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Jun 07

Migraines

Happy Monday, and welcome to Medical Mondays!

I generally try not to take medications for anything, unless I find it absolutely necessary. (I bought a tiny bottle of Ibuprofen back in 2009 when I messed up my back, and let’s just say…I still have it, and it’s still pretty full.)

However, last Sunday, I woke up with a dull, throbbing headache that kept me company all through my drive back to Kentucky. It stuck around all through the day as I tried to study, so I was all sorts of annoyed (and miserable) because I’d been hoping to catch up/get ahead, but with the accompanying nausea, dry heaves, and complete lack of appetite, I was a pretty pathetic sight by evening (aka curled up under a pile of blankets in my very-darkened room).

I managed to make it over to Isaac + Sean’s, and they gave me unexpired Ibuprofen, a glass of water, and covered me with a blanket.

M: (grabs my blanket from me)
F: Why would you do that!? ;_;
M: I asked you a question and you were ignoring me! :[
F: I never even heard your question!
M: Why are you being so pathetic? What’s going on?
I: Be nice to her! She has a bad headache!
M: …Oh. Oops. Sorry! (tucks me back in)

I can recall a handful of other times in my life where this has happened (e.g. DR beach day last year, although thankfully, it set in later in the day), but had always written it off and/or attributed it to stress or dehydration. But…maybe they’re not. My mom gets them too.

This whole back story is really just to introduce this week’s topic to you…Migraines!

Migraines

Migraines are a complex and recurrent headache disorder, and are one of the most common complaints in medicine. It is currently thought to be due to a neurogenic process with secondary changes in cerebral perfusion associated with sterile neurogenic inflammation.

In the U.S., >30 million people have 1+ migraine headaches per year. ~75% of those who experience migraines are female, and about 70% patients have a first-degree relative with a history of migraine.

Signs & Symptoms

  • Throbbing or pulsatile headache, with moderate to severe pain that intensifies with movement or physical activity
  • Unilateral + localized pain in the frontotemporal + ocular area, but pain can be felt anywhere around head or neck
  • Pain builds up over period of 1-2 hours, progressing posteriorly + becoming diffuse
  • Headache lasts 4-72 hours
  • Nausea (80%), vomiting (50%), including anorexia + food intolerance, and lightheadedness
  • Sensitivity to light + sound
  • Migraine aura may precede or accompany the headache phase, or may occur on its own
    • Usually develops over 5-20 minutes + lasts < 60 min
    • Most common visual phenomenon is the “scintillating scotoma” (arc or band of absent vision with shimmering or glittering zigzag border)

Physical Findings

  • Cranial/cervical muscle tenderness
  • Tachycardia (HR > 100) or bradycardia (HR < 60)
  • Hypertension or hypotension

Diagnosis

The diagnosis of migraines is based on patient history. Symptoms must not have been attributable to another disorder, and patients must have had at least 5 headache attacks that lasted 4-72 hours (untreated or unsuccessfully treated). The headache must have had at least 2 of the following characteristics:

  • Unilateral location
  • Pulsating quality
  • Moderate or severe pain intensity
  • Aggravation by or causing avoidance of routine physical activity

The patient must also have had at least 1 of the following:

  • Nausea and/or vomiting
  • Photophobia + phonophobia

Treatment/Management

  • Acute/Abortive Medications
    • SSRIs or triptans
    • Ergot alkaloids (e.g. ergotamine, dihydroergotamine)
    • Analgesics
    • NSAIDs
    • Antiemetics
  • Preventive/Prophylactic Medications
    • Antiepileptic drugs
    • Beta blockers
    • Tricyclic antidepressants
    • Calcium channel blockers
    • SSRIs
    • NSAIDs
    • Serotonin antagonists
    • Botulinum toxin

These can be considered if the patient has any of the following:

  • Frequency of attacks >2/month
  • Duration of individual attacks >24 hrs
  • Headaches cause major disruptions in patient’s lifestyle, with significant disability that lasts 3+ days
  • Abortive therapy fails or is overused
  • Symptomatic medications contraindicated or ineffective
  • Use of abortive medications >2/week

Other treatments that may be helpful include:

  • Reduction of migraine triggers (e.g. lack of sleep, fatigue, stress, certain foods)
  • Nonpharmacologic therapy (e.g. biofeedback, cognitive-behavioral therapy)
  • Integrative medicine (e.g. butterbur, riboflavin, magnesium, feverfew, coenzyme Q10)

I came up with this design ages ago for our class t-shirt contest! :]
Disclaimer: This is where I reiterate that I am merely a medical student struggling through the world that is her clinical rotations. The statements made on this blog should not be taken as medical advice to treat, cure or prevent any disease. Please contact your own physician or health care provider before starting a health or fitness/wellness program. (See full disclaimer here.)

Permanent link to this article: http://www.fairyburger.com/migraines/

30 comments

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  1. Elle

    I haven’t had a migraine in a while, but definitely did always experience nausea when I had them. I usually try to just sleep it off and not take medicine either.

    Just a reminder, double check the expiry date of your ibuprofen from 2009 if you plan to take it again!
    Elle recently posted…Biofreeze Reviews. The Good, the Bad and the Ugly. Plus, How to Get $47.88 (53%) OFF via AmazonMy Profile

    1. Farrah

      I tried to sleep it off and it worked for while I was asleep! Right back to square one though when I woke up. :[

      haha, my Ibuprofen definitely expired 6 years ago. ._. I need to go get a new bottle in case I ever get surprise-attacked by one of these suckers again, and don’t happen to have my friends nearby!

  2. Elsie @ Sharing Healthiness

    I’ve never had any head problems before but lately I have been having all sorts of symptoms that I am still trying to figure out. Since I have never experienced them I really don’t know what hey are. I still think they are not migranes but nevertheless this post comes at a perfect time! Thanks! By the way I also try to get away from meds..sleep is the best cure 😉
    Elsie @ Sharing Healthiness recently posted…How A Touch of Color Can Affect Your Experience With FoodMy Profile

    1. Farrah

      Oh noes! I hope they clear up soon! Head problems are never fun. I usually go for super-hydration, sleep, and some de-stressing before I’ll turn to anything else!

  3. Stephanie De Geeter

    I got migraines and cluster headaches, it’s an utter pain in my life (pun intended) The only medicine I take is ibuprofen and when it’s very bad, my triptans. I’m just recovering from 2 days in bed now and I’m still feeling light in the head and not hungry at all.
    I hop you feel better as well !!!
    Stephanie De Geeter recently posted…May Month, Nature Month – How I feel now !!!My Profile

    1. Farrah

      Aughh! I’m so sorry to hear that! :[ That double-whammy definitely isn’t any fun at all to deal with. I hope your headache(s) go away soon! <3

  4. Amber

    I actually got so many migraines and they were so bad when I was little (I’m talking 7/8) I had to get a catscan and MRI of my brain…to find out why. Results were inconclusive, I suffered migraines all through out high school and part of college, once I went Gluten Free for Celiac…they stopped almost completely – ironic, now they are far and few in between and from heat/dehydration/stress/tense neck and shoulders!
    Amber recently posted…Celiac Support SystemMy Profile

    1. Farrah

      Ack! I’m sorry to hear that, but super glad that they’ve almost completely stopped! (+ yay for being able to ID the triggers! Dehydration + sleep deprivation are probably my top two!)

  5. Regan @ The Healthy Aperture Blog

    I started experiencing migraine with aura not long after my first son was born. The first time it happened, I was totally freaked out. While I’d experienced headaches (bad ones) before, the phenomenon of aura is very unsettling. That’s been 8 years ago, and while I wouldn’t say I “suffer regularly” I do still have them sometimes. I can’t seem to pinpoint a particular food or drink trigger… mine tend to happen when I’m either dehydrated or overly hungry. Serena Ball from TeaspoonofSpice clued me in to the magnesium/migraine connection. And I’ve experienced much better control since I stared supplementing with magnesium. Hope this doesn’t become a regular occurrence for you. Migraines stink 🙂
    Regan @ The Healthy Aperture Blog recently posted…[Sweet Splurges] Honey Frozen Greek YogurtMy Profile

    1. Farrah

      They can definitely be creepy, especially the first time around! Migraines definitely suck, and I’m glad you’re having better control with them now! Identifying the triggers definitely helps a lot!

  6. Susie @ SuzLyfe

    I have so much sympathy for those dealing with migraines. I have a sinus headache right now, and it blows! My mom suffered horrible migraines during one of her hormone treatments, and it was just awful, and one of my friends growing up missed the last 2 months of school senior year because of them. She came to graduation, but that was the first time that we had seen her in a long time. I really hope that this was just a stress or pressure induced migraine, and not something that sticks around!
    Susie @ SuzLyfe recently posted…A Quiet Weekend that Spoke Volumes : Little Things In LifeMy Profile

    1. Farrah

      Ugh, that really sucks! I hope your headache goes away soon (sinus HA’s are really cruddy to deal with too–headaches in general, really ._.) I really hope it’s not something that sticks around! Good motivation to stay hydrated though? (I think that’s probably one of my triggers.)

  7. Eva

    We talked about delivering babies and I will tell you this I would rather deliver a baby than have a migraine. My migraines are pretty bad.
    Eva recently posted…Penny Lift Simple ScienceMy Profile

    1. Farrah

      Are you serious!?!?! My goodness, that’s intense, hahaha. I think I’d much rather get the migraine. 😡 (Neither would be even better! ;P )

  8. Julie @ Running in a Skirt

    I know this one all too well!!!!! It stinks! Thanks for raising awareness to it!
    Julie @ Running in a Skirt recently posted…Barnsley Resort – Take 2My Profile

    1. Farrah

      I figured I might as well make others/myself learn from it if I was going to suffer through em’! They do indeed suck! :[

  9. Alyssa @ Renaissancerunnergirl

    I have unfortunately been familiar with migraines since I was 6 (so, for 17, nearly 18 years) mostly in connection with insomnia. It is so important to realize they’re not “just headaches!”
    Alyssa @ Renaissancerunnergirl recently posted…Run-Eat-Repeat for the NYRR Retro 4-MilerMy Profile

    1. Farrah

      Nooo, I’m sorry to hear that! :[ And definitely agreed! I wrote mine off as “just [reallyreally bad] headaches” until about a week ago, ahaha. ._.

  10. Jessica @ Nutritioulicious

    ugh, i get horrible migraines and it is so debilitating. I have prescription meds that I take when I feel it coming on and it usually helps, but lately it seems to not be working as well. I find stress, lack of sleep, and time of month play big roles in the onset. Hope you don’t have them ongoing!

    1. Farrah

      Aww, I’m sorry to hear that! I hear ya on them being horrible though. :[ I think stress, lack of sleep, and dehydration are probably my biggest triggers. x_x

  11. Jill

    Migraine sufferer here! I’ve been getting them since I was a teenager so like 20 years?!? I know some of my triggers (dehydration, excess sugar, wine, lack of sleep, time of the month) but sometimes they just come on randomly too. I treat them with prescription Imitrex along with OTC stuff like excedrin, Aleve & aspirin. Pretty much a cocktail until it goes away! They are horrible but def run in my family. My grandmother had them and my sister gets them all the time too.
    Jill recently posted…Fitness Friday: Let’s Talk About Half-Marathon Weight GainMy Profile

    1. Farrah

      Ahh, that sucks! I’m so sorry, but I’m really glad you’ve managed to identify your triggers! I think mine is probably dehydration/lack of sleep. I tried to drink a bunch of water when I had mine last week, but it (sadly) only succeeded in making my head pound even more. ;_; + darn that hereditary part!

  12. Rebecca @ Strength and Sunshine

    My mom suffers from debilitating ones (and was just in the hospital last night for one), but they’re due to other health problems. It’s so scary.
    I used to get bad migraines when I was younger before I went through 5 years of allergy shots (immunotherapy) and now I’m 100% awesome!
    Rebecca @ Strength and Sunshine recently posted…Cranberry Bean & Pepper TacosMy Profile

    1. Farrah

      Oh man! I’m sorry to hear that–I hope she’s doing better now! :[ I’m glad you don’t get them anymore! <3

  13. Dixya @ Food, Pleasure, and Health

    i know a lot of people who suffer from migraine and its terrible 🙁 m sharing this on my facebook.
    Dixya @ Food, Pleasure, and Health recently posted…Easy Black Bean BrowniesMy Profile

    1. Farrah

      They’re definitely not fun. :[! Thank you for sharing!

  14. Angela Tolsma

    I actually wrote about how my migraine (http://clutterboxblog.com/blog/2015/04/21/the-attack-of-migraine/) made me feel last time I had one. They are terrible and evil. I enjoyed your post. Though I am confused by the use the term anorexia. Food intolerance absolutely, I don’t generally eat when I have one, anorexia just seems a weird term to include.
    Angela Tolsma recently posted…Wild and IncompleteMy Profile

    1. Farrah

      They are indeed horrible. :[ Anorexia is a term they sometimes use to describe extreme food intolerance, but I can definitely get where it gets confusing! I’ll go clear it up! :O

  15. Jess @hellotofit

    One of the physical therapists I used to work with would tell me how his migraines set on: seeing spots, immediately vomiting, and then the migraine. Crazy!
    Jess @hellotofit recently posted…Versatile Blogger AwardMy Profile

    1. Farrah

      They’re definitely not a fun time! :[

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