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Migraines Are
Nothing to Laugh About

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed in the February 5-6, 2005 issue of
The Mississauga News under the feature: Health & Wellness, Doctor's Corner.
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

A migraine is one of many different types of headaches. Close to 20% of Canadians are afflicted with migraines. The typical migraine headache is described as being pulsatile on one side of the head with mild to severe pain that interferes with daily routines. It is often associated with nausea, vomiting and photophobia which is a tendency to avoid light. Migraines tend to have prodromes and auras. Prodromes are symptoms that precede the headache such as irritability, depression, loss of appetite and restlessness. Prodromes may disappear or lessen as the headache starts. An aura is a neurological symptom that precedes the headache and defines a Classical Migraine. An aura may consist of visual changes such as flashes or tunnel vision, tingling, numbness, and, in some cases, actual paralysis may occur. Migraines without auras are called Common Migraines. The exact mechanism of migraine headaches involves minor swelling and inflammation within the brain structures. This is accompanied by constriction of the blood vessel supplying blood to the brain itself. Migraines tend to start early in life and affect women to a greater extent than men. But the migraine mechanism can extend to other body parts. For example, some people suffer severe ocular migraines involving one eye only, while others, a minority, suffer abdominal migraines with excruciating stomach pain. Many different substances have been implicated in having a role as migraine triggers. Common food triggers include: chocolate, alcohol and red wine, freshly baked goods containing yeast, certain cheeses, pickled meats containing nitrites or amines, and certain beans. Many non-food triggers also exist. Emotional states, menstruation, hunger, intense sexual activity, smoking, computer screens and sleep deprivation can all trigger migraines. Migraines are linked to strokes. Migraine sufferers who experience auras are twice as likely to suffer a stroke. Women who use birth control pills and suffer aura associated migraines increase their risk by almost sevenfold. If you smoke, take birth control pills, and suffer from classical migraines, your risk for strokes increases even more. Migraines tend to cluster in family groups. Menopause certainly improves the migraine prone state, and it is rare to see a new onset of migraines in older people.

Two general approaches are used in migraine treatment. The more sensible approach involves identifying a person's migraine triggers and trying to avoid them. This is sometimes coupled with using medications to prevent onset such as beta-blockers (Propranolol), calcium channel blockers (Flunarazine), anti-epileptics (Valproate), and even low dose amitriptyline. For persons who only get the occasional migraine, a different approach makes more sense. In that strategy, over the counter medications such as Advil and Tylenol are ingested at the first sign of the headache. The sooner, the better. Often the effect of these medications can be enhanced by adding cold compresses, massaging the temples and avoiding bright light. Sometimes stronger narcotics are required such as Tylenol with codeine, Percodan, Fiorinal, Talwin or Demerol. Doctors tend to refrain from encouraging the regular use of narcotics for migraines. These drugs are potentially addictive and can cause rebound headaches which fuel a vicious cycle. A new class of agents appeared on the horizon several years ago that made a wonderful impact in the early phase of migraine evolution. They are designed to abort the vasoconstriction of cerebral blood vessels. Most of them do this by binding to specific serotonin receptors in these vessels. Common triptans include Zomig, Amerge, Imitrex and Maxalt. Recently, caution has been raised about heart patients using these medications. Sometimes migraines are so disabling that hospitalization is required and various intravenous cocktails are employed in the hopes of relieving them.

When dealing with migraines, taking a good history is the key to making a diagnosis, but an examination to rule out other more sinister causes is essential. Tension headaches are more common than migraines and originate when the neck and upper back muscles constantly pull on the scalp muscles. This produces a band like headache that is mostly felt in the temple areas. Before deciding that it is a migraine that plagues you, make sure that you have been evaluated by a qualified physician.


Related resources:
Prevention: The Future of Migraine Therapy. Stopping a migraine headache before it ever begins is the new focus of treatments by Jeanie Lerche Davis, WebMD Feature, Migraines and Headaches Health Centre.
Nerve Stimulator May Provide Effective Drug-Free Migraine Treatment by Joseph Nordqvist. Copyright: Medical News Today.
Symptoms of a Migraine: The Symptoms and Stages of a Migraine Attack by Teri Robert, Medically reviewed by Nicholas R. Metrus, MD, Verywell Health, Sep. 22, 2020.
Migraine: Symptoms and Causes by Mayo Clinic Staff.
Migraine: Diagnosis and Treatment by Mayo Clinic Staff.
Electric New Treatment Offers Hope for Migraine Sufferers: Stimulator Is Implanted and Activated by Remote Control from CBS New York, October 14, 2013.
Get Rid of Migraines Naturally and Fast! YouTube video, 7:39 min. Published by Milton Chiropractic Clinic Cambridge, Apr 8, 2020. The video describes the 6 most common triggers for migraine and what the best natural remedy/coping mechanisms is for each one of them. The 6 most common triggers for Migraines are:
1. Food
2. Stress
3. Intestinal Issues (IBS, Celiac Disease)
4. Hormones
5. Idiopathic
6. The Neck
Migraine Headache: Overview by Jasvinder Chawla, MD, MBA; Chief Editor: Helmi L Lutsep, MD. from eMedicine. Medscape. Signs and symptoms, Diagnosis, Management. Article includes 8 images:

Migraine headache. Example of a visual migraine aura, image from http://emedicine.medscape.com/article/1142556-overview
1 of 8 images: Migraine headache.
Example of a visual migraine aura
as described by a person who experiences migraines.

Migraine Mechanism by Craig Blackwell, MD, Fellow American Academy of Ophthalmology. YouTube video, 14:25 min. Dr. Craig Blackwell explains: What is going on in the Brain. Visual Aura and Headache. Cortical Spreading Depression. Trigeminal Nerve carrying Pain Impulses. Role of Serotonin. Treatment with Triptans and CGRP Blocker.
What Are Migraines? YouTube video, 11:05 min. Published by Institute of Human Anatomy, Feb 21, 2020. Jonathan from the Institute of Human Anatomy, describes the underlying mechanisms, anatomy, and symptoms of migraines. Head Massage - 5 Simple Exercises to Reduce Headaches. Video, 3:39 min. Demonstration of exercises by Beijing doctor (in Mandarin Chinese) to help reduce headaches / migraines. View video to copy movements:
    • 1. Rub head from front to back with both hands as if combing hair, 20 times .
    • 2. Rub over both ears top to bottom, 20 times.
    • 3. Massage forehead and temporal area, 20 times.
    • 4. Locate grooves at base of skull in neck region, massage with thumbs, 20 times.
    • 5. Relax hands and lightly tap all over head for 1 minute.
Migraine from Wikipedia, the free encyclopedia.
Migraine from MedlinePlus.
Migraine Headache from MedicineNet.com.
Migraines: Myth & Reality from Migraines.org, National Migraine Association. M.A.G.N.U.M.: Migraine Awareness Group: A National Understanding for Migraineurs.
Migraine Treatment & Management: Current Treatment Methods from MAGNUM.
Migraine Information Page from National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH).

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