Here’s Part 2 of the fantastic information I learned on Friday:
5) What are some migraine triggers?
- Migraines were previously thought to be stress related. However, now the International Headache Society does not even define a stress headache. Instead, we know that stress is a trigger for the underlying migraine.
- Knowing your triggers is the first step to migraine management. For example, establishing a regular sleep pattern is essential for migraineurs.
- Things like stress and barometric pressure do not cause a migraine; they trigger it. Anything upsetting the internal homeostasis, like eating certain foods or sleep schedule changes, can trigger the brain to activate networks and cause symptoms of migraine.
- Notorious triggers include wine, MSG, nitrates, fluorescent lights (flickering), and coffee. However there are no generalities for triggers. They really vary between individuals. Some people have tried severe elimination diets and not found a single dietary trigger.
- As a side note, there is currently NO research at the NIH on dietary triggers and migraine.
6) Are migraineurs prone to other health conditions?
- YES. Migraine sufferers are more likely to have psychiatric disorders like anxiety, depression, bipolar disorder. They are more likely to have epilepsy or stroke. They are also more likely to attempt suicide.
- Migraineurs generally have an increased risk of stroke. Those who experience migraine with aura are two times more likely to experience stroke. Migraineous stroke is more likely in women, specifically women under 40.
- Because of these serious comorbidities, we really need more research into migraine disorder.
7) What is the research with Botox and migraines?
- The FDA has approved Botox for a specific type of disorder called chronic migraines (patient must have 15 or more migraines a month lasting 4 or more hours a day).
- Botox injections are given in the scalp muscles: in the forehead over the eyebrows, over the temples, and in the neck muscles.
- The reduction in frequency lasts about 3 months.
- It’s not entirely known how this works to decrease the frequency of migraine
8) What about rebound headache?
- 14% of episodic migraineurs fall into chronic migraine patterns, sometimes because of overuse of analgesics. Patients can’t rely on overused medications for this reason.
- Some drugs, like the abortive medications with caffeine, can subject someone to a rebound headache.
- It’s recommended to take medication 2-3 days per week at the most for migraine relief.
9) What kind of medicines are out there for migraine prevention and treatment?
- Triptans are the only class of medicine that have been designed to treat migraine in the past 60 years.
- Triptans come in the form of pills, injections, and nasal sprays. They were developed on the premise that they would constrict blood vessels back when we thought migraine was a blood vessel disorder. Now we know that the triptans get into nerve endings and find centers of the brain that shut pain off.
- They work for acute treatment of migraine. but patients can’t take them if they have heart disease, high blood pressure, or stroke. Some triptans can’t be taken w other medicines. While 60% of patients have some response to triptans, only about 20% of patients respond consistently to being pain free after taking them.
- Prophylactics are an underutilized treatment for migraines, especially because people who take too many acute pain medications can actually invite chronic migraine.
- There are currently 4 FDA drugs approved for migraine prevention and several others with evidence that they work. It’s hard to detect which medication is appropriate for each person, so most doctors go through a trial and error period with each patient or choose medications that might attack two things at once. For example, topiramate causes weight loss so an obese or diabetic person w migraine might benefit from that.
- Supplements are just beginning to get evidence of efficacy.
Did any part of this interview surprise you? Will you share it with your migraineur and non-migraineur friends?