Migraines
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If someone told you that they sometimes see bright, flashing purple and white spots in front of their eyes, and that it had nothing to do with drug use or looking at the sun too long, would you believe them? Millions of people world-wide would. Those flashing lights are part of a group of symptoms called aura, and they often accompany a condition that strikes approximately 8% of the Canadian population (Canadian Medical Association Journal, 2001) - migraines. In Canada 1 in every 12 people (over age 12) has been diagnosed with migraine. Many more sufferers will go undiagnosed, and 4 out of every 10 people who receive diagnosis by a professional, will go without treatment. (The Daily, 2001)
The term "headache" covers a variety of conditions, migraine being only one, and that migraines are not just "really bad headaches". The IHS (International Headache Society) created a classification system for 12 different groups of headaches sectioned into two main categories: primary and secondary. Secondary headaches have an underlying cause, such as head trauma, stroke, or other diseases. Primary headaches are those where headache itself is the problem. (UIHC, 2001) It is within the primary group that migraines fall.
Description and Definition of Migraine
Migraines, as defined by Migraine Canada, are the primary example of vascular headaches. Vascular headaches are caused by an abnormal reaction of the cerebral arteries (those that provide blood supply to the head). There are many theories as to what causes the actual migraine to occur, or even what happens when the migraine is occurring. One of the most popular theories is that a migraine is triggered within the brain itself. When an attack begins, "the pain and other symptoms of migraine arise from an inflammatory process resulting from an interaction between the Trigeminal nerve [the main sensory nerve of the face and motor nerve for the muscles of mastication] and blood vessels in the coverings of the brain." (NHF, 2001) More specifically, that cranial vasodilation (expansion of the blood vessels) activates Trigeminal nerve endings, and that this activation of the 'trigeminovascular system' causes the release of chemical substances called neurotransmitters (chemicals that transmit nerve impulses across a synapse). During a migraine attack, neurogenic inflamation (inflammation of the tissue surrounding the brain) worsens the pain. (Migraine Disability Website, 2002) Serotonin, one of the neurotransmitters, is linked to the development of migraines, yet their relationship is unclear. (JAMA, 1997) In addition, a new theory suggests that migraine is caused by inherited abnormalities in certain cell populations in the brain. (NINDS, 2001)
Types and Stages
A migraine can manifest in several stages (though not all sufferers experience each of them), and although there are several different types of migraine, they are commonly divided into two main types: classic and common. Classic migraines are those with aura, and common migraines are those without aura. Some people also experience aura without any following head pain, though this is unusual. Migraine is characterised by recurrent headache attacks with the pain occurring (most often) on one side of the head, and may be accompanied by combinations of symptoms such as nausea, vomiting, and sensitivity to light and sound. There are as many as five stages to a migraine: prodrome (an early symptom that a disease is developing or that an attack is about to occur), aura, overt attack (headache), termination / resolution, and postdrome. During the prodrome, which may occur hours (or even days) before an attack, a person might experience changes in mood, behaviour, and energy level. Aura generally develops over 5 - 20 minutes, and lasts for less than an hour - though this is not true for all sufferers, particularly those who have aura with no following pain. Sufferers may experience visual, auditory and sensory disturbances, as well as headache, nausea, and sensitivity to light and sound. The overt attack phase can last from 4 - 72 hours, and a person may experience a one-sided headache pain, pulsating or throbbing pain, stress or physical activity aggravated pain, sensitivity to light and sound, nausea, and (or) vomiting. The termination phase, the cessation of pain, may last from 4 - 72 hours, and is followed by the postdrome in many people. Postdrome can last several days, and a person may experience exhaustion, weakness, listlessness, lethargy, and, in some cases, even elation. (Merck Co.)
Aura
Aura is one of the most unusual aspects of a migraine. They are a group of symptoms that can, in only a minority of migraine sufferers, precede a migraine headache. Aura can consist of visual changes (flashing lights, zigzag lines), tingling / numbness in the face and other parts of the body, slurred speech, confusion, and mood changes (irritability, depression). In fact, many aura manifestations have been likened to symptoms that some sufferers of stroke experience. (Better Health Channel, Brain Foundation Victoria) Aura are caused by waves of electrical activity spreading across the surface of the brain, that leave behind a zone of "exhausted" nerve cells. People who do not experience aura may still have the brain wave without the symptoms. The occipital lobe of the brain, the posterior lobe of each cerebral hemisphere, containing the brain's visual centre, is most prone to aura occurrence. (Gordon and Hister, Medbroadcast.com, 2001)
Migraine Incidence
Migraines, after puberty and into adulthood, occur more frequently in females than in males. Before puberty, they occur in more males than females. The higher incidence in women seems linked to increased oestrogen levels, from both birth control pills and oestrogen therapy, though the exact nature of this relationship is unknown. (Comforth, About.com)
Triggers and Links
Migraines can be triggered by, and linked to, a variety of stimuli that can include:
- Diet (Some of the more common food aggravants include those foods that contain MSG, the food additive monosodium glutamate, and nitrates, which are often used as preservatives in processed meats.) (3)
- It is estimated that 20 percent of migraines are caused by food sensitivities. (Sinclair)
- Sleep (too little, too much, interrupted)
- Hormones (menstrual cycle)
- Mood and psychological factors (stress, anxiety, depression, affective disorders)
- Medications
- Environmental factors (odours, changes in air pressure, altitude)
- Allergy and chemical sensitivity
- Chemicals (caffeine, colouring agents, additives)
- Other chronic physical conditions (arthritis, rheumatism, sinusitis, ulcers)
Migraine and Allergy
A report by the National Headache Foundation states that the link between migraine and allergy is controversial, because of the way in which the human immune system works. The report states that "the vast majority of foods that play a role in migraine contain vasoactive or neuroactive amino acids." The report further stated that while these amino acids are not the building blocks of proteins, they are produced from amine acids, which are. The human immune system prevents the body from being able to be allergic to amino acids but not proteins, so that a person may be allergic to a protein, but not the amino acids that it is made from. The same report went on to say, "when a true allergy exists to a compound in the air, the nasal or respiratory tissues react because of the white blood cells involved in allergy. [...] Studies of migraine patients to evaluate for abnormalities of that portion of the immune system and white blood cells responsible for infection have not found evidence of a relationship between allergy and migraine."
Migraine and Chemical Sensitivity
Chemical sensitivity is an extremely important concern if you couple the increased numbers of manmade chemicals found in food, perfumes, cleaning products, and other areas of the environment, with the fact that approximately 15-20% of the Canadian population also suffers some sort of breathing difficulty. (Lung Association of Newfoundland and Labrador) Chemical sensitivity, as defined by the CHN (Canadian Health Network), is "when the effect of all these [manmade] chemicals builds up, and a person can no longer tolerate them. They will gradually become more sensitive to everyday chemicals. [...] Some people may reach a point where they react to just about every human-made chemical around them."
Migraine and Depression
Dr. Naomi Breslau, a professor of psychiatry at Henry Ford Hospital in Detroit, conducted a two-year study that she feels proves that migraine and depression are linked in bi-directional way that goes beyond the idea that depression is not simply a psychological response to the migraine condition. She feels that the lack of increased depression prevalence in her study's severe headache group is proof of a shared aetiology (the cause of a disease, or the philosophical study of causation). Dr. Breslau stated that, "Otherwise, you really have to come up with some very complex explanations as to how migraine could influence depression and then depression could influence migraine through another type of mechanism." (Begany, NeurologyReviews.com, September 2002)
Avoidance, Prevention, and Treatment
If a person finds that contact with, or ingestion of, any particular substance, or chemical triggers their migraines, then avoiding that substance can reduce the incidence of migraine. It should be noted that contact with any particular substance could indicate allergy or chemical sensitivity, rather than just migraine. Treatment for migraine can include avoidance, medication, vitamin treatment, and medications that are more traditional.
Headache Diary
Before proper diagnosis and treatment can occur, it is important for you to have as much information as possible to share with your health care professional. A common suggestion is that you keep a "headache diary". A headache diary will help you chart the occurrence of your migraines, and may help you to determine what triggers them. For one month (or for your next 4 - 5 migraines, depending on frequency), taking particular note of the triggers mentioned above, record your migraine symptoms, start time and duration of the migraine, diet, sleep patterns the night before onset, physical and emotional state, and environmental factors such as the weather. It would also be helpful to make note of any other illnesses you have suffered, and medications you have been on, during migraine experiences. In addition, record any other information not covered previously, that you think might be significant for tracking your migraines.
Medications
Steven Sinclair (N.D., LAc) suggests that conventional treatments could include the symptomatic use of NSAID's (anti-inflammatory drugs that do not contain steroids), beta-blockers, tricyclics (amitriptyline), Ergotamine derivatives, and selective-serotonin receptor agonists (sumatriptan). It should be noted, however, that some medical practitioners consider Ergotamine to have addictive potential. There are also many medications specifically designed for prevention of migraine, and treatment once the attack has begun. Preventative medications could include Anticonvulsants, Antidepressants, Beta-Blockers, and Calcium Antagonists. Treatment medications could include Analgesics, Serotonin (5-HT) Receptor Agonists, Antiemetics (drugs that prevent or alleviate nausea and vomiting), Phenothiazines, and Corticosteroids. Ergot Derivatives and NSAID's can be used for both prevention and treatment.
Natural Treatment
The list of things you can do to alleviate migraine, migraine pain, aura, and other forms of headache, is vast. Catherine Woodgold suggests the following as some ways to treat a migraine after onset: bathe, rest in a dark room, avoid bright or flashing lights, use a cool compress on the pain affected area, drink water or natural juice, eat (especially if you haven't done so for a while), and avoiding any sources of physical or emotional stress. She also suggests employing gentle self-massage on (or having someone else gently massage) the face, head, neck, shoulders or any other tense muscles, and gently leaning your head to the left and right to stretch neck muscles.
Other Treatments
Sinclair, along with his list of suggested medicinal treatments, mentions several other methods of treatment that could be beneficial in the treatment and prevention of migraine. He suggests that nutrient therapy could include ingestion of riboflavin (but notes that amitriptyline, another medication prescribed for migraine, appears to interfere with riboflavin metabolism), magnesium (which affects several migraine related issues), melatonin (which affects sleep related issues relating to migraine). His suggestions for botanical therapy included: Feverfew, ginger, and gingko. Despite these being natural substances, they, along with more traditional medications, should not be self-administered.
Endnotes
1. Serotonin is a neurotransmitter involved in sleep, depression, memory, whose receptors are, for example, the site of action of most psychedelic drugs.
2. Some types of migraines include Basilar artery migraine, Carotidynia, Headache-free migraine, Ophthalmoplegic migraine, and Status migraine. Explanations and definitions for all of these can be found at the Neurology Channel website. Another explanation of Basilar Artery Migraine can be found via the Vanderbilt University Medical Center website. The UCLA School of Dentistry provides an explanation of Ophthalmoplegic and retinal migraines. HeadacheHelp.org provides a short explanation of cold stimulus, sex (exertion), and non-headache migraines, as well as other migraine information.
3. JAMA lists the following as some foods containing MSG: frozen pizza and dinners, bacon bits, Oriental foods, breaded foods, processed and canned meats, relishes, salt substitutes, and corn chips. They list the following as some foods containing nitrates: bacon, beef jerky, pork and beans, ham, sausage, smoked fish, hot dogs, and lunch meats. The McKinley Health Center lists the following as some common migraine triggers: aged cheese, raisins, beer, wine, hard liquor, caffeine (coffee, tea, chocolate), dairy products, fermented and pickled foods, some processed nuts and snack chips, and some citrus fruits.
4. Patients given Ergotamine tartrate may become addicted. Ergotamine may fuel the continuation of the headaches, and its use more than two or three times a week may cause the patient to become dependent. The frequency of Ergotamine use is more crucial to dependency than the dose given. Patients frequently have to be hospitalised for Ergotamine withdrawal. (Austin, 1985)
5. Woodgold had a more detailed list, but many of her suggestions included ingestion of vitamins or minerals, and while they are natural substances, they should only be used after consultation with a physician. She further states that not all her suggestions will work for everyone, and when they do work, they may not always do so, and that their effectiveness can be dependent on during which phase of the migraine was employed.