My aching head.What did Ulysses S. Grant, Edgar Allan Poe, Karl Marx, Sigmund Freud, and Charles Darwin have in common? Migraine headaches. If you belong to this distinguished group, you're not alone You're Not Alone may refer to:
Like many other "migraineurs," you may first see flashing lights in front of your eyes before the throbbing throb intr.v. throbbed, throb·bing, throbs 1. To beat rapidly or violently, as the heart; pound. 2. To vibrate, pulsate, or sound with a steady pronounced rhythm: pain begins. During the painful attacks you are often nauseated nau·se·at·ed adj. Affected with nausea. , and may feel dizzy, have cold hands, and be sensitive to light or sound. You have probably tried over-the-counter drugs, which brought little or no relief. As a fellow sufferer, I have another trait common to many migraineurs--curiosity. I wanted to know why I have this affliction, what I can do to ease the pain, and if there's a cure. To get the answers, I put these and other questions to Dr. Seymour Diamond, director of the Diamond Headache Clinic in Chicago, and executive director of the National Headache Foundation. Q: Are there different kinds of migraine headaches? Dr. Diamond: Most specialists divide migraine headaches into two broad categories: the classic migraine classic migraine Migraine with aura Neurology An episodic headache that accounts for up to 20% of all migraines, lasts 4 to 72 hrs, is associated with N&V, photo- and phonophobia, and often follows an aura, which may not occur on the same side as the migraine; and the common migraine common migraine Migraine without aura Neurology An episodic headache that accounts for ±80% of migraines, and lasts between 4 and 72 hrs, associated with N&V; it is a common type of chronic headache, more common in ♀ between age 10 and 46, and not . With the classic migraine, the person experiences an aura--vision of bright lights of wavy lines. Some have blind spots or a distortion of the vision field. With the common migraine, the aura is missing and, as the name implies, this type of migraine headache is more common. Q: Is there a heredity factor? Dr. Diamond: Yes. We see some patients who have no family history of migraines, but the number of cases in which there is a family connection is striking. Q: It has been said that migraine headaches are more common among women than men. Is this true? Dr. Diamond: Specialists estimate that 60 to 80 percent of migraine patients they see are women. women. But we are not sure whether women are more susceptible to migraines or whether men simply do not report that they have migraines, thinking it's "unmanly" to go to a doctor because of a headache. Q: Is there such a thing as a migraine personality? Dr. Diamond: Many migraine patients are perfectionists Perfectionists: see Noyes, John Humphrey. . They tend to be intelligent, doers, and achievers. However, many specialists reject the idea of a migraine personality because the psychological makeup of migraine sufferers tends to be similar to that of nonmigraine sufferers. Q: What actually goes wrong in the system when a person has a migraine headache? Dr. Diamond: In all cases there is a swelling, or dilation dilation /di·la·tion/ (di-la´shun) 1. the act of dilating or stretching. 2. dilatation. di·la·tion n. 1. , of blood vessels Blood vessels Tubular channels for blood transport, of which there are three principal types: arteries, capillaries, and veins. Only the larger arteries and veins in the body bear distinct names. in the scalp and covering of the brain. Many specialists now believe that the blood vessels also become inflamed during an attack, and we think this accounts for a good deal of the prolonged pain in migraine. Q: Are there things that touch off a migraine attack? Dr. Diamond: Yes, many things. Hunger, because it lowers the blood sugar, may set off an attack. But eating after an attack begins will not stop the headache. Stress can also be a factor. Changes in barometric pressure have been blamed, but the jury is still out on this point. Eating certain foods is high on the list of triggering factors. In women an influx of certain female hormones, especially estrogen, is believed to play a part. We do not know why these factors trigger migraines or why they bring on attacks one time and not the next. Q: If foods are a triggering factor, which foods should I avoid? Dr. Diamond: Before I begin, let me say that there is some variation among migraineurs as to which foods touch off an attack. Also, a food that triggers a headache one time may have no effect the next time it is eaten. Foods that are believed to trigger migraine attacks include freshly baked bread, pork, cheese (except cottage cheese cottage cheese a soft, uncured cheese made from soured skim milk; most of the lactose is removed with the whey. Used in low-residue diets for dogs and cats. ), herring, navy beans, lima beans, most citrus fruits, vinegar (except white vinegar), onions, nuts, and chocolate. Add to the list alcohol. Q: What do you, as a physician, do to help a migraine victim? Dr. Diamond: First we attack the pain, to reduce the severity and the frequency of the attacks. This is usually accomplished by prescribing one of a variety of medicines. If one does not work, we try another. Second, we try to find the underlying cause, and this is not as easy. The causes are sometimes subtle. Q: How do you go about attacking the pain of migraine? Dr. Diamond: We begin by trying to abort or interrupt the pain with medication. Then we attempt to prevent future attacks. By giving carefully prescribed medicines at the first sign of a migraine, we are usually able to abort the headache. A medicine often prescribed is egotamine tartrate tartrate /tar·trate/ (tahr´trat) a salt of tartaric acid. tar·trate n. A salt or ester of tartaric acid. tartrate a salt of tartaric acid. . Usually combined with caffeine (a combination called Cafergot), it tends to constrict con·strict v. To make smaller or narrower, especially by binding or squeezing. the blood vessels, thus reducing the swelling of the vessels that cause the pain. Midrin, a milder constrictor con·stric·tor n. One that constricts, especially a muscle that contracts or compresses a part or organ of the body. , is also useful. It is very important that egotamine tartrate be taken at the first hint of a migraine. Q: Can anyone take ergotamine ergotamine /er·got·amine/ (er-got´ah-min) an alkaloid of ergot; the tartrate salt is used for relief of migraine and cluster headaches. er·got·a·mine n. compounds? Dr. Diamond: It should not be used by women during pregnancy, nor by anyone with certain kinds of heart conditions or circulatory problems and the elderly. Also, it should not be used on a daily basis. Q: You speak of preventing migraine attacks. What do you do in this case? Dr. Diamond: There are several medicines that we prescribe to prevent the headache from getting started. Propranolol propranolol /pro·pran·o·lol/ (-pran´o-lol) a ß, used as the hydrochloride salt in the treatment and prophylaxis of certain cardiac disorders, the treatment of tremors and of inoperable pheochromocytoma, and the prophylaxis of migraine. , (Inderal) a beta blocker, is one. The treatment of choice is Inderal LA, which is to be taken once a day. There are the "nonsteroidal non·ste·roi·dal or non·ster·oid adj. Not being or containing a steroid. n. A drug or other substance not containing a steroid. antiinflammatory" medications. Naproxen sodium and ketoprofen are examples. A milder medicine, with few side effects, is cyproheptadine cyproheptadine /cy·pro·hep·ta·dine/ (si?pro-hep´tah-den) an antihistamine with anticholinergic, sedative, and serotonin-blocking effects, used as the hydrochloride salt. It is also used in migraine prophylaxis. (Periactin). Another class of medicines are the calcium channel blockers Calcium Channel Blockers Definition Calcium channel blockers are medicines that slow the movement of calcium into the cells of the heart and blood vessels. , such as verapamil verapamil /ve·rap·a·mil/ (ve-rap´ah-mil) a calcium channel blocker that dilates coronary arteries and decreases myocardial oxygen demand, used as the hydrochloride salt in the treatment of angina pectoris and of hypertension and the (Isoptin and Calan). Other medications are available, but as with all medicines, the patient's physical condition has to be taken into consideration. Q: What about aspirin? Dr. Diamond: If it works, use it. But in many cases it has very little impact on the deep and persistent pain of migraine. Q: Are cold packs any help? Dr. Diamond: They may help relieve the pain. Worth trying. Q: Is there a place for stress management in the control of headaches? Dr. Diamond: Drugs are not the only way to prevent headaches or control the pain. Many migraine sufferers have reduced the number and severity of their headaches by applying various relaxation therapies and behavior modification techniques. But even if these therapies do not eliminate headaches, I am sure they improve self-image. Learning to handle stress, criticism, anger, or frustration may reduce the frequency of the attacks and make a person feel better about himself or herself. Q: Where should I look for help with this problem? Dr. Diamond: Begin with your own physician. Or, if possible, get in touch with a clinic or physician who specializes in the treatment of headaches. Also, write to the National Headache Foundation, 5252 N. Western Avenue, Chicago, Illinois 60625, and ask for their Headache Handbook, fact sheet, and a complimentary copy of their newsletter. Include with your request, a selfaddressed, business-size envelope with 45 cents for postage. Gary Bousman, free-lance writer and himself a migraineur, writes from Phoenix, Arizona. |
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