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- Migraines affect
approximately 24 million Americans.
Seventy-five percent of these
sufferers are women' many of whom are not
aware that there are several
medications for their painful, disruptive
and sometimes debilitating
headaches. Dr. Donnica Moore, women's health
expert for "Later
Today' says there are now many ways to get relief
" but start with
a visit to your physician.
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- WHAT IS MIGRAINE?
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- Migraines affect
approximately 24-million Americans,
many of whom describe these
headaches as "the worst pain of my life...
except for childbirth.
But migraines are more than severe headaches...
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- Migraines affect approximately
24 million Americans,
many of whom describe these headaches as
"the worst pain of my life...
except for childbirth. But migraines
are more than severe headaches: they're
a complex disorder that is
often accompanied by many symptoms such as nausea,
vomiting, and
sensitivity to light and sound. For many' the worst symptom
is the
prolonged throbbing, recurring pain. Migraines are thought to be
caused
by extreme constriction and then dilation of blood vessels in the
head.
Recent research suggests that migraines may result from altered levels
of neurotransmitters (neurologically active chemicals) in the brain'
particularly
serotonin.
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- Overall, 18% (nearly one in five) women and 6% (nearly
1 in 20) men get migraines. The 30s and 40s are peak years, but even
children
as young as 2 have been known to experience migraine. They
usually trail
off after age 55.
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- Common myths,
misconceptions, and
misinformation about
migraine.
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- Just because migraine is common doesn't mean that it's
normal. Despite the out-dated myths that migraine is "all in your
head, it is a real, legitimate, biologic syndrome that can be prevented,
treated, and managed. It does not mean that you are neurotic, weak, or
have a mental illness. It does not mean that patients with migraine are
malingerers looking for excuses to get out of work or other
responsibilities.
It does not mean that patients with migraines just
like to take drugs.
It does mean that if you have severe headaches,
particularly on one side
of the head, with or without other symptoms,
you should see a physician
for the appropriate diagnosis and treatment.
Do this sooner rather than
later.
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- Because migraine symptoms vary
for each individual patient'
making the diagnosis may be complicated.
In many patients, migraines may
be preceded by certain warning symptoms
or a "sense that the attack
is about to come; this is called an
"aura. Associated symptoms include
one or more of the following:
visual changes such as blurry vision' developing
blind spots, or
appearance of zigzag shapes; sudden sensitivity to light'
smells, or
noise; numbness and tingling in the arms; nausea, dizziness,
or
vomiting. Some patients have no warning symptoms at all.
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- Once a migraine
begins, it may last for several hours
or even 2-3 days. Typically' pain
is on one side of the head, but it may
spread to both sides before
decreasing. Many patients say that once a migraine
begins, they must
lie quietly in a darkened room until it resolves.
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- A 12-year-old migraine sufferer
wrote an excellent description
of her experience, which sounds fairly
typical: "At first I was really
scared because I didn't know what
was going on in my head... My face feels
like it's splitting in two. I
feel like barbed wire is going in and around
my head with sharp points
sticking in it. I would like other(s)... to know
that if they
experience migraine they are not alone. They used to be alone
in terms
of therapy. Now, the good news is that there are several excellent
medicines available " by prescription and over-the-counter "
which are proven to work for many patients in both preventing and treating
migraines. There is no "cure for migraine, but there is hope.
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- Clearly' most
migraine sufferers are not availing themselves
of these medicines:
physicians report that the average patient suffers
from migraine for
3.5 years before seeking treatment! According to the
National Headache
Foundation' migraine is such a pervasive problem, that
157 million work
days are lost each year in the U.S., at a cost of $17.2
billion. This
does not factor in the social cost of migraine or the personal
costs.
Migraine sufferers owe it to themselves, to their families and to
their
jobs to see a physician for proper evaluation and treatment' even
if it
means taking a day off from work to do so.
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- What causes
migraines?
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- In many patients, migraines have well known
"triggers:
Factors which cause a migraine to start. These
include:
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Foods (eg. chocolate, smoked fish, nuts, pickled foods,
or aged
cheese)
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Beverages (eg. red wine, other alcoholic beverages;
caffeine
withdrawal)
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- Food additives (e.g. nitrates, nitrites or MSG)
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- Environmental
factors (e.g. bright or flashing lights;
changes in weather;
increased stress; missed meals; changes
in altitude)
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- Significant changes
in sleep (either too much or too
little)
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- Hormonal changes: especially
changes in estrogen levels
(e.g. with pregnancy' premenstrual
syndrome, and perimenopause)
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- Medications: starting or stopping many medications
may increase or decrease migraine incidence (e.g. birth control
pills,
hormone replacement therapy' certain antidepressants,
certain blood
pressure medications). This is another reason never
to stop taking
a chronic medicine suddenly without first
discussing it with your
physician.
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- Migraine headaches can also be
hereditary. If both parents
have them, there is a 75% chance that their
children will have them; if
only one parent has migraines, there is a
50% chance that the child will
be affected.
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- Why is migraine a
particular issue for women?
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- One in six American women
experience migraines. Migraine
is much more common in women than men: 3
out of 4 migraine sufferers are
female. This is believed to be due to
hormonal changes, particularly those
related to the menstrual cycle,
pregnancy' PMS and perimenopause (the 2-10
years preceding menopause
when hormonal levels fluctuate considerably).
Of the 18 million women
estimated to be migraine sufferers in the U.S.,
approximately two
thirds experience migraine right before their menstrual
periods.
Migraine headaches of this type are typically the most severe
and least
likely to respond to treatment.
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- In some women taking birth control pills, migraines may
also worsen or increase in frequency (although some women experience the
opposite effect). Changing to a lower dose birth control pill may help.
The good news about menopause is that migraines usually decrease
dramatically.
Taking estrogen replacement therapy (ERT) may cause
migraines to continue,
however. This is not a reason not to take ERt'
just another issue to discuss
with your health care provider if it
affects you.
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- Despite the prevalence of migraine in women' nearly half
of
women migraine sufferers surveyed are unaware of this. This causes many
women with migraine to feel alone, misunderstood, or ashamed. It causes
them to question the seriousness of their condition and avoid seeking
treatment.
Some women suffer in silence out of fear of being perceived
as "weak,
emotional, hysterical or unable to handle stress.
Ironically' the multiple
stresses and roles that many women juggle may
contribute to exacerbating
a migraine once it starts and may prevent
many women from retreating to
a restful, quiet environment to get the
respite they need. Recent research
shows that one in three female
sufferers of migraine reported that it has
affected their ability to be
in control of their lives. Of these women'
nearly half (46%) claim they
cannot really control their plans or activities,
or even function
during a migraine attack; one in five reported lost confidence
in their
ability to do their work, could not think clearly' felt "extremely
ill or felt "depressed. According to most of these women' marriages
and other relationships suffer as a result; having migraines also affects
women's level of sexual satisfaction.
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- Diagnosis
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- Any person " adult or child " who has
"the
worst headache of my life which does not resolve with
standard over-the-counter
therapy should contact his or her physician
immediately. While the diagnosis
may be a migraine, this diagnosis can
only be made after other serious
and even life-threatening problems are
considered and ruled out. If it
is a migraine, there are now many
preventive and therapeutic regimens.
See your doctor!
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- How to
tell if you have a migraine
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- Take Dr. Donnica,s
Decisionnaire to see if your headache
pain is a migraine. Check off all
that apply and take this list with your
to consult your
physician.
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- Your headache pain is generally on one side of the
head The
pain is pulsating or throbbing The pain is worsened by routing
physical activities The pain is moderate to severe in intensity The
pain inhibits or prohibits your usual activities The pain is accompanied
by nausea or vomiting The pain is accompanied by sensitivity to light
and sound You can often feel the headache coming on You get 2 or more
moderate to severe headaches per week Your severe headaches occur in
the 2-3 days before your period Your pain is so severe it requires
bedrest
Your pain does not go away within 48 hours You get a severe
headache
from caffeine withdrawal or eating Chinese food (sometimes
high in MSG)
Consult your physician immediately if: Your headache
is the worst headache
of your life Your headache is accompanied by
fever and a stiff neck
Your headaches begin after or are caused by
head injury' exertion' coughing
or bending You experience your first
severe headache after the age of
50
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- Prevention
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- I recommend keeping a headache diary (notebook or log)
to write down when you have a migraine attack, how long it lasts, its
intensity'
which medication(s) you took, or which triggers might apply.
This will
help you identify your triggers and avoid them. It may help
your physician
identify which medications would be most appropriate for
you.
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- Since
stress is high on the list of migraine triggers,
stress management
techniques are high on the list of migraine prevention
strategies.
These include massage, meditation' biofeedback and having a
positive
attitude.
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- Lifestyle modifications can also help: try to eat meals
regularly while avoiding dietary triggers; get enough rest;
exercise.
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- Medicines to prevent migraine: These medications are
prescribed to prevent the number of attacks in patients who have more than
two migraines per months. In general, these drugs act to prevent
blood-vessel
swelling; they don't treat the migraine-associated
symptoms and most won't
help a migraine once it has started. Your
doctor may recommend one of many
medicines from the following
categories:
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- Beta-blockers (e.g., propranolol) Antidepressants (e.g.,
Elavil
or Zoloft) Calcium channel blockers Methysergide
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- Treatment of
migraine
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- Drugs: There are now several categories of drug therapy
for migraine: these are divided into drugs which treat the pain and other
symptoms of migraine once it has already begun' drugs which act to stop
the migraine process, and drugs which prevent migraines. The only
over-the-counter
medication proven to treat a migraine is Excedrin
Extra Strength® (which
contains acetominophen plus caffeine); this
is the same preparation as
Excedrin Migraine ®. Numerous other
medicines from aspirin to nonsteroidal
anti-inflammatory drugs are used
routinely to try to stop the pain although
they have not been proven to
be effective. Medications to treat the nausea
of migraine are sometimes
necessary' such as Compazine® and Decadron®.
Prescription pain
medications which have been used traditionally include
ergot
preparations (such as ergotamine tartrate), and narcotics (such as
codeine, Demoral, Fiorinal, and morphine). What's news to many patients
is that there are several relatively new migraine drugs now available
including
Amerge ® (Glaxo Wellcome), Imitrex ® (GlaxoWellcome),
Maxalt ®
(Merck), Migranal Nasal Spray ® (Novartis
Pharmaceuticals), and Zomig
® (Zeneca). If you suffer from
migraines and you are not satisfied
with your current therapy' ask your
doctor if you are a candidate for one
of these newer
medications.
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- Amerge (naratriptan hydrochloride): A selective serotonin
(5-Ht'1) receptor-agonist indicated for the acute treatment of migraine
attacks with or without aura in adults. Comes in tablet form. It should
not be used for the prevention of migraine and it is contraindicated in
many patients with underlying cardiovascular disease. This drug should
not be used in pregnancy or while nursing.
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- Imitrex (sumatriptan
succinate): A selective serotonin
(5-Ht'1) receptor-agonist indicated
for the acute treatment of migraine
attacks with or without aura in
adults (does not prevent migraine). Imitrex
treats the pain of migraine
as well as its associated symptoms. Recent
studies also show that it is
effective in relieving migraine pain associated
with menses within one
hour of injection; tablets take about 4 hours to
provide relief in 67%
of patients. Imitrex comes in injection' tablet'
and nasal spray dosage
forms. It should not be used for the prevention
of migraine and it is
contraindicated in many patients with underlying
cardiovascular
disease. This drug should not be used in pregnancy or while
nursing.
Currently being tested in children.
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- Maxalt (rizatriptan benzoate):
A selective serotonin
(5-HT-1B) receptor-agonist indicated for the
acute treatment of migraine
with or without aura in adults. It should
not be used for the prevention
of migraine and it is contraindicated in
many patients with underlying
cardiovascular disease. This drug should
not be used in pregnancy or while
nursing. Available in a pill and
sublingual tablet form.
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- Migranal (dihydroergotamine mesylate): An ergot
preparation
indicated for the acute treatment of migraine attacks with
or without aura
in adults. Available only as an injectable since the
1950,s, it is now
available in a nasal spray dosage form. While
Migranal treats the pain
of migraine, it does not treat the associated
symptoms. It is contraindicated
in patients with certain types of
underlying cardiovascular disease. This
drug should not be used in
pregnancy or while nursing.
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- Zomig (zolmitriptan): A selective serotonin (5-HT-1B)
receptor-agonist indicated for the acute treatment of migraine with or
without aura in adults. It should not be used for the prevention of
migraine
and it is contraindicated in many patients with underlying
cardiovascular
disease. This drug should not be used in pregnancy or
while nursing.
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- Diet: Avoid dietary triggers religiously!
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- Migraine
diary.
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- Your doctor may advise you to keep a diary of your
headache
frequency' duration' associated symptoms, triggers, and sleep
patters.
Combined with a record of medications taken and their results,
this will
help monitor your progress.
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- Alternative and
adjunctive therapies.
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- The difference between
alternative and adjunctive therapies
is that alternatives are
techniques and modalities which have yet to be
proven to work in people
in general by scientifically controlled clinical
research trials, but
which many people have testified work for them. Adjunctive
therapies
are approaches which have been shown by clinical research to
improve
prevention and treatment outcomes, but which are often recommended
in
addition to pharmacologic therapy. In the approach to migraine therapy'
the best recommendation is if it works for you, do it! Examples of
alternative
therapies for migraine include muscle relaxation techniques
and massage,
acupunture, biofeedback, counseling and behavior
modification therapy.
Examples of adjunctive therapies for migraine
include keeping a migraine
diary' avoiding migraine triggers, and
keeping a regular sleep schedule.
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- Whatever your choice of
therapy' remember that you,re
not committed to that choice for life!
You and your physician will monitor
your progress and your comfort
level with your treatment plan. If there
are factors that change "
including your level of satisfaction "
discuss this with your
physician. ______________
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- Donnica L. Moore, MD is President' Sapphire Women's
Health
Group and is the regular women's health contributor for Later
Today. She
is a nationally recognized women's health expert and a
migraine sufferer.
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