Migraines can be more than just painful; they can be debilitating, affecting a person’s quality of life in ways that many people underestimate. I’m Dr. Sal, a practicing surgeon for over 30 years. Today, we’re diving into migraines—understanding their causes, triggers, symptoms, and effective management strategies.
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What Are Migraines?
Migraines are more than just severe headaches; they are a neurological disorder affecting around 12% of Americans, making them the sixth most disabling disease worldwide. They are categorized as a primary or secondary disorder: primary migraines start in the head itself, while secondary headaches are linked to other physical issues that eventually cause head pain. While imaging and blood tests can rule out other conditions, a migraine diagnosis is made clinically based on a patient’s symptoms.
Types of Migraines
1. Migraine with Aura (Complicated Migraine)
These migraines are often accompanied by visual or sensory symptoms like seeing flashing lights or experiencing tingling.
2. Migraine without Aura (Common Migraine)
Common migraines are more straightforward, usually lacking the sensory symptoms associated with aura.
3. Hemiplegic Migraines
These migraines cause weakness or paralysis on one side of the body, often mimicking stroke symptoms, which can be frightening for sufferers.
4. Ocular or Retinal Migraines
Starting with pain in the eye, these migraines can spread and lead to intense head pain, impacting vision and often causing blind spots.
5. Chronic Migraines
Defined as 15 or more headache days per month, these can vary in intensity but often progress to more severe symptoms that sometimes require hospitalization.
6. Migraines with Brainstem Aura
These affect the brainstem and can lead to dizziness, slurred speech, and double vision—symptoms that mimic serious conditions like strokes.
7. Status Migrainosus
A rare and severe type, Status Migrainosus lasts over 72 hours and is so intense that it often necessitates hospitalization for IV therapy.
Phases of a Migraine
1. Prodrome Phase
In the hours or days before a migraine, many people experience mood changes, irritability, difficulty concentrating, and sleep disruptions.
2. Aura Phase
This phase, which lasts from 5 to 60 minutes, involves visual or sensory disturbances, such as tingling, numbness, or flashes of light.
3. Headache Phase
Often the most intense phase, this is characterized by throbbing pain that can be migratory or accompanied by nausea, vomiting, and sensitivity to light and sound.
4. Postdrome Phase
Following the headache, many people experience a “hangover” effect, marked by fatigue, low motivation, and poor concentration.
Causes and Triggers of Migraines
Migraines are believed to be a combination of genetic and environmental factors. The older theory that migraines were solely caused by blood vessel dilation has been debunked, and modern research indicates that migraines likely stem from a short-circuiting within the brain, where neurotransmitters fire improperly. This can lead to inflammation and other intracranial and extracranial changes.
Common Triggers
• Emotional Stress
• Dietary Factors: Certain foods like chocolate, alcohol, and foods containing nitrates (such as processed meats) can trigger migraines.
• Excessive Medication Use: Overuse of pain relievers can lead to rebound headaches.
• Hormonal Changes: More common in women, hormonal fluctuations can trigger migraines.
• Environmental Factors: Light sensitivity, especially from screens or flashing lights, as well as weather changes and strong smells, can also be triggers.
Treatment Approaches
Migraines cannot be fully cured, but they can be managed. Treatment strategies generally fall into two categories: abortive (for treating symptoms once a migraine starts) and preventative (to reduce migraine frequency).
1. Abortive Medications
These should be taken at the first sign of a migraine. Over-the-counter options, such as Excedrin Migraine (which contains caffeine), can help with mild to moderate pain. Prescription medications like Imitrex (sumatriptan) and newer options such as monoclonal antibodies that target calcitonin gene-related peptides are effective for more severe migraines.
2. Preventative Medications
For chronic migraines, doctors may prescribe blood pressure medications like calcium channel blockers, beta blockers, or even antidepressants. Anti-seizure medications can help prevent the neurological short-circuiting often associated with migraines. Supplements like magnesium, coenzyme Q10, and riboflavin (vitamin B2) are also beneficial.
3. Lifestyle Strategies
Simple lifestyle adjustments can make a big difference. Resting in a dark, quiet room, applying cold or warm compresses, meditation, and biofeedback are all effective at-home remedies. For chronic sufferers, developing a strong relationship with a neurologist is crucial—especially one who can provide on-call support or arrange IV treatments if necessary.
4. Alternative Treatments
Vitamins like B2, minerals like magnesium, and herbs such as feverfew and butterbur can supplement traditional treatments. Magnesium is particularly important, as it’s estimated that many Americans are deficient, and this deficiency is linked to increased migraine frequency.
Seeking Help and Building a Treatment Plan
Establishing a proactive treatment plan is essential for anyone dealing with chronic migraines. You should have access to a neurologist who understands your case and can support you if your symptoms worsen. Consider treatments like IV magnesium and corticosteroids, nerve blocks, and dihydroergotamine therapy, which are often administered in a hospital setting for severe cases.
Final Thoughts
Migraines are complex, but with the right treatment, lifestyle adjustments, and professional support, you can find relief and improve your quality of life. If you experience chronic migraines, it’s worth exploring both medical and natural treatments under the guidance of a knowledgeable healthcare provider.
I hope this message resonates with you and inspires you to take steps toward a life of health and purpose. Each blog post is backed by research, helping you align your health with a disciplined, purpose-driven life. Please share your thoughts, leave a review, or reach out with any questions. May this journey bring you closer to the health and vitality God intends for you.
God bless,
Dr. Sal
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