strong scents;
  • Changes in sleep patterns: Too little or too much sleep;
  • Environmental factors: Heat, dust, pollution;
  • Medications: Certain medications may trigger migraines.
It’s also believed that stress may serve as a trigger for some migraine sufferers. “For people who don’t get migraines, stress won’t cause them to start having migraines,” says Dr. Paisarn. “For most people, stress can trigger regular tension-type headaches characterized by pressure or tightness on both sides of the head -- but without the more severe symptoms like nausea and vomiting that are unique to migraines. For people who are genetically pre-disposed to migraines, stress can certainly act as a trigger.”

Treatment Options

Medical research continues to study potential new migraine treatments. There are a number of medications currently available that are helping lessen the painful symptoms patients experience following the onset of a migraine headache, so they can enjoy a better quality of life and more fully engage in normal daily activities.
“Before recommending a specific treatment,” says Dr. Paisarn, “we consider migraine frequency and pain severity. Roughly 80 percent of migraine patients experience migraines once or twice a month. For a small percentage of patients, migraines can occur almost every day. Medications are available to help provide pain relief and to help prevent a migraine from occurring.”

Dr. Paisarn continues: “Normal pain medications like paracetemol usually don’t provide much relief for migraine patients. A stronger type of pain medication is usually prescribed, and patients are closely monitored for possible stomach irritation that may occur because of the medicine’s high acidity.

For patients with a high migraine frequency, doctors usually consider other medications that can prevent some migraines from occurring. The four main medication types used for migraine prevention include anti-hypertensive, seizure control, anti-depressant, and calcium-based medicines.”
One drawback for some patients is that the preventive medications are most effective when taken on a daily basis. “Some patients want more flexibility with preventive medication,” Dr. Paisarn explains. “In most cases the patient doesn’t have to take them daily, if they’re willing to bear with the occasional episodes of migraine pain. I make sure they follow my advice on other things they need to be doing to take proper care of their health.”

Better Living with Migraines

Although there’s no specific migraine cure, the following tips have been shown to help reduce migraine frequency, duration, and severity of pain:
  •  Avoid your triggers: Learn from your past experiences and be vigilant to avoid the triggers that you’re aware of;
  • Get enough (but not too much) sleep: Adults should sleep between six and eight hours a day, and stick to a consistent sleep schedule every day;
  • Rest when pain occurs: Resting in a dark, quiet room and applying a cold cloth or towel to the neck should provide some pain relief;
  • Exercise: A 30-minute workout is a great stress reliever;
  • Keep a headache journal: Write down the details of each migraine episode, including the day, time and duration. Keeping a record of things like the type of pain you experience, what kind of food you consume, etc., can help you and your doctor spot patterns that may be triggering your migraines;

When to See a Doctor

While most headaches and migraines are typically independent events, Dr. Paisarn cautions patients to be vigilant about seeking medical attention under certain circumstances.

“When severe head pain occurs together with other symptoms such as high fever, blurred vision, difficulty speaking or slurring speech,” says Dr. Paisarn, “this combination of symptoms isn’t a migraine; it’s more likely to be a more serious neurological problem, such as a stroke, that requires urgent medical attention.”

“There are other instances when headache sufferers should consult their doctor,” Dr. Paisarn advises. “These include experiencing a painful headache-type event happening for the first time, or a re-occurrence after a long period, where normal pain-relief medication doesn’t alleviate the pain; a headache combined with weakness of the arms or legs, numbness on one side of the body, or difficulties with speech. In any of these instances, it’s important to see a doctor immediately.”
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