Migraine Headache Problems

            Migraine headache is a common problem which affects over 20% of the population, at least some time in their life.  Migraine headaches are a phenomenon of altered blood flow to the head.  In many instances there is increased blood flow to the sides of the head I the temple area, behind the ears, and sometimes in the front of the face.  Blood flow in the head is sometimes “shunted” or taken away from areas of the brain and diverted to the scalp, sinus areas, ears, and so on.  This diversion of blood flow from the brain sometimes causes symptoms resembling a stroke.  In particular, there can be loss of vision to one side or sometimes complete lack of vision in one or both eyes.  On occasion, there is numbness and tingling of the face and of one arm and in extreme cases a severe paralysis of one side of the body which may last for twelve to up to twenty-four hours.  Visual warnings of flashing lights and arcs of color may precede a migraine.  More subtle manifestations of migraine can be associated problems of irritability, personality change, sleepiness, nausea, vomiting, and abdominal pain.  Migraine headaches can last from a few hours to up to several weeks or longer.  In some individuals, migraine becomes more of a “continuous” problem with a perpetual increased blood flow to the area of the ears and sinuses which tend to cause persistent sinus congestion and a feeling of ear stuffiness.  The discomfort of a migraine can vary in intensity from no pain at all, to a severe excruciating pain which incapacitates the individual and forces them to curl up in a ball in a dark room away from loud noises.

            The cause of migraine headaches remains uncertain although there appears to be an inherited or familial contribution in many cases.  Many individuals troubled by migraine headaches have had prior problems with motion sickness or car sickness and this suggests an undue sensitivity of their nervous system to external stimuli or change.  Factors that can precipitate migraine include ingestion of alcohol, going without adequate sleep, fasting, or skipping meals, and changes in hormonal status as with menstrual periods, or menopause, bright sunlight, and on occasion certain foods.  However, foods other than alcohol are not a common precipitant of migraine.  Migraine headaches tend to come somewhat unpredictably, not necessarily during times of stress, but sometimes when a person is most relaxed and otherwise happy.  Precipitating factors or causes of headaches should be watched for, though are not often found.

            Migraine can imitate many other varieties of headaches, thus causing some confusion as regards diagnosis or classification.  Some migraine headaches are associated with marked pain in the back of the head and cause a feeling of tightness and tension in the neck.  They are sometimes misunderstood as being a stress or muscle contraction type of headache.  Migrainous pain in the sinus area can feel like a “sinus” headache.  Many people have a mixed type headache with some migraine component and some tension or stress type headache in addition.  Tension or stress type headaches can usually be handled by simple type analgesics as aspirin or Tylenol and by trying to take a break from demanding stressful activities.  More persistent and unresponsive type of stress or tension headache can sometimes be seen in the setting of more serious underlying depression or unresolved family problems that need address.  Migraine attacks can be nearly continuous for prolonged periods.  In these protracted cases, it is important to consider the possibility of other disease in the brain such as a tumor, or malformations of blood vessels as aneurysms.  If appropriate, x-rays can be done to check out the brain, sinuses, neck and head structures, although these tests are usually of little help in dealing with or treating most headaches.

            Treatment for bothersome migraine headaches should initially include attempts to eliminate any factors which obviously bring them on.  Unfortunately, this is usually not enough to eliminate headaches and most assuredly does not decrease the intensity of headaches when they do occur.  Hypnosis, relaxation techniques, biofeedback, and even supportive psychotherapy can be helpful in some instances of chronic tension or stress type headache.  However, these modalities of treatment offer very little for management of severe migraine.  A person with a migraine tendency is unfortunately afflicted with a disorder that is most often beyond his or her control.  In particular, it often does very little good to confront the person with the headache suggesting that they have a headache just because they were not able to tolerate stress, or have a weak constitution.  The pain of migraine and other vascular type headaches can incapacitate the strongest, most well conditioned weight lifter as well as the elderly frail individual with many other medical problems.

            The treatment of migraine with medications can probably offer the most direct and effective relief in most circumstances when compared to other more indirect means of treatment.  Two approaches need to be considered in lessening the symptoms of headaches with medications.  The initial abortive approach is to try and “stop the headache in its tracks” by giving medication that gets rid of the headache as it comes on.  Unfortunately, migraine headaches are sometimes stubborn in responding even to strong medications and the best one can hope for is to be tranquilized or calmed such that they can sleep until the headache has passed.  “Sleeping it off” is not always an option when someone has to continue functioning and does not have the opportunity or leisure to lie down and take a nap.  Recurrent use of oral narcotic medications or of intramuscular shots should be avoided with migraine headaches.  There is a tendency for narcotics to wear off quickly with return of a rebound headache such that more narcotic pills or shots tend to be craved.

            The second approach of treating migraine or vascular headache syndromes with drugs includes a prophylactic regimen with an individual taking medications every day to try and prevent the headaches from occurring in the first place.  If headaches do “break through” with prophylactic treatment, there is hope that they will be less intense and shorter lasting than they would have been if the individual would not have been on the prophylactic drug.  Benefit from taking the drug has to be weighed against side effects and inconvenience with having to be on regular medication.  In general, it is useful to institute drug treatment, either in an abortive or prophylactic regimen, if headaches are severe and frequent enough to decrease the quality of life in the individual who is afflicted.

            It is fortunate that the vast majority of migraine headache suffers can be relieved of their symptoms, either by some preventive approaches or by intervention with medication treatment of some sort.