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What is a migraine? Is it different from a headache?

A migraine is one of several categories of headaches. To understand them more thoroughly I have taken the different categories of headache and gotten information on each one. I will start with migraines because it is the focus of my search but the others are important as well because understanding their symptoms and causes helps identify just what type of headache I am, as a chronic headache sufferer, experiencing. If I am able to identify the type of headache, I am also better able to identify what type of intervention is most suitable. My research indicates that different headaches require different treatments which I will explore in a later question.

Migraines
A migraine is a headache thought to be caused by an abnormal response of the brain to stimuli, the brain releases chemicals that irritate nerve endings and cause blood vessels on the surface of the brain to swell eliciting a throbbing pain sensation. Other changes in the brain sometimes cause sensitivity to light, noise and other symptoms such as nausea and dizziness. (http://www.1on1health.com/web/info/migraine/english/migraine-animation/AnimationPage/LookListenLearnType=1).

This type of headache varies in severity, duration and frequency. According to About.com, a migraine episode is more than just a headache, it consists of four parts: The prodrome, aura, headache and postdrome. This information is highly useful to me and I suspect other migraine sufferers. I often experience some of these signals prior to a migraine I just never identified them as part of, or a warning about an approaching migraine! I also experience postdrome symptoms and never have been able to identify them as such. I always feared it was caused by a negative reaction to my medication, thus making me hesitant to use it.

The Prodrome- this is the warning stage. This occurs hours and sometimes days prior to the actual migraine headache. Migraineurs who experience the prodrome stage can sometimes avoid or “abort” the migraine before it becomes full blown. Some typical prodrome symptoms are: changes in bowel/urinary function, food cravings, muscle pain (especially in the neck), abnormal fatigue and or mood changes.
The Aura- the aura also appears prior to the migraine headache. This phase however is much shorter than the prodrome. These symptoms tend to also be much more sever/noticeable than those of the prodrome. They include: visual, auditory and olfactory symptoms or hallucinations, numbness or partial paralysis in the face, difficult or slurred speech, vertigo and changes in sensation. Just as with the prodrome, this phase is an early warning and if action is taken immediately it is possible for some migraine headaches to be prevented.

The Headache- a migraine headache can last for minutes or even 2-3 days. It is a throbbing pain that not only affects the head but can spread throughout the body and is usually exacerbated by movement or physical activity. Some typical symptoms include: nausea and other body function disturbances, light/noise sensitivity (phobia), hot flashes or chills, deep depression or severe anxiety, fluid retention or dehydration, loss of appetite. This is said to be the most debilitating phase of the migraine.

The Postdrome- after the pain recedes, the migraine isn’t quite done. EEG studies have shown blood flow interruptions for up to two days following the migraine headache. This is said to be the cause of the “hangover” or “zombie like feeling” immediately proceeding the headache. Common symptoms of the prodrome stage are: low levels of mental function, depression and difficulty concentrating.
(http://headaches.about.com/cs/headpain101/a/anatomy_mig.htm)

Some other types of “function headaches” as found in the Fundamentals of Chiropractic Diagnosis and Management are:

Tension Headaches- this headache is the most common to the American culture. It is caused by a prolonged contraction of head, neck or face brought on by an internal or external stressor. Some such stressors are poor posture, eye strain, abnormal neck or jaw muscles or structure, unusual sleeping positions as well as emotional stress or depression. The recognizable characteristic of a tension headache is a dull pain throughout the entire head accompanied by a feeling of tightness as though the head were being squeezed. Usually an over the counter medication is sufficient to handle these headaches. The National Headache Foundation (NHF), breaks tension headaches, otherwise known muscular contraction headaches, into two categories: Acute and Chronic MCH’s.
The acute MCH is usually brought on by a period of stress and continues until the stressor is removed.
The chronic MCH is always present and varies only in intensity. This headache is described as a weight, pressure of tightness.

Cluster Headaches- The pain of a cluster headache is located on one side of the head, similar to that of a migraine, sometimes located behind the eye region. Unlike the migraine, a cluster headache begins suddenly and recedes relatively quickly; also CHs usually are not accompanied by nausea and vomiting. The pain has a burning or piercing quality and is said to be extremely intense. They are named cluster headaches because they generally appear in a clustered sequence. A CH sufferer will often experience several episodes over a period of time and then they will go into remission for sometimes years. These headaches are the most likely to be misdiagnosed as migraines because during the “cluster period” the sufferer becomes sensitive to substances such as tobacco smoke, alcohol, extended naps, flexion or extension of the neck, glare and oversleeping. “Investigators believe that the CH is a variant form of migraine headache. As such, the CH sufferer may have a positive family history of migraines and, in fact, may have previously experienced migraine headaches.”
(Headache Disorders. 1991. Page. 106).

Sinus Headaches- the sinus headache is caused by irritation or inflammation of the nasal sinuses. The pain is generally localized to the region of the affected sinus, aka, above, behind or below the eyes. Sinus headaches can range in intensity depending on the level of sinus irritation. Often these headaches are accompanied by congestion and sometimes discharge from the nose. Pressure on the affected area will elicit pain and sometimes promote drainage to relieve the pain. Bending, coughing and straining often accentuate the pain of a sinus headache, while a sinus decongestant will usually help relieve it.


Are there different types of migraines? Which type do I suffer from?

There are several types of migraines, some of which are exotic and very rare. For the purpose of this search I will focus on types of migraines to which I can relate. My maternal grandmother suffered from ocular migraines, one of my nieces suffers from basilar artery migraines, while my mother, sister and I suffer from classic and common migraines which are by far the most widespread migraine types. Most of my migraines tend to be of the classic type.

Ocular Migraine- these migraines are quite common and typically pain free. They are thought to be caused by abnormal spasms in the blood vessels of the eye. Flashing or zigzagging light patterns, blind spots and often spots or stars are the identifiable symptoms of an ocular migraine. There is not consistent link to any cause for these types of migraines but certain foods, caffeine, stress, fatigue and even artificial sweeteners are the most common suspects.
(http://www.mayoclinic.com/health/ocular-migraine/AN01681)

Basilar Artery Migraine- these migraines usually affect young girls and women. They are classified as a “complicated migraine.” They are identified by severe throbbing pain in the occipital region (back of the head), speech disturbance and interruption in motor coordination. The headache phase is usually accompanied by nausea and vomiting which quickly relieves the headache symptoms. These migraines are closely linked to menstruation cycle.

Classic Migraine or Migraine with aura- this type of migraine is clearly defined in the answer to my first question.

Common Migraine or Migraine without aura- this is the same as a classic migraine only the migraineur has only a vague uneasy or irritable feeling rather than a distinct prodrome period preceding the migraine headache.


Are migraines genetic or environmental?

“A positive hereditary link is found in as many as 80% of migraine patients. (Headache Disorders. 1991. Page. 109).
This clearly points to an overwhelming genetic tendency; however, some studies show that certain personality types are more prone to migraine than others. The profile of a migraineur is usually that of an intelligent, driven individual who pushes themselves toward their goals. It is also revealed in these studies that a migraineur is more prone to periods of depression, which may have causal relation to the migraine onset, or vice versa. Gender is another factor in migraine tendency.

What types of food/activities/environmental events are known to trigger migraines? Do any of these things affect me?

There are literally hundreds of possible migraine triggers. I have taken the most common triggers that I have been able to verify from multiple sources, and broken them down into categories. Internal triggers, environmental triggers, chemical/ food triggers.

Internal triggers:
Stress seems to be the number one trigger for migraines. “The Headache Book” identifies the typical personality of a migraineur as someone who tends to be driven, goal oriented, self demanding and controlling. Environmental circumstances tend to interfere for most of us with this sort of life approach leading to stress. Uncontrolled or overwhelming levels of stress may lead to a migraine. The best way to neutralize this trigger is to deal with stressors when possible before they get out of hand.
Fluctuating hormones appear to be the second leading migraine trigger. This trigger primarily affects women however. The majority of women who suffer from migraines, experience their migraines before during or after their menstrual cycle.
Fasting is also said to be a very common migraine trigger. The bodies over reaction to a lack of food may very well lead to a migraine.
Dehydration is the last internal trigger. Healthcentral.com estimates that 64 to 80 ounces of water is needed daily to replenish what our body excretes during normal activity. Just because we do not think we are thirsty doesn’t mean our bodies do not need fluid. Exercise, warm weather and vomiting/diarrhea and alcohol consumption are commonly know causes of dehydration but levels of high elevation including air travel, the common cold and some medications may promote dehydration as well. Some common signs of dehydration are: reduced urination/dark colored urine, muscle weakness, fatigue, irritability, heart palpitations, confusion, dizziness…. and for some migraines. Over exertion in exercise and extreme temperatures (heat) are also triggers that may be linked to dehydration.

External Triggers:
Change in weather conditions is surprisingly the fourth leading migraine trigger according to emedtv.com. Teri Roberts, lead migraine expert for healthcentral.com reports that 51% of migraineurs that participated in a questionnaire study reported being sensitive to weather/climate changes. 34% were sensitive to changes in temperature and humidity, 14% reported sensitivity to changing weather patterns and 13% were affected by barometric pressure changes. One in ten of these people studied were affected by more than one type of weather change. In fact it is more and more evident that change in and of itself can be a trigger. Sleep disturbance/change in sleeping patterns is another part of that equation.
Light is another external trigger. Direct glare, flashing or sudden bright lights are linked to migraines. Concert or disco lights, passing vehicle headlights and even bright sunlight through a window may induce a migraine in those sensitive to this trigger.
Allergies are another external trigger. About.com claims that a person with allergic rhinitis is 14 times more likely to get a migraine than someone who does not have nasal allergies. There seems to be a correlation to migraines and histamines, perhaps because of the affect histamines have on the dilation and relaxation of blood vessels. Odors/Perfumes seem also to fall into this category.
Chemical and food triggers:
Alcohol, Tobacco smoke and certain medications or illegal drugs all are documented migraine triggers. I suspect many are these are linked to dehydration, allergy and hormone changes for those sensitive to these triggers.
Food is one of the most commonly known and studied migraine trigger. No one food affects all migraine sufferers just like not all migraineurs are not sensitive to triggers. I spent some extra time looking into possible food triggers because this seems to be the most easily avoidable/controllable trigger. Here is a breakdown of some specific groups and their subcategories that commonly trigger migraines.
-Dairy Products
aged cheeses (i.e. cheddar)
Swiss and Mozzarella cheeses
yogurt , sour cream and buttermilk
-Meats
any cured or processed meat (most commonly those with nitrate
preservatives)
-Vegetables
beans, peas, peppers and olives
-Fruits/Nuts
all types of nuts
bananas, avocados, figs, plums and any dried fruits

-Breads
any freshly baked yeast product and sweat breads.
-Beverages
fermented beverages (beer and red wine especially)
caffeinated beverages
-Miscellaneous
any fermented food such as pickles, sauerkraut, vinegar etc.
chocolate
MSG
*The triggers from these lists that I find affect me are lights/loud noises, odors (perfumes and colognes), weather changes, MSG and stress. A couple of these triggers I was already aware of but others are a nice revelation.

What types of treatments are available for migraines?

I have broken down the answer to this question into two categories: Chemical and Physical/Alternative.

Chemical treatment involves pharmaceutical treatments which are broken down into two types: Preventative and Reactive.

Preventative medications: webmd.com recommends preventative treatment for people who suffer from severely disabling migraines, migraineurs who have migraines more than three or four times per month or people who take too much pain medication or their medication is not working affectively to treat their headaches. The classes of preventative medications are: beta-blockers which relax blood vessels, calcium channel blockers which reduce the amount of constriction in the blood vessels, antidepressants such as tricyclics or SSRIs and lastly, the FDA has recently approved the use of anticonvulsants like Depakote and Topomax for migraine prevention.

Reactive/Intervention Medications: The use of migraine pain medicine is often more affective the earlier it is taken in relation to the onset of the migraine. That is why it is so important to recognize triggers and understand how a migraine affects you (what type of migraine you suffer from and what your warning signals are). Narcotics have historically been used in treatment of migraines but as I have experienced it is difficult to keep down the medication when you are extremely nauseous. A newer type migraine therapy drug called a Triptan has more recently been developed to treat more than just the pain of the migraine. “Triptans are believed to effect migraine relief by binding to serotonin (5-hydroxy-tryptamine) receptors in the brain, where they act to induce vasoconstriction of extracerebral blood vessels and also reduce neurogenic inflammation.” (http://www.biopsychiatry.com/triptans.htm).
In the earliest classes of Triptans it was often necessary to take the medication at the very onset of the migraine for the treatment to be affective, but with the more newly developed chemicals, most prove to be affective at any point during the episode. Some companies even provide medicines in the form of nasal spray, suppository or dissolvable tablets for people unable to ingest pills during a migraine.
There are now over the counter migraine medicines that are mostly comprised of caffeine and aspirin which many people find helpful. Dr. Jean Benson explained to me that caffeine often makes pain medications more affective for a migraine because it allow the medication to cross the blood-brain barrier more readily.

Physical/Alternative treatments are usually preventative measures used to reduce the frequency and intensity of migraines. It is next to impossible for a migraineur to submit to treatment in the middle of a full blown episode. At times I have received physical treatment during the onset of a migraine and that has proven helpful but the timing has to be impeccable and once again understanding your migraine cycle and some luck is necessary to make that happen. I have chosen a few therapy treatments to overview for this treatment category.

Stress Management/Yoga/Relaxation therapy- this treatment is focused on removing and managing the affects of stress on the body. Yoga for migraines concentrates on keeping the body’s nervous system more relaxed. An interesting site for detailed yoga migraine intervention is http://www.yogajournal.com/practice/974.
Biofeedback, coupled with relaxation therapy is another way some migraineurs find to keep their bodies stress levels at a low even level. Biofeedback trains a migraineur to be more acutely in tune to their body’s responses (i.e. blood pressure, heart rate), and thus helps them control their body responses through relaxation.
Acupuncture is another form of alternative therapy that has become popular in the treatment of migraines. Acupuncture according to ancient Chinese medicine stimulates the body’s ability to fight pain and overcome sickness by correcting energy imbalances within the body. The energy force is called chi which circulated through meridians in the body but is disrupted by pain and illness.
A study reported on webmd.com found that migraineurs who received acupuncture treatments for migraines “used 15% less medication, made 25% fewer visits to their doctor and took 15% fewer days sick from work than the control group.” http://www.webmd.com/migraines-headaches/news/20040315/acupuncture-migraine-headache-pain).

I have lumped Chiropractic Treatment and Physical Therapy into the same category because both focus on restoring health to the nervous and skeletal systems of the body. Just as with acupuncture, doctors of chiropractic and physical therapy believe that disruptions in the bodies nerve pathways lead to muscle tension and pain. Poor posture, injury, arthritis and tmj disorders often lead to misalignment of the cervical (neck) vertebrae. Treatment through manipulation that realigns these vertebrae relieves the pressure on inflamed nerves at the top of the spine. Exercise and manipulation in tandem serve to strengthen the muscles and allow the neck to retain correct posture. A study done at Northwest College of Chiropractic in Minnesota found chiropractic treatment to be equally effective as antidepressant in the prevention of migraines. http://psychologytoday.com/articles/pto-20060628-000001.html.

Do migraines ever go away?

Surprisingly the answer is yes. Often with age and for women with the decline of estrogen, migraines sometimes go into remission and even disappear completely. Healthcentral.com published an article that claims migraine sufferers who “have a family history of migraine with aura, have migraines that are not triggered by light and have no other primary headaches” are most likely to go into migraine remission. http://www.healthcentral.com/migraine/understanding-migraine-000097_2-145_pf.html. Unfortunately for me I do not fall into this category.

What can I do to lessen the frequency of my migraines?

I am already receiving regular chiropractic treatment but I still get migraines more frequently than I like. I came across an idea during my research that I had never thought of before and that I considered to be ingenious; A migraine diary. A migraine diary tracks all of the phases of each migraine in minute detail. Triggers, preceding symptoms, intensity, duration, medications used and their effectiveness and impact on life/work. This diary not only helps you identify triggers and warning signals but it helps you accurately describe to your health care provider what is going on so together you can make the best choices regarding treatment and prevention! I was excited to learn this and downloaded my migraine diary at http://www.migrainehelp.com/pdf/MigraineDiary.pdf