June National Migraine and Headache Awareness Month

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1 June National Migraine and Headache Awareness Month A note from the author Hello NCP friends! This month, I wanted to feature a topic that has been much discussed amongst several of my friends and colleagues that routinely suffer migraine and headache awareness. I personally suffer from migraines and although I am fortunate enough to have good control over my pain, I have several friends, one in particular, whose suffering significantly impacts daily life, including work. I have found that it is difficult for people who do not suffer from migraines/ headaches to understand how debilitating this condition can be. Celebrate this National Awareness Month with me by reading more about Migraines and Headaches below! Why Celebrate National Migraine and Headache Awareness Month? Individuals with headache or migraine deal with the stigma associated with these diseases. Together, we can help make them more visible and educate others about these neurobiological diseases. National Headache and Migraine Awareness Month has three objectives: to gain recognition of headache pain as a real and legitimate condition; to encourage those with headache or migraine to see a healthcare provider for proper diagnosis and treatment; and, to let individuals with headache know that there are new treatments available. This year s theme, The Art of Managing Your Headache, recognizes how personalized the treatment of headache and migraine can be. For each person, treating and managing headache is different. Managing your headache is often an art and not a

2 science. This can make headache and migraine difficult to discuss and hard for others to understand. So, join the National Headache Foundation and get involved in National Headache & Migraine Awareness Month. You can help raise awareness for migraine and other headache disorders by wearing purple to show support. What is a Headache? Headaches are unpleasant pains in your head that can cause pressure and aching. The pain can range from mild to severe, and they usually occur on both sides of your head. Some specific areas where headaches can occur include the forehead, temples, and back of the neck. A headache can last anywhere from 30 minutes to a week. According to the Mayo Clinic, the most common headache type is a tension headache. Triggers for this headache type include stress, muscle strain, and anxiety. Tension headaches aren t the only type of headache; other headache types include:

3 Cluster headaches Cluster headaches are severely painful headaches that occur on one side of the head and come in clusters. This means you experience cycles of headache attacks, followed by headache-free periods. Sinus headaches Often confused with migraines, sinus headaches co-occur with sinus infection symptoms like fever, stuffy nose, cough, congestion, and facial pressure. Chiari headaches A Chiari headache is caused by a birth defect known as a Chiari malformation, which causes the skull to push against parts of the brain, often causing pain in the back of the head. Thunderclap headaches A thunderclap headache is a very severe headache that develops in 60 seconds or less. It could be a symptom of a subarachnoid hemorrhage, a serious medical condition that requires immediate medical attention. It may also be caused by an aneurysm, stroke, or other injury. Call 911 immediately if you experience a headache of this kind. Why do Headaches hurt? Information about touch, pain, temperature, and vibration in the head and neck is sent to the brain by the trigeminal nerve, one of 12 pairs of cranial nerves that start at the base of the brain. The nerve has three branches that conduct sensations from the scalp, the blood vessels inside and outside of the skull, the lining around the brain (the meninges), and the face, mouth, neck, ears, eyes, and throat. Brain tissue itself lacks pain-sensitive nerves and does not feel pain. Headaches occur when pain-sensitive nerve endings called nociceptors react to headache triggers (such as stress, certain foods or odors, or use of medicines) and send messages through the trigeminal nerve to the thalamus, the brain's "relay station" for pain sensation from

4 all over the body. The thalamus controls the body's sensitivity to light and noise and sends messages to parts of the brain that manage awareness of pain and emotional response to it. Other parts of the brain may also be part of the process, causing nausea, vomiting, diarrhea, trouble concentrating, and other neurological symptoms. What is a Migraine? Migraines are a specific type of headache. If you suffer from migraine headaches, you're not alone. About 12 percent of the U.S. population experience migraines. Migraine headaches are characterized by throbbing and pulsating pain caused by the activation of nerve fibers that reside within the wall of brain blood vessels traveling within the meninges. Migraines headaches are recurrent attacks of moderate to severe pain that is throbbing or pulsing and often strikes one side of the head. Untreated attacks last from 4 to 72 hours. Other common symptoms are increased sensitivity to light, noise, and odors; and nausea and vomiting. Routine physical activity, movement, or even coughing or sneezing can worsen the headache pain. Migraines occur most frequently in the morning, especially upon waking. Some people have migraines at predictable times, such as before menstruation or on weekends following a stressful week of work. Many people feel exhausted or weak following a migraine but are usually symptom-free between attacks. These headaches are intense or severe and often have other symptoms in addition to head pain. Symptoms associated with a migraine headache include: nausea pain behind one eye or ear pain in the temples

5 seeing spots or flashing lights sensitivity to light and/or sound temporary vision loss vomiting When compared with tension or other headache types, migraine headache pain can be moderate to severe. Some people may experience headaches so severe they seek care at an emergency room. Migraine headaches will typically affect only one side of the head. However, it is possible to have a migraine headache that affects both sides of the head. Other differences include the pain s quality: A migraine headache will cause intense pain that may be throbbing and will make performing daily tasks very difficult. Migraine headaches are typically divided into two categories: migraine with aura and migraine without aura. An aura refers to sensations a person experiences before they get a migraine. The sensations typically occur anywhere from 10 to 30 minutes before an attack. These can include: feeling less mentally alert or having trouble thinking seeing flashing lights or unusual lines feeling tingling or numbness in the face or hands having an unusual sense of smell, taste, or touch Some migraine sufferers may experience symptoms a day or two before the actual migraine occurs. Known as the prodrome phase, these subtler signs can include: constipation depression frequent yawning irritability neck stiffness unusual food cravings

6 Who Gets Migraines? Migraines occur in both children and adults, but affect adult women three times more often than men. There is evidence that migraines are genetic, with most migraine sufferers having a family history of the disorder. They also frequently occur in people who have other medical conditions. Depression, anxiety, bipolar disorder, sleep disorders, and epilepsy are more common in individuals with migraine than in the general population. Migraine sufferers-in particular those individuals who have pre-migraine symptoms referred to as aura-have a slightly increased risk of having a stroke. Migraine in women often relates to changes in hormones. The headaches may begin at the start of the first menstrual cycle or during pregnancy. Most women see improvement after menopause, although surgical removal of the ovaries usually worsens migraines. Women with migraine who take oral contraceptives may experience changes in the frequency and severity of attacks, while women who do not suffer from headaches may develop migraines as a side effect of oral contraceptives.

7 Phases of Migraine Migraine is divided into four phases, all of which may be present during the attack: Premonitory symptoms occur up to 24 hours prior to developing a migraine. These include food cravings, unexplained mood changes (depression or euphoria), uncontrollable yawning, fluid retention, or increased urination. Aura. Some people will see flashing or bright lights or what looks like heat waves immediately prior to or during the migraine, while others may experience muscle weakness or the sensation of being touched or grabbed. Headache. A migraine usually starts gradually and builds in intensity. It is possible to have migraine without a headache. Postdrome (following the headache). Individuals are often exhausted or confused following a migraine. The postdrome period may last up to a day before people feel healthy.

8 Types of Migraine The two major types of migraine are: Migraine with aura, previously called classic migraine, includes visual disturbances and other neurological symptoms that appear about 10 to 60 minutes before the actual headache and usually last no more than an hour. Individuals may temporarily lose part or all of their vision. The aura may occur without headache pain, which can strike at any time. Other classic symptoms include trouble speaking; an abnormal sensation, numbness, or muscle weakness on one side of the body; a tingling sensation in the hands or face, and confusion. Nausea, loss of appetite, and increased sensitivity to light, sound, or noise may precede the headache. Migraine without aura, or common migraine, is the more frequent form of migraine. Symptoms include headache pain that occurs without warning and is usually felt on one side of the head, along with nausea, confusion, blurred vision, mood changes, fatigue, and increased sensitivity to light, sound, or noise. Other types of migraine include: Abdominal migraine mostly affects young children and involves moderate to severe pain in the middle of the abdomen lasting 1 to 72 hours, with little or no headache. Additional symptoms include nausea, vomiting, and loss of appetite. Many children who develop abdominal migraine will have migraine headaches later in life. Basilar-type migraine mainly affects children and adolescents. It occurs most often in teenage girls and may be associated with their menstrual cycle. Symptoms include partial or total loss of vision or double vision, dizziness and loss of balance, poor muscle coordination, slurred speech, a ringing in the ears, and fainting. The throbbing pain may come on suddenly and is felt on both sides at the back of the head. Hemiplegic migraine is a rare but severe form of migraine that causes temporary paralysis-sometimes lasting several days-on one side of the body prior to or during a headache. Symptoms such as vertigo, a pricking or stabbing sensation, and problems seeing, speaking, or swallowing may begin prior to the headache pain and usually stop shortly thereafter. When it runs in families the disorder is called Familial Hemiplegic Migraine (FHM). Though rare, at least three distinct genetic forms of FHM have been identified. These genetic mutations make the brain more sensitive or excitable, most likely by increasing brain levels of a chemical called glutamate. Menstrually-related migraine affects women around the time of their period, although most women with menstrually-related migraine also have migraines at other times of the month. Symptoms may include migraine without aura (which is much more common during menses than migraine with aura), pulsing pain on one side of the head, nausea, vomiting, and increased sensitivity to sound and light. Migraine without headache is characterized by visual problems or other aura symptoms, nausea, vomiting, and constipation, but without head pain. Headache specialists have suggested that fever, dizziness, and/or unexplained pain in a particular part of the body could also be possible types of headache-free migraine.

9 Ophthalmoplegic migraine an uncommon form of migraine with head pain, along with a droopy eyelid, large pupil, and double vision that may last for weeks, long after the pain is gone. Retinal migraine is a condition characterized by attacks of visual loss or disturbances in one eye. These attacks, like the more common visual auras, are usually associated with migraine headaches. Status migrainosus is a rare and severe type of acute migraine in which disabling pain and nausea can last 72 hours or longer. The pain and nausea may be so intense that sufferers need to be hospitalized. The Impact of Migraines Migraine is the third most common disease in the world with an estimated global prevalence of 14.7%. In the United States, migraine affects 38 million people. About 85% of migraine sufferers are women. While most people experience attacks once or twice a month, over 4 million people suffer chronic daily migraine. It is an extremely debilitating condition in which headaches are often accompanied by symptoms such as nausea, vomiting, visual disturbances, extreme sensitivity to sound and light and tingling or numbness in the face. Approximately 25% have a migraine attack with an aura, a visual disturbance that lasts less than an hour. Migraine also affects children half of all children who suffer from migraine have their first attack before the age of 12. Boys suffer more than girls, however, the proportion changes in adolescents. Despite being a major public health issue, migraine remains a poorly understood, under-diagnosed and under-treated condition. In fact, over half of all migraine sufferers are never diagnosed and majority of sufferers do not seek medical

10 care for their pain. Migraine sufferers like those who suffer from other chronic illnesses, experience high costs of medical services, too little support, and limited access to quality care. Research efforts in migraine and headache have increased in the past 2 decades. Pubmed shows an increasing number of migraine and headache publications in the last 15 years (figure) leading to substantial accumulation of data and new information. The trend continues in 2016 (867 publications) and 2017 (506 publications so far!). How do I know if I have a migraine or a headache? Headaches are one of the most common health problems that doctors and other health care professionals treat. It is among the most debilitating health conditions in the world. Although many people describe all moderate to severe headaches as migraine, there are specific criteria used to identify migraine, tension, and other lesscommon headache varieties. It may be helpful to understand that doctors and other health professionals consider most headaches painful, annoying, or even transiently debilitating to a patient, but they cause little risk. Tension headache, also known as tension-type headache, is the most common form of headache. The majority of the world s population has experienced a tension headache at some point in their life.

11 Migraine headache or migraine pain is also common, but occurs far less frequently than tension headache. The pain associated with migraine headache is quite different from tension-type headache and can help determine which type of headache a person is experiencing. Cluster headache, chronic daily headache, and medication overuse headache occur much less frequently than tension and migraine headache. Migraine headaches tend to have some marked differences from other headaches, which helps your doctor determine which type of headache you have. However, there are several different types of migraine headaches. Migraine with aura is one type. An aura is a neurological symptom such as vision change, numbness, tingling, or even difficulty speaking which precedes the onset of the headache), and migraine without aura are the most common. Although many people believe that any moderate to severe headache is a migraine, there are some specific criteria regarding the type of pain and associated symptoms, which leads to the diagnosis of migraine. Migraine VS. Headache: What is the Difference? The pain of migraine and tension headache are similar and tend to be mild, moderate, or severe in nature. The pain for each type of headache may be located on one side of the head or on both sides of the head. The differences between the pain of migraine and headache are that migraine pain has a throbbing quality, and many people report that even slight physical exertion (like walking up a flight of stairs) may worsen their pain. In contrast, the pain associated with tension-type headaches tends to be more chronic and steady. Many people with tension headache describe a band-like tightness or pressure when asked about their pain. Symptoms and signs The only similarity between a migraine and a headache are that they both cause pain. The headache may come on gradually or suddenly. Migraine is different from other headaches because it may cause symptoms like: Nausea or vomiting Sensitivity to light, sound, or smells Worsening of the headache with slight physical exertion Some doctors consider these symptoms to be an acute migraine attack. Tension-type headaches may be associated with tenderness of the muscles of the head, neck, and shoulders. If you have this type of headache, you do not have a

12 change in pain with physical activity, and there are no associated sensitivities to light, sounds, or smells. Causes of Migraines vs. Headaches Doctors believe that the underlying cause of migraines is related to changes in the blood flow in certain areas of the brain, with subsequent alterations in the blood vessels in that region. Chemical reactions may lead to swelling and irritation of the blood vessels (thought to contribute to the characteristic throbbing quality of a migraine headache). A number of different factors can increase your risk of having a migraine. These factors, which trigger the headache process, vary from person to person and include sudden changes in weather or environment, too much or not enough sleep, strong odors or fumes, emotion, stress, overexertion, loud or sudden noises, motion sickness, low blood sugar, skipped meals, tobacco, depression, anxiety, head trauma, hangover, some medications, hormonal changes, and bright or flashing lights. Medication overuse or missed doses may also cause headaches. In some 50 percent of migraine sufferers, foods or ingredients can trigger headaches. These include aspartame, caffeine (or caffeine withdrawal), wine and other types of alcohol, chocolate, aged cheeses, monosodium glutamate, some fruits and nuts, fermented or pickled goods, yeast, and cured or processed meats. Keeping a diet journal will help identify food triggers.

13 The specific cause of tension-type headache is unknown. Doctors believed at one time that chronic muscle tension was the underlying factor, but there now appears to be a more complicated combination of factors that are involved.

14 Triggers Migraine triggers Foods like red wine, chocolate, peanut butter, dairy products, and citrus fruits. Hormonal swings associated with menstrual cycles or pregnancy. Weather changes Certain smells Lack of sleep Gluten can be a migraine trigger for people who have true celiac disease. If you are concerned about this issue, eliminate gluten from your diet for a test period and keep a log for a possible trigger. emotional anxiety contraceptives alcohol hormonal changes menopause The cause of tension-type headache tends to be related to stress and associated tightness or tension in the muscles of the neck or scalp.

15 When should you see the doctor about your headache? Not all headaches require a physician's attention. But headaches can signal a more serious disorder that requires prompt medical care. Immediately call or see a physician if you or someone you're with experience any of these symptoms: Sudden, severe headache that may be accompanied by a stiff neck. Severe headache accompanied by fever, nausea, or vomiting that is not related to another illness. "First" or "worst" headache, often accompanied by confusion, weakness, double vision, or loss of consciousness. Headache that worsens over days or weeks or has changed in pattern or behavior. Recurring headache in children. Headache following a head injury. Headache and a loss of sensation or weakness in any part of the body, which could be a sign of a stroke. Headache associated with convulsions. Headache associated with shortness of breath. Two or more headaches a week. Persistent headache in someone who has been previously headache-free, particularly in someone over age 50. New headaches in someone with a history of cancer or HIV/AIDS. Diagnosing Migraines VS. Headaches Although there are no specific tests for migraine headaches, your doctor may order tests to exclude other conditions or problems that are triggering your headaches. This may include blood work or different brain imaging, such as CAT scan or MRI. In rare cases, your doctor may order a spinal tap to exclude causes of more serious, severe headaches.

16 A doctor who is experienced in treating various headaches can help differentiate the type of headaches that you have. A sinus headache (caused by sinus infection or allergic rhinitis) often mimics some signs and symptoms of migraines. Monitoring the duration of your headache can provide important information that can help diagnosis the type of headache you are experiencing. Migraine headaches may last a few hours to three days, while tension headaches may last only 30 minutes or linger for up to a week. Keep a diary of your headaches with the following information: Keep a headache diary to help identify any triggers that lead up to the onset of the headache, for example, menstrual cycles for women, hormone treatments, and alcohol intake. Keep track of when a headache begins, the severity of the pain, any associated symptoms, how long the headache lasts, and any medications that you have taken. If there does not seem to be any clearly identifiable cause for your headaches, maintain a dietdiary, and keep track of any foods or drinks that you may have consumed the day before a headache to identify possible triggers. Treatment Treatment of migraines often focus on reversing the inflammatory changes of the blood vessels thought to be the source of the migraine pain. Migraine pain treatment Triptans are a class of drugs effective at helping reduce inflammation and decrease the swelling of the inflamed vessel, which tends to lead to decreased head pain in a relatively short time. Many of these medications also can reduce the associated nausea, light-, and sound - sensitivity that occur with migraines. Examples of triptans

17 include sumatriptan (Imitrex, and Sumavel DosePro), eletriptan(relpax), zolmitriptan (Zomig), and rizatriptan (Maxalt). These drugs are available as a pill, nasal spray, or injection. Botox. If you have chronic migraines (defined as migraine headache occurring more than 4 hours in one day and more than 15 days for 1 consecutive month), Botox (botulinum toxin) may help you to decrease the frequency and severity of your migraines. This treatment has not been shown to be of benefit in treating other types of frequent headache. Your doctor may prescribe other drugs to relieve your migraine pain, for example, high blood pressure drugs, antidepressants, anti-seizure drugs, or natural supplements. Relaxation techniques Because most headaches are stress-induced, taking steps to reduce stress can help relieve headache pain and reduce the risk for future headaches. These include: heat therapy, such as applying warm compresses or taking a warm shower massage meditation neck stretching relaxation exercises

18 Foods that help decrease migraine frequency Foods in the diet: Some people with frequent migraines find that avoiding eating certain foods might help alleviate some of their headaches. For others, consuming products high in magnesium, riboflavin, and omega-3 fatty acids (spinach, whole grain or enriched breads, almonds, salmon) helps decrease some migraine frequency.

19 Drugs that treat migraine and headache pain Over-the-counter (OTC) medicine. The blood vessel changes identified in migraine headache do not occur with other headaches, including tension-type headache. Often simple over-the-counter OTC pain relieving mredications such as acetaminophen (Tylenol and others), or nonsteroidal anti-inflammatories (NSAIDs) ibuprofen (Motrin, Advil, Midol) or naproxen (Aleve, Naprosyn, Anaprox) can be extremely effective in alleviating tension headache pain. Home remedies and essential oils for migraine and headache pain You can use essential oils as a home remedy to treat migraines and other types of headaches. Some people have benefited by using lavender oil and peppermint oil as an aromatherapy. You can even apply the oils to your scalp. Other home remedies are Basil oil Feverfew Buckwheat Flaxseed Alternative Therapies Some people have reported much success with acupuncture and/or pressure point therapy. See the diagram below:

20 Prevention Tips Prevention is often the best treatment for migraine headaches. Examples of preventive methods your doctor may prescribe include: making changes to your diet, such as eliminating foods and substances known to cause headaches, like alcohol and caffeine taking prescription medications, such as antidepressants, blood pressure-lowering medicines, or antiepileptic medications taking steps to reduce stress Can migraines and headaches be cured? Migraine headache and tension-type headaches can occur frequently, even daily. If you have a headache for at least 15 days each month, your doctor or other medical healthcare professional may recommend daily medication. These may include: Antidepressants Anti-seizure medications Certain types of muscles relaxants, depending on the underlying headache. People with chronic migraine headache may improve with Botox injections. Patients who experience migraine headache often will respond extremely well to therapeutic intervention, and their ultimate prognosis (which is good) is no different from patients who experience other types of headache. Although it may be tempting to treat headaches at home, repeated or recurrent use of medication can lead to a condition known as Medication Overuse Headache, a condition in which headaches occur near daily. If you are experiencing frequent headache or head pain, it is important to seek appropriate evaluation and treatment. A doctor trained in identifying different types of headaches, for example, internal medicine, neurologists, or allergists, can help diagnose the cause of your headaches. If you are experiencing a headache that is very different in quality or severity (the worst headache of your life) than your usual headaches, is associated with unusual symptoms, or is associated with an elevated temperature, you need medical evaluation immediately to exclude serious underlying causes.

21 Resources Research/Headache-Hope-Through-Research