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Understanding Migraine and Other Headaches

Understanding Migraine and Other Headaches

Stewart J. Tepper
Copyright Date: 2004
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  • Book Info
    Understanding Migraine and Other Headaches
    Book Description:

    In the United States, eighteen percent of women, six percent of men, and four percent of children suffer from migraine headaches. All races are affected, although, for reasons which are unknown, whites are more likely than African Americans to be afflicted with the condition, and Asian Americans are least often migraine sufferers. Migraine is an inherited condition-many families can trace it back for generations-and it has enormous economic and social consequences, both to individual sufferers, and to the society as a whole. The cost to the U.S. society alone is in excess of $13 billion per year in lost productivity and in health care.

    Understanding Migraine and Other Headachesprovides up-to-date information on the causes and diagnoses, as well as current preventive measures, effective treatments, and surgical procedures. The book gives an overview of every major type of headache, including the debilitating, nausea-inducing forms of migraine, episodic tension-type headaches (the most common form), chronic daily headaches, and more obscure head-aches such as trigeminal neuralgia and cluster headaches.

    This book is intended for those who are burdened by headaches as well as for their families, coworkers, employers, and friends. As such, it is written in a lucid and simple style that is accessible both to lay readers and medical professionals.

    In the last two decades, revolutionary new migraine-specific medications have been developed. This book undertakes a comprehensive look at medications for acute "as needed" treatment of headaches and for preventing the onset of an attack. It offers guidelines for assessing headache pain, the level and type of medication needed, possible side effects, and drug effectiveness.

    Stewart J. Tepper is director of the New England Center for Headaches in Stamford, Connecticut.

    eISBN: 978-1-60473-048-7
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Introduction
    (pp. vii-2)

    Headaches have bedeviled humanity for all of recorded time. Even in ancient Egypt, suggestions were included in hieroglyphics on how to eliminate severe headache. The Egyptians recommended strapping a crocodile to the top of the head, which might have distracted the sufferer significantly, but advances have brought treatment to a designed, specific level undreamed of even 25 years ago.

    Migraine, in particular, is becoming easier to identify and treat. Eighteen percent of women, six percent of men, and four percent of children have migraine. All races are affected, although for reasons that are unknown, whites are affected more than African...

  4. 1. What Is Migraine?
    (pp. 3-13)

    The diagnosis of migraine was simplified and standardized when the International Headache Society (IHS) put together diagnostic criteria that are now used worldwide. Revisions in classification will soon be available. The IHS divided headache into two major types, primary and secondary.

    Secondary headaches are caused by underlying medical conditions. Immune diseases (such as lupus erythematosis and rheumatoid arthritis), infections (such as meningitis and HIV), metabolic conditions (such as low thyroid function), neurologic conditions (such as high spinal fluid pressure and hemorrhage in the brain), and head trauma can all cause headache. Primary headaches are their own disorder, caused by changes...

  5. 2. Who Gets Migraine?
    (pp. 14-16)

    Migraine is a genetic condition. Ask migraine sufferers whether they have any family members with migraine, and at least 50% will answer yes. But ask the first-degree relatives of a migraine sufferer if they have migraine by describing the characteristics of the headache, and there will almost always be a family member with migraine.

    Most migraine is not caused by a single gene. With the rare exception of familial hemiplegic migraine, migraine (with or without aura) is likely to be “polygenic,” with multiple genes involved.

    Migraine can encompass a spectrum from mild to moderate headache that interferes with activities, to...

  6. 3. The Role of Hormones
    (pp. 17-20)

    In women, migraines frequently occur at or around ovulation and menstruation. Most women lose their headaches during pregnancies, and often lose them after menopause. Some women have the reverse—worse headaches during pregnancies and after menopause—but they are the exception.

    The onset of a migraine around menstruation appears to be triggered by the drop in estrogen during the second half of the cycle as a woman approaches her period. High-dose estrogen, taken just before the day of flow, can blunt or prevent menstrual migraines. Low-dose estrogen, administered by skin patch or pill, is usually ineffective. Pre-treating with estrogen has...

  7. 4. What Causes Migraine?
    (pp. 21-30)

    If migraine is inherited, what is it that is inherited? One way to think about this is that migraine patients have a brain that is too excitable, a so-called “hyperexcitable brain.” For some reason, specific neurons in the brain—or nuclei—discharge too easily, activating pathways that initiate the mechanism of pain and associated symptoms, and resulting in the migraine syndrome. The tendency to fire is what is inherited.

    The brain is composed of nerve cells (neurons) that communicate with each other by chemical and electrical signals. Cells can fire individually or en masse. There are many hypotheses about what...

  8. 5. Evaluating Migraines
    (pp. 31-37)

    The treatment for migraine depends upon how bad the migraine is, in terms of all of its characteristics. Migraines vary in frequency and in intensity. The severity of the migraine determines how disabled a patient is; establishing the degree of disability leads to the crafting of appropriate treatment.

    Migraine treatment should always be at least in part non-pharmacologic—that is, without medications. Medications can be preventive (prophylactic) or as-needed (acute, abortive).

    Preventive care means taking a daily medication to prevent the migraines. The U.S. Food and Drug Administration, when evaluating a medication for prevention, looks for whether the medication reduces...

  9. 6. Acute Treatment of Migraine
    (pp. 38-65)

    How does one tell how well a medication works to eliminate a migraine? Researchers and doctors use many measures in evaluating as-needed, acute treatments that stop a migraine attack. The FDA then uses the results of testing of medications on these measures to determine efficacy.

    In older studies on acute medications, patients were required to wait to treat until their migraine reached moderate to severe levels of pain. In real life, patients usually treat early, when their pain is mild, as soon as they know that a migraine is developing. Since the medications are studied in treatment of more advanced...

  10. 7. Preventing Migraines
    (pp. 66-95)

    There are a number of steps that can be taken to prevent migraine that do not require medication. One is trigger reduction.

    The concept of trigger reduction is that, if migraine is caused by a hyperexcitable brain, exposure to certain external factors can set off a firing of the nerves in the brain that cause migraine. These triggers do not cause headache in a person without migraine, but they commonly trigger migraine in those susceptible. In fact, some headache specialists think that migraine should be diagnosed by the fact that it can be triggered by recognizable triggers that often do...

  11. 8. Other Headaches
    (pp. 96-114)

    Episodic tension-type headache is the ordinary headache that most of us get from time to time. It is generally mild, dull, on both sides of the head, and not throbbing. It is often not even worth taking medication for, and usually short-lived, without nausea or other features. The International Headache Society has developed criteria for diagnosing episodic tension-type headaches:

    1. The patient should have had at least ten of these headaches.

    2. The headaches last from 30 minutes to seven days.

    3. The headaches must have at least two of the following four:

    a. Non-throbbing quality

    b. Mild or moderate intensity, either not...

  12. 9. New Areas of Research
    (pp. 115-120)

    One area of hot research is the search for a gene or genes for migraine. In chapter 4 I discussed the genes so far found that determine familial hemiplegic migraine (FHM). Those genes code for calcium channels or sodium channels. The question is whether other migraines could be caused by abnormal gates or channels that have problems in regulating how chemicals or molecules get into or out of the nerve cells.

    One area of research has demonstrated that there are, in fact, abnormal calcium channel manifestations in other forms of migraine. Clinical signs include subtly abnormal cerebellar incoordination (the cerebellum...

  13. Appendix: Sources for Information and Support
    (pp. 121-124)
  14. Index
    (pp. 125-130)
  15. Back Matter
    (pp. 131-131)