"Migrain Is It Here Too Stay".........

by Tania Ashraf⁽³⁾
Tani

Migraine is it here too stay?

Migraine is the most talked about medical issue all over the world and if you take a deeper insight of it we will see that Migraine is not here to stay for ever it does has a treatment, therefore my article is written in order to inform all the people at large that do not get depressed due to Migraine it does have a break through.

BOTOX APPROVAL FOR MIGRAINE: WHAT DOES IT MEAN?

Botox was recently approved by the FDA for chronic migraine prevention. The use of Botox injection for migraine prevention is not new; most headache centers have been injecting Botox “off label” for years with relatively good success. So, what will this new FDA approval mean for migraine sufferers?

In my opinion, insurance companies can no longer deny Botox on the grounds that it is “investigational” and not FDA approved as they often did before this recent approval. Now insurance companies have to consider approving Botox for chronic migraine prevention.

Keep in mind that the current FDA approval is only for the prevention of chronic migraine and not for episodic migraine prevention. Chronic migraine refers to patients that are having 15 or more days a month of headache. Not all of the headaches have to be full-blown migraine; some headaches may be tension headaches but at least some of the headaches have to be migraine.

What is the current downside of injecting Botox? Answer: the cost!!! Botox is very expensive. At the time of writing this blog, my cost as a medical provider is $525 for a 100 unit vial and $1050 for a 200 unit vial. The current recommendation, based on clinical studies, is to inject 155 units in 31 sites across the forehead, around the eyes, temples, neck and upper back. Also, this quoted cost does not include the procedure fee or the supplies, including needles and syringes, needed for the Botox procedure. Until the recent approval, many headache centers, including mine, were injecting 100 units to keep the cost down.

However, now I am recommending the full 155 units.

Are insurance companies beginning to approve Botox? Answer: Yes, but not all of them. Most are requiring prior authorization. My office is swamped with requests to get the Botox approved. In some cases, the insurance company is paying for and shipping the Botox directly to my office. This direct payment for Botox by the insurance company is desirable since I don’t have to order directly and charge the patient for the Botox; this way, when they come in, they only have to pay for the procedure fee.

Am I getting good results? In my practice: YES!!! Does everyone respond?

No. Traditionally, I don’t recommend Botox unless migraine patients have had trouble tolerating traditional preventives like Top Amax, Elavil, Inderal, Pamelor, and Depakote. Botox can be useful in the following scenarios:

1. Migraineurs who suffer with headaches > 15 days/month and …

2. Have trouble tolerating current available preventive medications OR

3. Are not optimally responsive to their current preventive regimen

4. Prefer to not take a daily preventive and like the convenience of simply coming in for a Botox injection every 3 months

The benefits of Botox are usually apparent in 2 weeks and in some cases, within 24 hours. For those who respond to Botox the benefits usually last for 3 months. Success for any migraine preventive, including Botox, is often measured as a greater than 50% improvement in both the quantity and quality of migraine headaches.

MIGRAINES CAUSES AND TRIGGERS:

Migraine triggers are factors that contribute to migraine attacks.

Migraine causes are the underlying reasons in the body, especially in the brain, that may chemically lead to migraines.

About migraine triggers

Different migraine sufferers have different migraine triggers, which are also called precipitating factors. The same triggers may not spark a migraine each time. Triggers somehow lead to a series of events in the brain of migraine sufferers which leads to migraine symptoms.

About migraine causes

The underlying reason for migraines isn’t certain. However, there are several chemical reactions and changes in the brains of people with migraines that have been documented and may cause the recurring attacks.

To better understand your migraines, it is a good idea to write down as much information about your health history. You should also use a migraine journal to keep a record of each and every migraine attack. Write down what you were doing before each attack, anything you ate as well as the weather conditions. This information will help your migraine specialist give you the best advice on avoiding future attacks.

• Alcohol Migraine triggers: an introduction

When migraine sufferers, also called migraineurs, are asked to list their food and beverage migraine triggers, alcohol is named the most often.

Determining if alcohol is the true reason behind an attack can be a murky subject since alcohol ingestion can result in “hangover” headaches in many people, even those who don’t suffer from migraines. For those with alcohol-triggered migraines, even a small amount of alcohol can launch an attack.

Alcohol and migraines

Roughly a third of migraine sufferers say that alcoholic beverages can trigger their migraine attacks. A tenth of migraine sufferers say alcohol is a frequent or consistent trigger.

Early written references of alcohol provoking migraines date back to the words of Celsus (25 B.C.-50 A.D.) “the pain…is contracted…by drinking wine.” Another early reference is found by Paul of Aegina (625-690 A.D.) who also wrote of the relationship between drinking wine and migraines. Certain chemicals in alcohol, such as tyramine and histamine are believed to act on chemicals in the brain, kicking off the series of events that leads to a migraine attack.

Because alcohol use can increase with stress, some researchers believe it is a combination of the alcohol and stress which sets migraine attack in motion.

Migraine and red wine

Different studies report different findings on which type of wine triggers the most migraine attacks. For example, a European study found that 11 percent of migraine sufferers pointed to red wine as the most common culprit. However, a French study showed that 54 percent of the alcohol-induced migraine attacks came after drinking white wine. Histamine, which may be responsible for triggering migraines, is found in far higher quantities in red wine than in white. Red wine contains 20 to 200 times the amount of histamine than white wine. Women are more likely to have migraines triggered by red wine than men.

EMOTIONS AND STRESS: Anxiety, stress, excitement, worry, anger and other emotions can spark a cascade of symptoms in most people. In those who suffer from migraines, these emotions can trigger a migraine attack.

Migraines and stress

Some sufferers consider stress the most common cause of migraines. Several studies place stress near the top of the list as the trigger most often named by migraine sufferers. Many studies show that 60 percent to 70 percent of those with migraines cite stress as a regular trigger.

Stress can come in many forms: pressure at work to complete a project, excitement about an upcoming wedding, a traffic jam making you late for an appointment or a family conflict. During stressful moments, the brain releases chemicals, including adrenaline, as the body goes into self-preservation mode. When the brain senses stress it prepares for “fight or flight.” These chemicals cause a range of changes in the brain and body, including muscle tension and dilation of blood vessels. These chemicals are activated in the brain when you have a migraine. For a person who suffers from migraines, these reactions to stress can trigger a painful migraine. Stress can come in many forms, both negative and positive. Events that are taxing and worrisome, surprisingly have similar effects on some migraine sufferers as events that are happily stressful such as a big job promotion or anticipation of an exciting date. Stress can also make an existing migraine worse.

For some people who battle migraines, the attack doesn’t start during the stressful or emotional event. Instead, the migraine symptoms may start after the stressful event has passed, during what is called the “let-down period.” This occurs after a period of high stress or pressure ends and the individual relaxes. These migraines happen often on the weekend or at the beginning of vacations when everything has calmed down.

Managing emotions and migraines

Learning what causes changes in your emotional state can help you manage and perhaps even avoid setting off a migraine attack. Recording your feelings, experiences, events along with each case of migraine in your migraine journal will assist in determining what types of situations produce painful results.

ENVIRONMENTAL CHANGES : Different factors in the environment – some which the migraine sufferer is unable to control – may lead to a migraine attack. As with many issues related to migraines, it is unclear how these changes in the surroundings lead to migraines. Some researchers believe that people with environmentally-induced migraines are more sensitive to influences in the atmosphere. Changes in the environment have also been blamed on allergies, pain and fatigue.

How do weather changes cause migraines

For ages, people have reported being able to “feel” an oncoming thunderstorm. This, researchers believe, is a result of a buildup of positive ions in the air which may raise the body’s serotonin. Serotonin is known to be linked to migraines. There are also people who experience seasonal migraines, which means they have far more migraines during certain times of the year.

Types of environmental triggers

• Weather changes including: temperature changes, extreme heat or extremely cold weather, humidity, barometric pressure changes and storms

• Odors, pollution and smells including: smog, cigarette smoke, perfumes and chemical odors

• Lights, such as: bright lights or glaring lights, fluorescent lights, flashing lights or screens

• High altitude

• Flying, jet lag, travel or motion

• Dusty conditions

• Dry conditions

• Patterns, including: stripes, checkers or zigzag lines

A 2008 study of 200 migraine sufferers found that 74 percent of female migraine sufferers and 45 percent of males named environmental factors as a migraine trigger. The average sufferer named three environmental factors that led to migraine attacks. In the same study, 35 percent of patients counted smell as a trigger, while 26 percent blamed air conditioning, 14 percent pointed to the sun and 11 percent named cigarette smoke.

Coping with environmental migraine triggers

Learning which changes in the environment might trigger your migraine attacks is an important step in managing your migraines. To learn what leads to your discomfort, keep a detailed migraine journal. Write down information about your surroundings, including what you see, smell and how you feel. Be sure to jot down information on weather-related factors and what you were doing before the migraine arose. Also keep tabs on all of your migraine symptoms. This journal will be invaluable as you seek treatment from a migraine specialist.

• Food and Drinks Migraine triggers: an introduction

Foods, drink and eating habits have long been blamed for triggering migraines in sufferers. Some studies show that about 20 percent of migraine sufferers count certain foods as triggers. Other studies report that anywhere from 7 percent to 44 percent of migraine sufferers point to certain foods as triggers.

Sometimes it’s not necessarily the food itself that triggers the attack, it may be an additive in the food such as food coloring that launches the migraine attack.

Specific foods may serve as triggers in some individuals, while others might suffer a migraine attack if they miss a meal. Studies show that almost half of people with migraines have attacks if they fast. The migraine typically occurs after roughly 16 hours of fasting. The reason behind this isn’t certain, but some researchers believe that without food the body produces stress hormones, which activate chemicals in the brain responsible for migraines.

Another belief is that the food cravings are actually part of the disease which leads to eating non-typical foods, such as chocolate. In this scenario, the food itself may not be the trigger. Most common foods that trigger migraines

• Chocolate, 75 percent

• Cheese, particularly aged cheese, 48 percent

• Citrus fruits , 30 percent

• Alcohol, particularly red wine and beer, 25 percent

According to a 1979 study of 500 migraine sufferers

An additional list of foods that trigger migraines

• Ham, hot dogs, other cured meats

• Monosodium glutamate, MSG, commonly found in Chinese foods, soy sauce and packaged foods

• Asparatame and other artificial sweeteners

• Asian foods

• Snack foods

• Fatty foods

• Ice cream and other frozen foods

• Food dyes

• Coffee, tea, cola (other items containing caffeine and caffeine withdrawal)

• Dairy products, yogurt

About specific migraine food triggers

Chocolate contains several ingredients that may play a role in triggering migraines. One substance, phenylethylamine may alter blood flow in the brain or cause the release of other chemicals in the brain leading to migraine. Chocolate also contains caffeine.

Caffeine has well-known effects on the central nervous system and the blood vessels of the brain. Marketed as a stimulant that increases alertness and energy, caffeine may also induce insomnia. Withdrawal from caffeine is also known to cause head pain which can last for days.

MSG, monosodium glutamate, a food additive used to enhance flavor of foods. It is commonly found in foods from Chinese restaurants, frozen foods, canned or dried soups, processed meats, salad dressings, snacks as well as tomato or barbecue sauce. MSG, has been found to cause animal blood vessels to narrow and contract, may trigger migraines by this action in the blood vessels of the brain. It could stimulate certain receptors in the central nervous system or lead to the release of nitric oxide, which may lead to the head pain.

Cured meats such as bacon, sausage, hot dogs and ham contain nitrites to preserve color and flavor, while preventing growth of botulism. Nitrites may cause the release of nitric oxide and widening of blood vessels.

Managing migraine food triggers

The best way to manage your food or any other migraine trigger is to take notes in your migraine journal. This journal should contain:

• A detailed description of every migraine attack

• What you were doing before you experienced the migraine

• How long the migraine lasted

• A list of all symptoms you experienced

• A description of how severe your migraine symptoms were

Your migraine journal will help you make your own migraine trigger list. You can probably reduce the number of migraine attacks by avoiding items on your list.

Hormonal Changes: Hormonal changes migraine triggers: an introduction

Hormones, the powerful chemicals that send signals throughout the body, play a large role in women with migraines. Hormones serve as migraine triggers in numerous stages of hormonal activity throughout a woman’s menstrual cycle and throughout her life.

Women experience hormonal changes when they:

• first begin menstruating

• begin their monthly menstrual cycle

• end their monthly menstrual cycle

• take oral or other hormonal contraceptives

• are pregnant

• post-partum

• first enter menopause

• take any form of hormone therapy

• are further along in menopause

Since migraines and hormones are related and because women have several fluctuations in hormones, it’s no wonder that some 70 percent of migraine sufferers are women. Migraines can be triggered by or made worse by the hormonal changes a woman experiences. Studies show that women complain of more severe head pain, migraines what causes migraines in women

Changes in the hormone estrogen are thought to trigger reactions in the brain the lead to migraines in women. The amount of estrogen circulating in a woman’s drops right before the start of the monthly menstrual cycle. Some women have migraines that are closely tied to their period. These are called menstrual migraines. They usually occur right before or in the very first days of the menstrual cycle and improve after menopause. In one study, 62 percent of women reported that their migraine symptoms improved after they stopped having their monthly menstrual cycle. However in 18 percent in that study said the migraines got worse.

Pregnant women and migraines

Pregnancy offers a reprieve for most women who suffer from migraines. Because estrogen levels gradually rise during pregnancy, many women say their migraine symptoms improve. However, after the pregnancy ends, when the hormone levels drop suddenly, the migraine symptoms can return immediately.

that last longer and cause more disability than men with migraines. How to prevent hormonal migraines

Keeping a migraine journal will help you discover when during your cycle the migraines occur. For some women, taking an over-the-counter or prescription pain reliever a few days before the start of their menstrual cycle helps prevent the migraine attack. Consulting a migraine expert will help determine what’s best for your migraines.

Exercise- Physical activity: Exercising and Physical activity Migraine triggers: an introduction

One of criteria for diagnosing migraines is that the pain and discomfort worsens with physical activity. For people with tension headaches, the head pain is not aggravated by routine physical activity. Also, physical activity triggers migraines. Sometimes it is everyday activities that launch an attack, other times heavy activity is to blame. Terms such as “weight-lifter’s headache” or “sports-related migraine” are used to describe it because the pain and symptoms arise after physical exertion or effort. Many people who suffer from persistent migraines avoid certain physical activities hoping to prevent migraine attacks. Types of physical activity that triggers migraine attacks

Different types of activity can cause migraines in different people.

• Walking up and down stairs is a common complaint. Many migraine sufferers say this triggers or aggravates their migraines.

• Head movement commonly makes migraines worse. In some people, abrupt head movements can trigger an attack.

• Bending over or rising up can also worsen head pain. Some people describe throbbing pain, or explosions of pain.

• Exerting a lot of energy may also trigger migraines in certain sufferers. Lifting heavy objects or working out vigorously

• Changes in sleep schedules can also trigger migraines. This can be a problem

if you get too little or even too much sleep. The best way to manage this is to stick to a regular sleep schedule, so your body is properly rested but not too much so. This means maintaining the same sleep routine on the weekends and on vacation. Jobs that require irregular shift work should probably be avoided to prevent migraine attacks. Even so, for some who suffer from migraines, sleep is the only way to stop the symptoms.

Coughing and sneezing are thought to increase pressure inside the head, which can lead to migraines. This increase in pressure is called the Valsalva’s maneuver, which is sometimes done deliberately by closing the mouth, pinching the nose and exhaling. It is done to equalize pressure in the ear, for example, if pressure builds while flying. However, there is the risk of applying too much pressure to the middle ear and causing damage. There are several possible reasons for why physical activity can lead to a migraine. For heavy activity, the reasons might be:

• Dehydration

• Extreme exercise

• Heat

• Altitude, which might prompt migraines because of low oxygen

• Low blood sugar

Exercising with a migraine

Head pain caused by exertion accounts for 75 percent of women’s sports-related head pains, while it is responsible for less than half of men’s. Running and jogging are usually the biggest culprits. One 1994 sports report breaks the migraines into two categories. Exertion pain accompanies strenuous lifting, bending or physical jarring. The pain is usually in the neck or the bottom, base of the head and lasts only a few minutes. Effort migraines may last much longer, up to several hours, and comes after aerobic activity and made worse by dehydration, heat, fatigue and extreme exercise.

SEXUAL ACTIVITY : Sexual activity migraine trigger: an introduction

Sex stirs up lots of emotions, chemicals and other reactions within the body. Therefore it’s understandable how sexual activity can be a migraine trigger. It is sometimes called “coital headache.” Sex-related migraines are usually unpredictable and don’t occur with each sexual experience. This type of migraines occur most often in people ages 20 to 60, with it most commonly first occurring around age 40.

Migraine sufferers and sexual intercourse

The head pain and other migraine symptoms can sometimes arise with sexual activity and also with masturbation.

Why do men get migraines after sex

Sexual activity triggers migraines in men four times as often as it does in women. The pain and discomfort may occur because of the energy exerted during sexual activity, the increased activity in the buttocks and legs or because of the alterations in blood pressure.

Migraines and other types of head pain may occur:

• During the escalation of activity lead up to sexual intercourse

• During sexual intercourse itself, pre-orgasmic

• After climax, which is called orgasmic

• In the base, occipital region of the head

• Gradually and increase along with sexual excitement

• Explosively

• With throbbing pain

For head pain to be blamed on sex, the International Headache Society says the pain must:

1. Be brought on by sexual arousal

2. Have pain on both sides

3. Be prevented or lessened by stopping sexual activity before orgasm

4. Not be caused by any other disorder

Possible reasons for sexually – induced migraines

The reason behind the head pain may be related to contracting muscles during sex. The attacks may be avoided by working on relaxing neck and jaw muscles during sexual activity. The explosive pain has been blamed on the rapid increase in blood pressure and heart rate during sexual climax.

If the head pain is the worse ever experienced or resembles a “thunderclap” of pain, seek immediate medical attention. The pain may be a symptom of an un-ruptured aneurysm.

Therefore from the above discussion I hope I am able to convince people that migraine is not here to stay forever but with care and caution you can get rid of migraine to a great extent.

Article submitted Monday, November 28, 2011 & read 410 times.

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