Migraines Overview

Migraines Video

HOST ON CAMERA:
Hello and welcome to the Answered Patient.  I’m Jane Hanson. In this episode you’ll learn about the symptoms of Migraines and the triggers that can cause them. You’ll find out how Migraines are diagnosed, and who is most likely to develop them. We’ll also give you strategies for preventing and treating this often chronic and frustrating condition.

MERLE DIAMOND: I think the best definition of a migraine is, uh, headache that stops you from functioning.

MATT: When I heard other people say things like that they had a bad headache, I would take it like, how can you even walk then, how can you even function, when I get a bad headache, I’m laid out.

HOST ON CAMERA; 
If you‘ve ever had Migraines, you know how painfully disabling they can be.  Fortunately, the medical community has come a long way in understanding and effectively managing them. Migraines affect about 28 million Americans. And prominent people throughout history were “migraineurs” – people who suffer from this troubling condition.

DR. RAMADAN: JFK, Serena Williams, Scottie Pippin, Julius Caesar, Bonaparte, Presley…

HOST ON CAMERA:
Migraines can occur at any time.  But in most people they begin just before puberty and continue through middle age.For many, migraines may become less severe or even stop altogether between the ages of 50 or 60. Migraines are three times more common in women than men, and tend to run in families.

HOST NARRATION: Experts believe that one trigger may be the female hormone estrogen.  When estrogen levels fluctuate, migraines can occur.

DR. RICHARD KRAIG: The fact that there is some type of correlation between the two is clear.  The science of why, I’m afraid we’re not getting yet.                                                   

HOST ON CAMERA: This may explain why Migraines affect more women than men.  And why women who have migraines frequently experience them around their menstrual cycles. There are various triggers for Migraines, such as

HOST NARRATION: Weather patterns…bright lights…loud noises…and in foods like salami, aged cheese, wine and chocolate.

DAVID GROTTO: Keep a log of what foods may be correlated, may be associated with the bringing on of that event of the headache.

HOST NARRATION: 
While we don’t know exactly why migraines occur, doctors believe that they begin in the brain itself, and involve the nerve pathways. Chemicals in the brain and complex changes in blood flow, also play a role. 

DR. RAMADAN:
The whole idea in the past that use to be migraine as a blood vessel problem where the blood vessel constricts, and then the blood vessel dilates, and you have the pain.//  That really has modified quite substantially now a days, and what we look at it is we look at it more of a nerve storm // that leads to the blood vessel changes subsequently.

HOST ON CAMERA: So how do you distinguish Migraines from other headaches? The symptoms are different and specific.

MERLE DIAMOND: You might be nauseated, light and noise sensitive but it’s defined by the interruption of your life and that it’s not necessarily predictable.

HOST ON CAMERA:
Doctors use these symptoms to diagnose Migraines, so it’s important to know yours. And while there’s no medical procedure to confirm the diagnosis, a neurological exam can rule out other disorders. A CT scan or MRI of the head may also be ordered by your doctor to search for any organic reasons for your pain. Additionally, some people experience “prodromes” -- changes in mood or behavior as early as 24 hours before a Migraine starts. About 25 percent of people experience “auras” – temporary disturbances in vision, hearing, balance or speech that begin about an hour before a Migraine starts.  

HOST VO: Seeing flashing lights is common.  Auras usually disappear as the Migraine begins. 

DR. TRUPTI GOKANI: 
Some patients present with an aura, an interesting visual phenomenon, which is just a wave of excitation, that’s passing from the back to the front of the head.  So there’s this shift of serotonin, there’s the activation of the nerves, the wave of excitation, and then the blood vessels constrict, and then dialate, and the nerve endings become inflamed, and that’s a full blown attack of a migraine.

HOST ON CAMERA:
And when it ends, about 25 percent of people experience a “postdrome,” a change in mood or behavior similar to a prodrome. While Migraines can be chronic, frustrating and disruptive, they usually don’t affect your general health.  However, there is some evidence linking migraine with stroke. 

HOST NARRATION: 
But for most people, Migraines are more of a pain than a threat.  They can last for a few hours to a few days – and can disrupt life for patients, their families, and even the workplace. It’s estimated that 150 million work days a year are lost to migraines and other types of headaches. 

BLONSKY:
There’s about a billion dollars worth of medical expense per year for migraine // and about fourteen billion dollars worth of cost in terms of lost, uh, work time, lost productivity, and so forth.

HOST ON CAMERA: But there’s good news.  Migraines can be prevented and managed both with lifestyle changes and medication.  

MERLE DIAMOND, M.D.:
Well we’ve come a long way in the last 30 years because 30 years ago migraine was considered to be a neurotic disorder and so we know that it’s a neurologic disorder and in fact some of us believe disease.

HOST ON CAMERA:
The key to prevention is to identify your specific triggers so you can avoid them.  Keeping a diary of foods and environmental changes that precede your Migraines can help you do that. If you have more than three Migraines a month, you may benefit from preventive medication. 

HOST NARRATION:
When Migraines do occur, you might lessen their severity by acting quickly when the first symptoms appear. Some people find hot or cold compresses to the head and neck can help. So can resting in a dark, quiet place. And you should take any over-the-counter or prescription medications your doctor has advised for you.

MERLE DIAMOND, M.D.:
I’ve seen a dramatic change in how we can help people and I can only hope that those dramatic changes will continue because we understand a lot more.

HOST ON CAMERA: 
The Answered Patient is here to give you the information you need to manage your migraines. In the other chapters of this episode, you can learn more about how migraines are diagnosed, the physical changes that occur during them, and useful tips for limiting their frequency and severity. We’ll also tell you about the latest research into new and effective treatment options. In our “Personal Stories” chapter, you’ll meet real patients and discover how they’re handling their condition.