Fort Bliss Monitor

Migraines can be managed by understanding treatment, options available
Lt. Col. Roman Bilynsky MD
WBAMC

Migraine is a common problem in people of all ages that may be managed and treated if sufferers understand diagnosis and treatment options.

Overall, about 15-18 percent of women and 6 percent of men have a migraine attack every year that causes significant disability in terms of time lost from work, decreased effectiveness at work or at home, or missed leisure activities. In children it results in absence from school, decreased opportunities for learning when in school, inability to complete homework assignments, and secondary affects working parents who need to stay home or pick up their children up early from school.

Migraines are periodic, typically throbbing, one-sided headaches of moderate to severe intensity. Some people, especially children and adolescents, have bilateral, constant, or frontal headaches that they describe as sinus or tension headaches. The duration of migraines is typically hours to all day, or several days at a time.

One of the best ways to differentiate a migraine from a tension or sinus headache is to ask yourself the question: Is my headache disabling – is my ability to perform work, housework, homework, etc … affected or diminished by my headaches? If the answer is yes, then you probably have migraine headaches. About 20 percent of people with migraines will have an warning before their headache, usually consisting of visual phenomena to include flashing lights, spots, sparkles, temporary loss of vision, numbness in the hands or feet or vertigo.

People with an aura prior to their headache are said to have classical migraines or migraine with aura. The constellation of clinical features allows your health care provider to make a diagnosis of migraine headaches.
There is no specific proven cause of migraine headaches, but various theories have been proposed including changes in the blood vessels and nerves around the brain during an attack with or without inflammation, or changes in the neurochemical transmitters in the brain. Migraine headaches often run in families, so asking family and relatives about significant disabling headaches is a relatively easy way to find out if there is a hereditary component to your headaches.

Treatment of migraine headaches can be divided into several components:

• Identify and avoid potential triggers – about one in six migraineurs will have a food trigger for their headaches. These include missed meals, alcohol – especially red wine, aged cheeses – due to the tyramine, preserved meats – from the nitrates and nitrites, overuse of caffeine, nuts – often peanuts, leading to after lunch headaches in school children, or food containing monosodium glutamate. Even though some people have food triggers, most do not. A diary of foods eaten prior to an attack can help you find out if you have a dietary trigger for your migraines.

• Lifestyle and behavior changes – increasing your level of fitness including regular cardiovascular exercise and getting enough, but not too much sleep. Many migraine patients are sensitive to bright lights even between attacks, so sunglasses may help.

• Utilizing medications to prevent and treat migraine attacks. If you have migraines more than once a week, or attacks that last days every time they occur, daily prophylaxis may help to reduce the frequency, intensity and/or duration of your headaches.

Abortive medications, medications taken at the start of an attack, are most effective when taken during the first few minutes, usually 15-20 minutes, of the attack before the headache reaches its maximum intensity. Medications commonly used and effective in the majority of people include acetaminophen, ibuprofen, naproxen, or aspirin. There are also various combination medications available over the counter containing these active substances along with a dose of caffeine, which can help relieve the headache in some patients by itself – though not those who overuse caffeinated beverages, but mostly work by increasing the effectiveness of the acetaminophen, ibuprofen or aspirin.

Prescription medications that are effective for various people include Midrin, Fioricet or Fiorinal (containing a barbiturate sedative, caffeine, and either acetaminophen or aspirin), Cafergot, dihydroergotamine and the triptans. Triptan medications are the most specific for migraine and include zolmitriptan, sumatriptan, rizatriptan, almotriptan, frovatriptan, naratriptan, and that come in various combinations of tablets, disintegrating tablets, injection and nasal spray. Migraine sufferers should see their health care providers to find out if any of these medications are right for them. Triptan medications are contraindicated or not recommended in patients with uncontrolled hypertension, angina or other significant heart or peripheral vascular disease.

Medications can also be taken on a daily basis to reduce the frequency, intensity and/or duration of migraines when they do occur. They may help one, two or all three of these components. The question to ask is: Are the headaches bad enough, long enough or frequent enough that it would be worthwhile to take a medication every single day to try to relieve them? If the answer is yes, then this approach to treatment coupled with appropriate abortive medications is recommended.

It is important to consider other factors, such as underlying depression, anxiety or mood disorders in adults and children which contribute to or a major trigger of migraine headaches in some patients. Food and Drug Administration approved medications for prevention of migraine include Elavil, Depakote Inderal and various other trade names – a beta blocking blood pressure medication effective for migraine prevention.

There are a number of other medications used for migraine prevention that are not FDA approved but effective in select patients to include: Neurontin, Topamax, Periactin – a centrally acting antihistamine typically effective in young children for migraine prophylaxis, Calan, Pamelor, Prozac, Paxil, Celexa, Zoloft, vitamins and others. A careful review of a person’s history, triggers, medical and/or psychological conditions will help the doctor decide which medications to recommend.

Information on migraines can be found at www.aan.com, www.achenet. org or www.headaches.org.



www.bliss.army.mil	Published for the Fort Bliss/El Paso, Texas Community	October 7, 2004

<map name="boxmap-b4"> <area shape="rect" coords="0, 589, 120, 600" href="http://rcm.amazon.com/e/cm/privacy-policy.html?o=1" > <area coords="0,0,10000,10000" href="http://www.amazon.com/exec/obidos/redirect?tag=&creative=92501&camp=8117&link_code=dl1&path=subst/misc/amazon-cobrand-cc/v3/marketing-from-associates-step1.html/ref%3Db1_assoc_29" > </map>	Migraines can be managed by understanding treatment, options available Lt. Col. Roman Bilynsky MD WBAMC Migraine is a common problem in people of all ages that may be managed and treated if sufferers understand diagnosis and treatment options. Overall, about 15-18 percent of women and 6 percent of men have a migraine attack every year that causes significant disability in terms of time lost from work, decreased effectiveness at work or at home, or missed leisure activities. In children it results in absence from school, decreased opportunities for learning when in school, inability to complete homework assignments, and secondary affects working parents who need to stay home or pick up their children up early from school. Migraines are periodic, typically throbbing, one-sided headaches of moderate to severe intensity. Some people, especially children and adolescents, have bilateral, constant, or frontal headaches that they describe as sinus or tension headaches. The duration of migraines is typically hours to all day, or several days at a time. One of the best ways to differentiate a migraine from a tension or sinus headache is to ask yourself the question: Is my headache disabling – is my ability to perform work, housework, homework, etc … affected or diminished by my headaches? If the answer is yes, then you probably have migraine headaches. About 20 percent of people with migraines will have an warning before their headache, usually consisting of visual phenomena to include flashing lights, spots, sparkles, temporary loss of vision, numbness in the hands or feet or vertigo. People with an aura prior to their headache are said to have classical migraines or migraine with aura. The constellation of clinical features allows your health care provider to make a diagnosis of migraine headaches. There is no specific proven cause of migraine headaches, but various theories have been proposed including changes in the blood vessels and nerves around the brain during an attack with or without inflammation, or changes in the neurochemical transmitters in the brain. Migraine headaches often run in families, so asking family and relatives about significant disabling headaches is a relatively easy way to find out if there is a hereditary component to your headaches. Treatment of migraine headaches can be divided into several components: • Identify and avoid potential triggers – about one in six migraineurs will have a food trigger for their headaches. These include missed meals, alcohol – especially red wine, aged cheeses – due to the tyramine, preserved meats – from the nitrates and nitrites, overuse of caffeine, nuts – often peanuts, leading to after lunch headaches in school children, or food containing monosodium glutamate. Even though some people have food triggers, most do not. A diary of foods eaten prior to an attack can help you find out if you have a dietary trigger for your migraines. • Lifestyle and behavior changes – increasing your level of fitness including regular cardiovascular exercise and getting enough, but not too much sleep. Many migraine patients are sensitive to bright lights even between attacks, so sunglasses may help. • Utilizing medications to prevent and treat migraine attacks. If you have migraines more than once a week, or attacks that last days every time they occur, daily prophylaxis may help to reduce the frequency, intensity and/or duration of your headaches. Abortive medications, medications taken at the start of an attack, are most effective when taken during the first few minutes, usually 15-20 minutes, of the attack before the headache reaches its maximum intensity. Medications commonly used and effective in the majority of people include acetaminophen, ibuprofen, naproxen, or aspirin. There are also various combination medications available over the counter containing these active substances along with a dose of caffeine, which can help relieve the headache in some patients by itself – though not those who overuse caffeinated beverages, but mostly work by increasing the effectiveness of the acetaminophen, ibuprofen or aspirin. Prescription medications that are effective for various people include Midrin, Fioricet or Fiorinal (containing a barbiturate sedative, caffeine, and either acetaminophen or aspirin), Cafergot, dihydroergotamine and the triptans. Triptan medications are the most specific for migraine and include zolmitriptan, sumatriptan, rizatriptan, almotriptan, frovatriptan, naratriptan, and that come in various combinations of tablets, disintegrating tablets, injection and nasal spray. Migraine sufferers should see their health care providers to find out if any of these medications are right for them. Triptan medications are contraindicated or not recommended in patients with uncontrolled hypertension, angina or other significant heart or peripheral vascular disease. Medications can also be taken on a daily basis to reduce the frequency, intensity and/or duration of migraines when they do occur. They may help one, two or all three of these components. The question to ask is: Are the headaches bad enough, long enough or frequent enough that it would be worthwhile to take a medication every single day to try to relieve them? If the answer is yes, then this approach to treatment coupled with appropriate abortive medications is recommended. It is important to consider other factors, such as underlying depression, anxiety or mood disorders in adults and children which contribute to or a major trigger of migraine headaches in some patients. Food and Drug Administration approved medications for prevention of migraine include Elavil, Depakote Inderal and various other trade names – a beta blocking blood pressure medication effective for migraine prevention. There are a number of other medications used for migraine prevention that are not FDA approved but effective in select patients to include: Neurontin, Topamax, Periactin – a centrally acting antihistamine typically effective in young children for migraine prophylaxis, Calan, Pamelor, Prozac, Paxil, Celexa, Zoloft, vitamins and others. A careful review of a person’s history, triggers, medical and/or psychological conditions will help the doctor decide which medications to recommend. Information on migraines can be found at www.aan.com, www.achenet. org or www.headaches.org.