From Baptist Health South Florida
3 min. read
Is it a migraine or just a bad headache? For those who have suffered from chronic migraines, the answer is quite obvious. Most tension headaches don’t typically cause nausea, vomiting, stomach pain, weakness or numbness, which can occur with severe migraines or other conditions. Although some people experience sensitivity to light or sound with tension headaches, these symptoms are not as common as they are with migraines.
How common are migraines? The Migraine Research Foundation estimates that 12 percent of the population – including children – suffers from migraine. In the U.S., an estimated 18 percent of women, 6 percent of men, and 10 percent of children experience migraines.
The U.S. Centers for Disease Control and Prevention (CDC) says that about 15 percent of U.S. adults report a migraine or severe headache in the previous three months, “a figure that has remained stable for almost two decades.” (June is National Migraine and Headache Awareness Month).
Moreover, migraines can be severely debilitating and are considered one of the main causes of disability worldwide. In one study among patients with migraines in the U.S., more than half of participants “reported severe impairment in activity, the need for bed rest, and/or reduced work or school productivity due to migraines,” the CDC says.
But for those who may not suffer chronically from migraines, when should they seek medical help?
Neurologist Pooja S. Patel, M.D., director of the Epilepsy Program at Marcus Neuroscience Institute, part of Baptist Health, explains: “A person with headache should seek medical attention if headache is thunderclap or worst headache of their life, if it seems different from their usual headache, lasting for longer duration than usual headaches, or consistently waking them up from sleep.”
The most distinct differences between migraines and headaches are related to duration, intensity and other symptoms.
“Migraines are a primary headache meaning there is no obvious secondary cause for it,” explains Dr. Patel. “Migraines have some common characteristics including light sensitivity, noise sensitivity, nausea/vomiting and at times auras. Migraines tend to be more intense and last for longer duration than most of the other headaches with exception of few.”
Migraines are considered chronic if they occur for 15 or more days per month for more than three months, explains Dr. Patel.
Migraine triggers differ from person to person, but common ones are stress, weather changes, hormonal changes for females, alcohol — especially red wine, certain foods such as aged cheese, chocolate, processed food and foods containing MSG, Dr. Patel says. Stress is a major trigger for a majority of those who suffer regularly from migraines. One study found that up to 70 percent of people had a significant association between their daily stress level and their daily migraine activity, according to the American Migraine Foundation.
Treatments for Migraines
For most migraine sufferers, medications make up the first line of defense to help prevent or ease the pain and other symptoms.
“For chronic migraines, we usually start with medications from various classes for prevention of headaches,” explains Dr. Patel. “If oral medications are not effective, Botox and newer injectable medications that are CGRP receptor antagonists are offered which are highly effective. Other peripheral nerve blocks are also offered for management of severe migraines.”
Treatment of migraine has in recent years seen the development of drugs that target a protein called calcitonin gene-related peptide (CGRP). Its mechanism of action is by blocking the CGRP receptor of nerve cells, which trigger intense pain and activate a CGRP cascade. By blocking CGRP receptors, pain can be prevented prior to initiation.
Botox — known primarily as a drug made from a toxin that can temporarily smooth out facial wrinkles — is recognized as an important tool in the treatment of chronic migraines. In 2010, Botox was approved by the U.S. Food and Drug Administration (FDA) for use with chronic migraine. As part of a treatment regimen that, Botox is injected around pain fibers and enters nerve endings to block the release of chemicals involved in pain transmission.
“A Botox injection prevents pain activation before it starts,” says Dr. Patel. “Botox also works by relaxing muscles.”
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