Health – Migraine Headaches

By Gilda Morales, ANP, DC

Today’s column will focus on a common malady that affects more than 28 million Americans, females three times more than males.  There appears to be a strong genetic component so it is not uncommon to find migraine headaches in several generations.

There are quite a few risk factors associated with developing migraine headaches, including family history, female gender, stress, hormone issues, disruption of normal sleep patterns, skipping meals, increasing alcohol use, cheese, overuse of caffeine, use of MSG, a common food preservative, artificial sweeteners and some medications such as nitroglycerine.

The diagnosis is made based on clinical presentation and symptoms and rarely requires advanced diagnostic imaging.  There is an exception if the patient experiences a new onset of severe headache after the age of 50, a change in headache patterns, or a prolonged aura. The patient usually presents complaining of a pounding, pulsating headache, lasting from 4 to 72 hours.  It commonly affects one side of the head, and if severe enough, can cause nausea, vomiting, and light and sound sensitivity.  There can also be muscle pain, dizziness and lightheadedness in some cases.

Treatment should focus on conservative measures initially, starting with medications such as Ibuprofen or Naproxen, cold towels to the head and lying down in a quiet, dark room to sleep.  Excedrin Migraine, is an FDA approved medication available over-the-counter, which is quite effective, inexpensive and contains Aspirin, Acetaminophen and caffeine.

For more intense headaches, there is a class of medications called triptans, and include brand names such as Imitrex among others.  Some patients respond better to one triptan than another, and as such, patients should try different ones until they find one that works for them. Patients should avoid using multiple doses of Aspirin or other NSAIDS, such as Aleve or Ibuprofen to prevent a phenomenon called rebound headaches, which worsen the more medication the patient takes.

Those that suffer from frequent migraine headaches may benefit from one of several medications available that can actually prevent headaches.  These can include valproate, topiramate, propranolol, timolol, metoprolol and low doses of amitriptyline.  One of the newest treatments for chronic migraines that fail to respond to standard medications is Botox injections, which have shown to be significantly effective in reducing the number of migraines suffered.