Migraines

What is a migraine?

A migraine headache is often described as an intense pulsing or throbbing pain in one area of the head and is often accompanied by nausea and disturbed vision.

What are the symptoms of a migraine?

Migraines are moderate to severe in intensity, often characterized by a throbbing or pounding feeling. Although they are frequently one-sided, they may occur anywhere on the head, neck, and face. At their worst, they are typically associated with sensitivity to light, noise, and/or smells. Nausea is one of the most common symptoms and it worsens with activity, which often results in patient disability. In up to 25 percent of patients, the migraine headache pain may be preceded by an aura, a temporary neurological syndrome that slowly progresses and then typically resolves just as the pain begins. While the most common type of migraine aura involves visual disturbances (flashing lights, zig-zags, blind spots), many people experience numbness, confusion, trouble speaking, vertigo (spinning dizziness), and other stroke-like neurological symptoms. Some patients may experience their auras without headaches.

What causes migraines?

Researchers have identified possible causes, but they don’t have a definitive explanation. Potential theories include:

1. An underlying central nervous disorder may set off a migraine episode when triggered.
2. Irregularities in the brain’s blood vessel system, or vascular system, may cause migraines.
3. A genetic predisposition may cause migraines
4. Abnormalities of brain chemicals and nerve pathways may cause migraine episodes.

People with migraines tend to have recurring attacks triggered by a number of different factors, including stress, anxiety, bright or flashing lights, lack of food or sleep, and dietary substances. Migraine in some women may relate to changes in hormones and hormonal levels during their menstrual cycle.

How are migraines diagnosed?

Diagnosis for a migraine is mainly clinical in nature. In order to get an accurate diagnosis it is important to be able to describe your migraine symptoms to your healthcare provider. It is helpful to track migraine occurrences (dates and times) and the details associated with migraines.

Procedures used to diagnose a migraine are generally used to rule out other possible causes of the symptoms. In addition to a complete medical history and physical examination, some procedures that may be used include:

Blood tests. Various blood chemistry and other laboratory tests may be run to check for underlying conditions.

Sinus X-rays. A diagnostic imaging procedure to evaluate for congestion or other problems that may be corrected.

Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than standard X-rays.

Spinal tap (also called a lumbar puncture). A special needle is placed into the lower back, into the spinal canal, which is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes the brain and spinal cord.

What are the treatments for migraines?

Migraines that are severe, frequent, or that are accompanied by neurological symptoms are best treated preventatively, usually with a combination of dietary modification, lifestyle changes, vitamins, and daily prescription medications. Most of our best preventative medications are often used for other medical purposes as well; the majorities are blood pressure drugs, antidepressants, or epilepsy medications. Individual headache attacks are best treated early, often with one or more of the following types of medications: triptans, NSAIDs, anti-emetics (anti-nausea), and sometimes narcotics or steroids

Botox injections: BOTOX® is injected into shallow muscles, not too deeply beneath the skin. Each treatment involves 31 injections in 7 key areas of the head and neck. Procedure is usually repeated every three months pending your results. Only patients with chronic migraine are eligible for treatment with Botox®. Chronic migraine is defined as headaches occurring on 15 or more days each month, at least half of which have migrainous features.

Sphenopalatine block: A sphenopalatine ganglion block is a minimally invasive procedure used to treat head and facial pain. It is directed towards a group of nerve cells that is linked to the trigeminal nerve, the main nerve involved in headache. The sphenopalatine ganglion, located behind the nose, carries information about sensation, including pain, and also plays a role in autonomic functions, such as tearing and nasal congestion. A sphenopalatine ganglion block is a relatively quick procedure that offers patients rapid pain relief. Patients usually report pain relief between 15 and 30 minutes after the procedure.