Man with migraine headache

It’s Not Just a Headache

It has been estimated that at least 10% of the population of children and adults are migraine sufferers but I suspect there are even more. Some are sporadic migraine sufferers while others have to deal with the daily torture of migraine attacks or at least the fear that a migraine will ruin their plans for the day. Living with the fear of a migraine can at times be as debilitating as the migraine itself. A migraine is not “just a headache.”

A migraine attack can come in several forms. It may be preceded by a visual aura where the individual has blurry vision or may see lights or flashing zig-zag lines, or cannot really see at all. It may be preceded by a prodrome – a constellation of symptoms that occur before a health event, usually only identified after several attacks – that can come in the form of despair, depression, fatigue, increased hunger, excessive yawning, or excessive urination. Or it may not be preceded by any identifiable symptom at all. The headache that either starts alone or follows the prodrome or aura is often on one side of the head, behind or on top of an eye, and throbbing. It can then radiate throughout the head. Often, though not always, the attack includes autonomic symptoms such as severe nausea with or without vomiting, dizziness, or imbalance. The head pain almost always is accompanied by light and sound sensitivity. Neurologic signs can be present such as difficulty speaking, arm or leg tingling, or weakness. Sometimes the symptoms of the aura may be present without the consequent headache. This is called migraine accompaniment and it is a migraine variant, as are cyclical vomiting syndrome seen in children and migraine-associated vertigo, among others.

Again, this is not “just a headache.” The reasons why migraines occur, and how they start, has been the subject of many research studies and theories yet one unifying explanation for the very existence of migraines has been elusive. It is considered an electrical as well as a vascular event. Some believe there is first hypoperfusion, or a decreased blood flow to an organ – a “shock” that results in an inadequate supply of oxygen and nutrients – of an area of the brain, often the occipital lobe, hence, the initial visual obscuration. Yet others believe the initial event is hyperemia, or an increase in blood flow to the area of the brain. A strong consensus exists that there is subsequent spreading of an electrical signal from the initial event along the cortex, referred to as cortical spreading depression (CSD). Eventually the signal will reach the trigeminal ganglion that will ultimately lead to the severe pain and distress experienced during an event.

This is obviously a simplified version of events and the reality is much more complex. It also does not explain why the migraine happens in the first place. And it does not tell us about the trigger for the migraine. Triggers are a common topic because it seems reasonable for us to ask ourselves:  Why did this happen? What caused it? How can I prevent the next one from happening? But answers to these questions and a real understanding of what triggers a migraine in any individual is poorly understood.

What we do know is that there are some foods that are accepted as common triggers for migraine. These include aged cheeses, nitrates found in processed meats, and additives and preservatives found in processed foods. There are also discussions on the trigger potential of poor sleep, poor lifestyle choices, stress, vitamin deficiencies, and hormones.

It is important to recognize that each migraine sufferer is different and those differences play an important role in their care. They vary in terms of their genetics, physiology, lifestyle choices, circadian rhythms, and other exogenous factors such as environmental exposures. This individuality is what the team at Center for Healing Neurology focuses on.

There are many options for both prophylactic and abortive migraine care, from both the conventional and alternative realms. Pharmaceuticals may play a role in both approaches. We use pharmaceuticals when indicated or as a bridge while we work with more natural options. Approaching patients holistically for their migraine preventative care includes a conversation to understand their lives, their rhythms, their diets, and their lifestyle choices. This helps us to identify those individuals that may benefit from other therapies such as neurofeedback and acupuncture as well as nutritional and supplement counseling, herbal formulations, and exercise guidance, all of which is offered at the Center for Healing Neurology.

After an initial consultation with a member of our Headache team, patients can elect to be seen for therapies and further guidance during our weekly Headache Clinic where we care for patients experiencing all types of headache, including migraines. Please contact the Center for Healing Neurology at (206) 379-1213 or visit our website at centerforhealingneurology.com

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