Pain Beyond MeasureApr 01, 2017 ● By Carolyn Cameron
Almost 40 million people suffer from the crippling effects of migraines throughout the U.S. Sorely misunderstood and many times dismissed as “just a headache,” migraines have the capacity to disrupt a person’s life, relationships and sense of well-being. As the third most prevalent illness in the world, migraines affect more than four million people chronically, with sufferers experiencing at least 15 migraine days per month. Indeed, more than 90 percent of sufferers are unable to work or function normally during their migraine.
Although migraines manifest differently in individuals, sufferers typically experience pounding pain on the side of the head, visual disturbances, nausea, dizziness and extreme sensitivity to sound, light and touch. Affecting three times as many women as men, migraines touch almost 12 percent of the population and are usually hereditary, but the type and frequency of migraines can vary between each family member. Some may suffer incredible pain while others experience migraines on occasion, perhaps after drinking alcohol or participating in other “trigger” behaviors. Triggers can include a wide variety of factors, such as hormonal changes in women, weather patterns, specific foods, food additives such as aspartame, increased stress or even changes or disruptions in sleep patterns. Migraine headaches are often accompanied by an “aura,” which is a visual disturbance, and they can also include gastrointestinal issues.
Dr. Aimee Garza, the medical director and neurologist from The Center for Neurology and Neurophysiology, explains, “Most individuals experience a trigger up to an hour before the throbbing pain begins. However, not all patients experience a predictable trigger, and some never identify a trigger for themselves. Migraines can typically last from four to 72 hours, and often patients then experience what we call a ‘hangover headache,’ which can include nausea, vomiting and sensitivity to light, noise and activity. While many individuals categorize migraines as just a headache, it is far more and can significantly degrade someone’s well-being and quality of life.”
Migraine Treatments De-Mystified
As any individual who has experienced a migraine understands, treatment for this disease can be extremely tricky. Of course, sufferers should avoid anything that aggravates or triggers the migraine. However, if the headache begins and persists, many avenues exist for sufferers to try. Ultimately, migraines are difficult to treat because there is no one side-effect-free, silver bullet that works for everyone experiencing the agony of the condition.
Kim continues, “When I began having migraines in my teens, I gravitated towards over-the-counter pain killers, such as extra-strength Excedrin®, taking it every four hours. Quickly, I noticed the more pills I took, the more extreme my rebound headaches became. These were debilitating. I soon discovered that I needed to try other avenues to treat the migraines.”
With much trial and error and after seeing numerous physicians, Kim discovered the use of triptans as extremely beneficial for managing her pain. According to the Pain Relief Center in Plano, triptans are a class of medicines used to relieve migraine attacks and cluster headache symptoms. Available in a wide variety of brands on the market today, triptans are typically used when painkillers are not effective. Known as brands such as Imitrex, Maxalt and Relpax, triptans have been in existence for 19 years and generally are successful in almost 65 percent of sufferers. Directed to be taken once a patient starts to feel a migraine headache develop, triptans work by stimulating serotonin in the body, which is a neurotransmitter found in the brain. The use of triptans constricts blood vessels in the brain and relieves swelling, which can help stop or minimize the headache or migraine. “Before the use of triptan drugs, I vividly remember not being able to go about my day and serve my family. I was unable to cope and function,” adds Kim. “Today, they have made my life worth living.”
Additionally, a newer option for treating migraines is Botox. Often known for use with the reality television housewives of America, this wrinkle-smoothing injectable was approved by the Federal Drug Association (FDA) in 2010, and over time, insurance companies began to approve the use for treating migraines. While Botox may help in removing wrinkles, the injections also relieve pain caused by chronic migraines because it relaxes muscles and blocks transmission of pain messages to the brain. Using a series of 31 tiny injections in the head, the process can be uncomfortable, but many see success with the treatment. Patients usually receive Botox every three months, but the time period from the injection to the onset of pain relief remains different for every patient. While some may have pain relief after the first round of injections, others may not have relief until a six to nine-month period. It takes time to re-train muscles to relax, and if insurance is not covering the treatment, the pain can be felt significantly in the pocketbook. Dr. Garza notes, “While my patients are becoming more aware of Botox as a treatment option for migraines, it is not designed for everyone. Typically, I recommend it for those who have not had success with oral treatments and experience migraines at least 15 days out of a month.”
Other migraine treatments include occipital nerve stimulation and occipital nerve block. The occipital nerves exist from the spine through the back of the neck and to the end of the scalp. According to the Pain Relief Center, “Occipital nerve stimulation involves placing a device, or lead, at the base of the skull by the occipital nerves. It is connected to a power source that sends electrical impulses to the lead. The lead then sends electrical impulses to the occipital nerves to disrupt pain signals.” With an occipital nerve block, a steroid is injected into one or both occipital nerves for migraine help. Dr. Garza adds, “While we offer different treatment methods at our office, I have not had a great success rate with several of them, and I just do not use them that often. Typically, we can treat patients effectively with oral treatments, and we try to individualize treatment based on the patient preferences, success rate and wishes.”
Thinking Outside the (Pill) Box
Although pills, injections and other treatments do help migraine sufferers, these solutions do not fight the battle alone. There is a lot individuals can do outside of medicine to fight migraines, including managing specific triggers. Basically, it boils down to lifestyle changes -- things such as getting the right amount of sleep, not skipping meals, appropriate exercising and eliminating stress.
While navigating through the dizzying array of treatment options can be as “painful” as the conditions they are supposed to treat, one of the best solutions for migraine sufferers is to work with a trusted headache specialist who listens and patiently works with each individual. “Today, with the help of managing my diet and activities, as well as the use of triptans, I have my life back,” continues Kim.