Managing Migraines

with Steven Park, M.D., neurologist with Advanced Healthcare

Last Updated: Sept. 1, 2003

Debilitating headaches, dizziness, nausea, sensitivity to outside stimuli – these symptoms are all too familiar to at least 28 million Americans. The culprit is migraine. Certainly a common complaint, but to those who have had the misfortune of inheriting its recurrent knock on the door, it’s not simple at all.

Steven Park, M.D., neurologist with Advanced Healthcare “Up until the early 1990s, we didn’t have many measures to help the migraine patient.”

Dr. Steven Park, a neurologist at Advanced Healthcare, knows all too well just how disrupting migraines can be for people. Up to 30% of his patients suffer from headaches.

Luckily, he said new and advanced medical care for migraines has changed the course of treatment. Interestingly, Park added that up to 80% of people who believe they are having sinus headaches, are really experiencing a migraine. “It’s the most widely accepted wrong information,” Dr. Park said.

Why you get migraines
A migraine is a very severe or disabling headache not caused by any physical or neurological disease. According to Dr. Park, it is a neurogenic process triggered by genetically oriented factors.

When the brain’s headache generator starts to process a migraine, three major areas are affected – the central pain center, nerve endings, and blood vessels of the head and face. This process is complicated by chemicals, known as neurotransmitters, that cause aseptic inflammation (tissue reaction) in the blood vessels and nerve endings.

If you experience frequent migraines, your pain threshold decreases, both in the brain and in your nerve endings – a vicious circle, leaving many without the ability to function normally in their day-to-day lives.

There are also two major groups of migraine, with aura and without aura. Aura means warning symptoms that are anatomically specific to part of the brain – dizziness, numbness, sensitivity or visual distractions, for instance.

About 50% of migraine sufferers experience prodromal symptoms that can take place several hours to days ahead. These are not anatomically specific to the brain and may include things like food cravings, mood swings and fatigue.

Diagnosis
During a patient’s first visit, Dr. Park takes a detailed history and conducts a physical examination. The exam, combined with some very specific criteria outlined by the International Headache Society (IHS), helps him to diagnose the problem.

“The way that we diagnose is through a thorough understanding of the headache and the patient,” said Dr. Park. “That helps us to manage the situation.”

When a patient describes recurrent, disabling headaches, but has no other underlying brain related disease, it’s likely a migraine.

“Many symptoms start in the back of the head (at the base of the skull) and come forward,” he added. “That’s the process (of migraine).”

Women are more frequently burdened with migraines, at a ratio of 3 to 1 more often than men. In addition, many women frequently experience migraines during their menstrual cycle.

In children before puberty, migraines tend to be slightly more prevalent in boys than girls. It leads to an interesting consideration regarding hormonal effects on migraines.

Feeling better
Within the last 10 years, help has definitely arrived in the form of triptans, a serotonin-specific receptor agonist. This drug treats migraine symptoms by decreasing the inflammation around the blood vessels and nerve endings around the head and face, and desensitizing the central pain center.

Fast-acting drugs include Imitrex, Zomig, Maxalt, Axert and Relpax, and long-acting medication includes Amerge and Frova. Long-acting drugs are used for patients who have recurrent headaches even after they’ve used the immediate acting triptans.

“The key, if you have aura or prodroma symptoms, is to take the medicine immediately,” Dr. Park said. “If you have no warning symptoms, and your headache starts slowly, then gets bigger, the sooner the better.”

Imitrex also comes in an injectable and nasal spray. These forms of the drug are used in cases when it’s too late for the early warning symptoms. For instance, a migraine sufferer wakes up and is already experiencing a headache, or for patients whose migraine is rapidly progressing.

“With triptan, we see a significant improvement in two-thirds of the cases,” he added. “That means they can continue living their lives.”

The down side is that 20% to 35% of patients have recurrent headaches after the triptan wears off. For them, a second dose is in store.

“If you have a migraine more than once a week or more than four times per month, you should treat them with prophylactic therapy,” advised Dr. Park.

Widely used prophylactic agents include beta-blockers (for blood pressure), the antidepressant tricyclics, and anticonvulsants (seizure medicine).

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