Migraine Headaches

What is it?

A migraine is a complex, chronic neurological disorder characterized by recurrent moderate to severe headaches. A migraine is recognized as a more complex series of neurologic and vascular events where vasodilation may or may not be present. Evidence states that a patient with migraine brain is hyperexcitable and uniquely predisposed to migraine headaches. Patients also demonstrate changes in the performance of functional tasks, suggesting early motor control deterioration.

Over 30 million Americans suffer from at least one migraine each year. One in six American women suffers from migraine headaches. Migraine headaches cause more work-related disability and lost productivity than any other common headache. Over 80% of migraine patients miss work due to their headaches, with an average of 4-6 absences per year.

Migraine headaches demonstrate a strong genetic component.

Overweight patients are more susceptible to migraines. Low cardiovascular fitness increases one's risk as well. Vascular risks include hypertension, hypercholesterolemia, impaired insulin sensitivity, coronary artery disease, and history of stroke.

Medication overuse is one of the more important risk factors for migraine progression. Migraines tend to become “chronic” when following the overuse of medications such as acetaminophen, aspirin, etc.

Hypocalcemia and a vitamin D deficiency are usually associated with an increased risk of migraine headaches. Some known triggers include smoking, strong odors (perfumes), bright or flicking light, fluorescent light, excessive or insufficient sleep, head trauma, weather changes, lack of activity or exercise, dehydration, hunger, and hormonal changes. Some food triggers include alcohol, excessive caffeine, artificial sweeteners, soy sauce, watermelon, citrus foods, papayas, avocados, overripe bananas, sour cream, nuts, peanut butter, aged meats and cheese, and anything fermented.

Upper cervical tension or the presence of a cervicogenic headache may be a trigger to a migraine.

Clinical Presentation

Approximately 60% of sufferers report prior symptoms in the hours to days before a headache onset. These symptoms include lethargy, yawning, food cravings, mood changes, excessive thirst, fluid retention, constipation, diarrhea, and hypersensitivity to light, sound or odors. Patients may experience irritable bowel syndrome along with migraines.

Symptoms are most commonly visual but also include a combination of sensory and motor components. The most common visual symptom is a band of absent vision with an irregular shimmering border. Another visual effect is tunnel vision. Less than one in five patients experience motor symptoms, including a sense of heaviness in their limbs or speech and language disturbances. Motor and sensory complaints, including paresthesia and numbness rarely occur in isolation.

Eighty percent of migraine patients experience some nausea. Seventy-five percent of patients report some type of associated neck discomfort. Researchers have identified the presence of nausea, disability, and photophobia as the most significant predictor of migraines.

During the attack phase the patient will usually complain of a unilateral, moderate to severe, throbbing or pulsating headache. The pain may be felt anywhere in the head and neck but is most common in the frontal, temporal and ocular areas. Headache pain develops over a period of one or two hours and can last up to 4 and 72 hours. Patients often report a hypersensitivity to light and sound and may retreat to dark, quiet places.