Migraine Management Migraine, Also Known as Hemi

Migraine Management

Migraine, also known as hemi crania and megrim, is a severe and recurring headache. Commonly known as sick headache, it often affects only one side of the head, and is usually accompanied by nausea, vomiting, visual disturbances, and sensitivity to motion, light sound and odors.

'The, International Headache Society (HIS) has created a checklist by which migraine can be diagnosed. This is a simplified, standardized and globally accepted diagnostic test for migraine. The following criteria define common migraine, which is the migraine without aura:

A patient should have had at least five of these headaches.

The headache lasts from 4 to 72 hours.

The headache must have at least two of the following:

a. One sided location.

Pulsing or throbbing quality.

c. Moderate or severe intensity, making daily activities difficult or impossible to perform

d. Headache is worsened by routine physical activity. Such a bending over or climbing stairs.

The Headache is accompanied by at least one of the following:

a. Nausea and/or vomiting.

b. Dislike of light (photophobia) or dislike of sound (phonophobia).

5. Secondary causes of headache are excluded with a normal exam and/or normal CAT or MRI scans." (Tepper, 2004, pg: 3, 4)

In some cases of Migraine, post-migraine hangover is also experienced in which sufferers often feel drained of energy after the headache (Heins, 2003). Migraineurs, or the migraine sufferers can be grouped into two categories; those who have warning signs before the painful part of the attack begins, and those who don't. However the people who experience these warning signs or auras are a minority. An aura experience includes seeing imaginary lights, other vision disturbances or numbness on one side of the body. (Harder, 2005). Heins describes auras as:

"Typically lasting 5 to 30 minutes, an aura can come in the form of a flickering or zigzag light in the field of vision" (Heins, 2003).

Man has been searching for preventive methods to severe headaches for all of recorded times. As a cure to severe headache, the Ancient Egyptian scriptures suggest strapping a crocodile to the head which might have surprised and disturbed the sufferer considerably beyond his headache (Tepper, 2004, i). Thus, providing root to the Shock Theory. However ironic this may sound, time and research has devised and brought forth such advances in migraine treatment as would have been undreamed of, even 25 years ago. Research on migraine management shows despite the intensity of Migraine pain, clinical treatment may not be the soundest approach to combat it and hence several alternative treatments are being recommended.

STATISTICAL DATA OF MIGRAIN SUFFERERS

Statistics reveal that, "Eighteen percent of women, six percent of men, and four percent of children have migraine. All races are affected, although for reasons that are unknown, whites are affected more than African-Americans, and Asian-Americans are least often afflicted." (Tepper, 2004, vii). Among all the complex disorders, migraines are more common than asthma, diabetes or congestive heart failure. According to American Medical Association migraine causes severe and often unbearable pain to about 26 million Americans. (Karen Goldberg Goff, 1999). This disease has considerable social and economic damages, to both the sufferers and the society as a whole. Since the U.S. society alone is at as much as of 13 billion dollars of lost-work owing to migraine (Tepper, 2004). Most sufferers miss out around of two days of work a month as a result of migraine-related problems (Heins, 2003). Therefore this problem is very critical and requires constant research for more effective treatment procedures.

However, surprisingly so, National Headache Foundation study estimates that less than half of migraine sufferers seek any kind of medical help (Heins, 2003). Even if they did seek help, it's likely that sufferers might not get the right treatment and support. Migraines are often wrongly linked to psychological problems, in cases of female patients particularly, who are 75 per cent of migraineurs (Heins, 2003). Richard B. Lipton, MD, professor of neurology at Albert Einstein College of Medicine of Yeshiva University in the Bronx, New York, is of the same view. While talking about how migraine is unjustly linked to psychological problems he says "Women are more likely to have their pain dismissed as being more imagined than real" (Lipton, 2002).

There are a range of effective medications available for migraine treatment from a benign to acute degree. These reduce a periodic count of attacks to about 40 per cent. (Harder, 2005). But all these are loaded with side effects ranging from forgetfulness to fatigue, nausea, and skin sensations that have no obvious cause. Some experts list drug dependency, and even cause severe headache that continues despite the use of medication, as commonly reported side effects. Therefore, most migraine experts suggest changing lifestyles to help prevent migraine and minimize pain if migraine occurs.

WHAT TRIGGERS MIGRAINE.

Migraine is sometimes developed due to stressful lifestyle but often it is passed down to generations. To be able to fight off migraine effectively it is important to understand what triggers it. As already known, migraines can strike men, women, children with wide range of variations, intensities and symptoms. Therefore there are a variety of triggers that bring about this pain. What all types of migraines have in common is a pain lasting 4-72 hours, often at one side of the head and accompanied by nausea, vomiting and sensitivity to light or sound.

Experts are of opinion that an attack is triggered from within the brain itself. Once one begins, pain and other symptoms of migraine arise from a process swelling resulting from some exchanges between the trigeminal nerve and blood vessels found in the coverings of the brain. Serotonin, a naturally occurring chemical in the brain is considered responsible in this inflammatory process. (USA Today, 2001)

"It is a severe, pounding headache and a misunderstood, mistreated and misdiagnosed condition," says Dr. Seymour Diamond, executive director of the National Headache Foundation and a headache specialist in Chicago. "About 30% of patients get a warning - an aura - before the headache, which can be seeing jagged lines or bright stars or having numbness in arms and legs. A migraine is caused when the brain sends an impulse to certain receptors that control the blood vessels," he says. "The blood vessels then constrict and dilate."(Macmillan, 1995). Here are some of the things that generally trigger migraine.

Interestingly, a good seventy per cent of the migraine sufferers are women. While in more than half of the female sufferers, the headache is linked to hormonal changes in the menstrual cycle, says Dr. Diamond, author of the book "The Hormone Headache" (Macmillan, 1995). As much as 90 per cent of the sufferers are genetically endowed with migraine attacks. Pinpointing what may individually offset this attack depends on person to person. Often it could be cheese, chocolate and red wine. While sometimes it could be low blood pressure and tyramine, which is found in raw onions and smoked foods. Relaxation Techniques which will be discussed in the course of this paper are also very effective in preventing the headache.

Migraine sufferers need to abstain from the following things which most commonly trigger migraine: Ripened cheeses such as Cheddar, brie, Camembert, Herring, pickled or dried, Chocolate, Sour cream, Peanut butter, Sourdough bread, Foods containing MSG, Figs, raisins, papayas, avocados, bananas, citrus fruits, Caffeine, Nitrates found in sausage, bologna, salami, hot dogs, pepperoni, Alcoholic beverages, specially red wine.

Chocolate, cheese and red wine are particularly thought to trigger migraine. However it is only recently been considered that sufferers may crave for these foods just before an attack, as Dr. Mark McClean, a GP at Shankill Health Centre, believes it. (Chapman, 1997). Another migraine expert, Professor Philip Lamey of Queen's University Belfast has contributed a new cause for the trigger. He as proved that teeth grinding is a factor that triggers migraine in those sufferers whose attacks occur in waking and during early mornings. He has designed a special splint that is worn in the night to avoid the teeth grinding and cure migraine. Since clenching and grinding teeth can cause chemical changes in the saliva which disturb the blood vessels in the brain thus triggering the headache.

Other factors that could trigger migraine include stress, or relaxation after a period of stress, physical fatigue, lack of sleep or too much sleep, tension, anger, missed meals, certain foods and hormonal factors (periods, menopause, use of the Pill). It is possible that all of these impose a chemical effect on the saliva of teeth grinding.

Doctor McClean believes that child sufferers can especially benefit from the modern preventive methods for migraine, while types of migraine suffered by women before and during period time can be treated by Vitamin B6 or hormone therapy such as progesterone.

A new phenomenal research carried out by a Neurologist Roman Sztajzel appears to fascinate the migraine experts worldwide (Stacey, 2005). It has linked the migraine preceded by auras to a seemingly harmless hole in the heart. This hole between the right and left chamber of the heart allows the blood of an unborn child to bypass the lungs while it gets oxygenated blood from the placenta of the mother; as the body of an unborn child doesn't rely on lungs for oxygen until he is born, and begins to breathe on his own. At birth or shortly after the birth, tissues flap and close this hole. But in about a quarter of the U.S. population, complete closure never occurs (Harder, 2005). What remains of this tunnel like opening is called patent foramen ovale or PFO and it can act as a valve. It is normally shut but occasionally throws blood to the lungs off to the brain and other part of the body. Most of the people who have a PFO never screened for it since the doctors rarely suspect it of causing health problems. But in some cases blood clots passing through the PFO can shoot to the head and trigger strokes. An Italian patient treated for PFO infusion due to a stroke had her migraine immediately disappear after the surgery.

'In the February Journal of the American College of Cardiology, Reisman, Jesurum, and their Seattle colleagues describe the results of 162 PFO closures in people with a history of stroke or related vascular blockages. Migraines had affected 57 of the patients before the operations. In more than half the patients who had been troubled with migraines, the headaches disappeared after the operation. Another 14% of patients reported a reduction by at least half in migraine frequency." (Harder, 2005). Researches are still being made to see if closing a PFO only, can help prevent migraine, but Professor Rothwell emphasizes the importance of good diet and daily exercise.(Stacey, 2005).

CHANGES IN LIFESTYLE TO AVOID INCEDENCE OF MIGRAINE

After having understood what exactly triggers migraine, experts and sufferers have devised various therapies, dietary plans and exercises to fight off migraine subtracting the adverse side effects of medications. Preventive treatments such as Biofeedback and other relaxation techniques such as aerobics, yoga, warm bath is also recommended by experts, doctors and herbalists. Biofeedback has been approved by the American Medical Association for treatment of headaches. It is a method which helps the sufferer to control specific target functions of both the central and automatic nervous systems, such as heart rate, blood pressure and muscle tension. This relaxes the blood vessels that are actually causing the pain.

Sue Turner a sufferer for 32 years shares her interesting experience of getting rid of migraine completely by only developing a habit of drinking more water. Dealing with migraine since childhood she was really worried, when she set her marriage date, that a migraine would keep her from walking up to the aisle. She had been taking over 200 pounds worth of drugs a month but to no avail. Then as her consultant told her to simply take lots of plain tap water, this subsided her migraine altogether.

"After all those years of suffering I couldn't believe the solution was so straightforward" (Collins, 1998).

Sue's naturopathic nutritionist explains that the migraines are a symptom of dehydration caused by drinking up to nine mugs of coffee a day. She advised Sue to stop polluting her body with caffeine drinks like tea, coffee and cola - all of which have a diuretic effect and increase the amount of urine produced. Other triggers for migraine include lack of food, anxiety, shock, fatigue, intense smells or noises, a change in climate, high altitude and certain foods like chocolate and cheese.

Jane Williams Jane William, a naturopathic nutritionist says that "Our bodies are 70 per cent water and our brains are 75 per cent water. If brain tissue dries out it leads to inflammation, heat and pain. These are the body's responses to lack of fluids. Most migraine sufferers simply do not drink enough plain water. If they did they would find that it could help their headaches. In any single day we lose around two liters of water through the kidneys, bowels, skin and through the lungs as we breathe. Unless that fluid is replaced we can end up dehydrated. The body can lose more than two liters in hot weather or if it is under stress. Alcohol, coffee, tea, chocolate and fizzy drinks all deplete the body's water level and lead to a higher concentration of toxins. If this is all that you drink you can end up dehydrated. These drinks also rob the body of the mineral magnesium, which is very important in balancing blood sugar levels. Headaches are just one of the symptoms that can occur when blood sugar levels are low. Many people who suffer with migraines who have bowel problems too."

"The two very often go together," she says. "A constipated bowel is a dry bowel because the stools lack moisture. If the body is dehydrated it will not be able to cleanse properly and congestion builds up. The key thing to remember is that we are made up of water, and even the ageing process is a drying process. We need water to re-hydrate as well as rid our bodies of the harmful toxins and chemicals that can build up. Fruit teas are great but you need to drink at least three or four pints of pure water a day. People say to me, 'How can I drink that much water?' But what they don't realize is if you are drinking five or six cups of tea or coffee that is probably the equivalent. Drinking water straight from the fridge is stressful on the stomach so it's best at room temperature. If you're swapping tea and coffee for tap water, fine, but some bottled water can contain high levels of minerals which are not so good. Best of all is filtered water."

"But if you are used to a high daily caffeine intake, you may feel worse if you stop suddenly. It is best to cut down gradually." (Collins, 1998)

Headache expert Dr. Andy Dowson, of London's King's College Hospital, seconds her opinion and says that "simple measures like increasing water intake and eating regular meals can help some migraine sufferers." (Collins, 1998).

Other Natural remedies include dietary plans; herbs and vegetables with soothing relaxing qualities, naturally occurring hormones and chemicals that provide relaxation and lessen the frequency of migraine attacks, are also added to the diet plan of the sufferer. These include Lavender, ginger, riboflavin, Vitamin b-2; Feverfew, an herb is also thought to help minimize the incidence of migraine. However being very mild it only starts affecting after six weeks of use and is not suitable for pregnant and breastfeeding women. Some naturally occurring enzyme tablets, migraine relief patches, Chinese acupuncture techniques and headbands specially designed for migraine sufferers, are also available in the market.

For women who experience migraine before and during their periods, are recommended to include crunchy sprouting seeds. Eating them raw or cooked in soups and stir-fries is a good remedy. Also red clover is very helpful in avoiding the occurrence of migraine since sprouting seeds and red clover is full of phytoestrogens. This is by all means a good option for a natural hormone therapy.

Analysts are of view that migraine can be managed effectively with help of identifying triggers that lead to their headaches. Prevention, according to them is the best known cure of migraine, to time. Most medications taken for migraine are loaded with a wide range of side effects, such as stomach discomfort, muscle cramps, edema, numbness, tingling of limbs, and depression. Long-term use of painkillers analgesics and other migraine medications can lead to serious conditions. Because of these side effects, drugs should not be used for more than six months at a time and a drug-free interval of three to four weeks should be observed between each course of treatment.

On the other hand, herbal treatments is very effective and carries minimal side effects as herbs are powerful healers, which can cleanse, strengthen and uplift you in both body and mind. A medical herbalist can help you to strengthen your immune system, detoxify your cells and boost your energy levels. Herbs work gently with the body to promote its own healing powers and in most cases they have no side-effects. Herbalist, Andrew Chevallier, president of the National Institute of Medical Herbalists is of opinion that for an herbalist looking at your entire lifestyle, getting to the root of your illness and seeking to find ways to restore you to perfect health is the objective. He says that the best thing about herbalism is seeing people change their entire lifestyles and how their patients once ill, become visibly healthy and happy. (Alexander, 1996). He suggests that fruit and herbal tea, essential oils and Lavender are very beneficial for migraine sufferers. Particularly Lavender that can be used in multiple ways as a relaxation therapist for migraineurs. Lavender is one essential oil that can be rubbed neat on the temple. Only a few drops applied and rubbed into temples give off soothing effect and help in subsiding migraine symptoms. Similarly Lavender tea can be taken for tension, anxiety, insomnia and low spirits all of which lead to migraine incidents.

According to Stewart J. Tepper, author of the book, Understanding Migraine And Other Headaches, there are a number of ways to prevent the occurrence and frequency of Migraine. Other than trigger reduction, caffeine and changing lifestyles, are two important decisive factors that a sufferer can use to avoid the headache. Physical therapy and alternative preventive methods are also useful. All these would be addressed in due course of this document.