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Doctor Recommend Alternative and Holistic Medicine for Migraines Contact us at AWW for an appointment, prescription medications, nutritional and alternative therapies, and personalized help. We take migraines seriously and look forward to helping you. AWW offers individualized care by an M.D. to help customize the management of migraines. Below the Table find answers to questions about migraines such as Definition, Causes, Diagnostic Criteria, Occurrence, Symptoms, Triggers, Therapies, Related Disorders, etc. Let us help you meet your personal nutritional needs and medications.
MIGRAINE Definition/Causes/Diagnostic Criteria/Occurrence/Symptoms/Triggers/Therapies/Related Disorders “It is important to realize that migraine is a disabling illness even though it’s not as obvious as a broken leg,” Dr. Seymour Solomon, Medical World News. December 1993. Understanding the impact of migraine itself and how it affects the patient’s life and then individualizing a therapy protocol can help the patient customize their own care. Ongoing studies are providing information on the role of nutrition, genetics, proper sleep, mental and physical stress, hormones, and the environment on headache occurrence and severity. “Effective management of migraines must include proper diagnosis, effective communication between patient and physician, and appropriate, individualized behavioral therapy and pharmacotherapy. When all of these components of treatment come together, migraine patients will experience considerable improvement.” CNS News. May 2001. Marcelo E. Bigal, MD, PhD, assistant professor of Neurology at the Albert Einstein College of Medicine, Bronx, New York, states that he “believes that clinicians dealing with chronic headache should focus on ‘preventing progression by addressing modifiable factors [such as] obesity, sleep problems, depression, caffeine use, and analgesic overuse.’” November 2006 Neurology Reviews. Progression of Migraine from Episodic Disorder to Chronic Disorder. Definition of Migraine: The International Headache Society Criteria for Migraine without Aura include: At least 5 attacks in which the following criteria are met and which can not be attributed to another disorder. 1. Headache lasting 4 to 72 hours and occur <15 days per month (untreated or unsuccessfully treated). 2. Headache has at least two of the following characteristics: a. Unilateral location. b. Pulsating quality. c. Moderate or severe pain intensity. d. Aggravation by or causing avoidance of routine physical activity (ie. walking or climbing stairs.) 3. During headache at least one of the following: 1. Nausea and/or vomiting. 2. Photophobia and phonophobia. Summary of Table from Neurology Reviews. April 2006. A. CAUSE: “Migraine can be broadly classified as headache with an associated disturbance in the form of sensory sensitivity…The specific cause of migraine headache is unknown, although genetic factors now appear to be important and discrete loci of brain activation can be seen with PET studies.” Neurology 2000;55(Suppl 2): S8-S14. Studies Help Supply Missing Pieces Of Migraine Puzzle: “Marcelo Bigal, M.D., PhD., Assistant Professor of Neurology at Albert Einstein College of Medicine, Bronx, New York states that ‘migraine is a neurologic disorder characterized by excitability.’ Others see migraine resulting from a brain dysmodulation instead of hyperexcitability…In either case, the activation of the CNS (central nervous system) that takes place during a migraine can be broadly outlined as a three step process: (1) Dysfunction of the brain stem and vascular control centers; (2) perception of pain in the anterior cingulated cortex; and (3) generation of the migraine involving such regions of the brain as the locus ceruleus and the periaqueductal gray matter. Dr. Bigal said, ‘…that there are brain stem regions that play a pivotal role in either initiation or termination of the acute attack of migraine.’ Based on their recordings of induced and spontaneous migraine aura, N. Hadjikhani and colleagues (using MRI to study migraine) concluded that migraine aura is not caused by ischemia (arterial narrowing restricting blood flow) but more likely by the aberrant firing of neurons on related cellular elements characteristic of cortical spreading depression, leading to vascular changes.” Neurology Reviews. November 2006 Morphologic changes result from repeated attacks. “In a study involving patients with episodic migraine (with and without aura) and those with chronic daily headache, K. M. Welch and colleagues found a positive correlation between the duration of illness and the increase in tissue iron levels in the periaqueductal gray matter (in the brain) of both groups (the increase was greater in the chronic group). One implication of these increases in iron deposition is that over time, migraine attacks can permanently alter the periaqueductal gray matter, thus affecting the perception of pain, Dr. Bigal emphasized...“the periaqueductal gray matter is the center of the brain’s powerful descending analgesic neuronal network. The periaqueductal gray matter may be in close relation to the migraine generator. So you are changing and damaging an area that is very important to the modulating and onset of migraine attacks.”… “These findings suggest, in Dr. Bigal’s view, repeated migraine attacks lead to repetitive damage, which in turn results in more migraine attacks and a reduced threshold for further migraines.” November 2006 Neurology Reviews. Medication Overuse and Snoring. “Dr. Al Scher, epidemiologist at the Uniformed Services University at Bethesda, Maryland, in an interview with Neurology News in November 2006, shared, “The role of medication overuse in the etiology of chronic headache is, in my opinion, not well established in the literature…I don’t think that it is possible to show-in an observational study-that medication overuse leads to chronic daily headache….There are some similarities between people’s chronic headaches and other chronic conditions, so there’s question in my mind whether there are shared genetic or maybe non genetic risk factors that can make episodic pain become chronic, independent of the site. Chronic lower back pain may share some risk factors with chronic headache… Among other risk factors, she pointed to snoring, citing data that she and colleagues published in 2003 indicating that daily snorers were at increased risk for chronic daily headache, compared to non snorers (odds ratio, 3.3).” November 2006 Neurology Reviews. B. DIAGNOSIS: The International Headache Society Criteria For Migraine Diagnosis Without Aura Include: At least 5 attacks in which the following criteria are met and which can not be attributed to another disorder. 1. Headache lasting 4 to 72 hours and occur <15 days per month (untreated or unsuccessfully treated). 2. Headache has at least two of the following characteristics: a. Unilateral location. b. Pulsating quality. c. Moderate or severe pain intensity. d. Aggravation by or causing avoidance of routine physical activity (ie, walking or climbing stairs.) 3. During headache at least one of the following: 1. Nausea and/or vomiting. 2. Photophobia and phonophobia. Summary of Table from Neurology Reviews April 2006. Underlying Serious Disease Must Be Ruled Out First: According to Seymour Solomon, M.D, “I think migraine can be diagnosed by two of the following four characteristics: the headache is unilateral, the headache is pulsating, there’s associated nausea, there’s associated intolerance to light or noise. Any of those two will establish the diagnosis of migraine if, and these are important caveats, there have been similar stereotyped headaches in the past, and if there is no evidence of underlying organic disease. You should never make the diagnosis of migraine on the basis of the first attack, because the first headache that looks like migraine could be a subarachnoid hemorrhage or a brain tumor or any other serious disease.”(underline by AWW) Not A Psychiatric Illness Or Stress Illness: According to Joel Saper, M.D. “data does not support migraine as a psychiatric illness or an illness that is rooted primarily in stress. Many of us now believe that migraine is a very complex disorder involving many areas of the brain and neurovascular physiology, and that it is an inherited disorder of significant complexity.” “Michael Moskowitz, M.D. and his group have shown that pain is basically related to the release of biochemicals, neuropeptides, from trigeminal nerve endings around the major blood vessels in the head. It’s the inflammation, as well as the vasodilation, that is the pain stimulus.” Seymour Solomon, M.D. reports, “We should say a word about the newer concepts with regard to aura, which is no longer thought to be due to vasospasm but rather to a slow spread of depressed cortico-neuronal activity.” Medical World News. December 15, 1993. Vol 34. No.12. C. MIGRAINE OCCURANCE: Common But Often Undiagnosed: “Migraine headaches are fairly common in the general population: 17.6 % of women and 5.7 % of men have one or more migraine headaches per year. Because of the episodic nature of migraine attacks, treatment options that rapidly and effectively minimize pain are needed.” American Family Physician. January 1, 2000. Vol 61, Number 1. “Up to 25% of patients in a typical primary care practice could be afflicted with migraine, and many of them simply do not report their headaches. Nearly half of all persons with migraine in the United States have not received a diagnosis for their disorder. Many of them suffer substantial functional impairment in daily activities and, thus, a diminished quality of life.” The Journal of Family Practice. December 2006. Vol. 55. No 12. How Often? “Some migraines occur once or twice in a lifetime, some occur once in a while, some cyclically in a month, and some two or three times a week. Attacks often last for 1 day but may range from 4 hours to 3 days in duration, according to the International Headache Society.” Neurology. 2000. Volume 55. Number 9. Supplement 2. “Approximately 59% of migraineurs experience one to four headache attacks per month: 22% have 10 or more attacks per month. The impact of frequent, inadequately controlled migraine may be disruptive to family life, social interactions, and work.” The Female Patient. Vol. 28. May 2003. Migraine Occurance Over Lifespan: In November 2006 Marcelo Bigal, MD, presented data that build on the findings of the landmark American Migraine Study, which studied the prevalence of migraine … through surveys of more than 145,000 participants. “The researchers found the prevalence to be 15%. Migraine prevalence peaked between the ages of 30 and 39 years… Among the 18 to 29 year old group with migraine, 83% experienced throbbing pain during the attacks, compared with 65% of those 70 years or older with migraine; severe pain was reported by 78% and 63%, respectively. In addition, 58% of individuals aged 18 to 29 years reported their migraine worsened with exercise, as did 33% of individuals 70 years or older. Sixty % of the individuals aged 18 to 29 years old had unilateral pain, compared with 67% of those 50 to 59 years and 53% in the 70 years or older group. They found that symptoms associated with migraine generally decreased in prevalence with age, whereas the prevalence of aura and the proportion of subjects with frequent attacks increased with increasing age.” Excellence in Migraine Management. November 2006. Reporting on Migraine Across Lifespan from the American Academy of Neurology April, 2006 Annual Meeting. D. Migraine Symptoms Migraine symptoms seem to reflect an abnormal increased sensitivity to sensory input. 1. Symptoms that precede an upcoming migraine: a. Flashing lights, jagged lines, snowy vision, fuzzy or reduced vision. “In approximately 15% of migraine sufferers, attacks may be preceded by transient neurologic symptoms that are manifested as visual aura.” Neurology. , 2000. Volume 55. Number 9. Supplement 2. b. “In some patients attacks begin within 2 to 24 hours of premonitory signs, such as changes in mood or activity or hypersensitivity to light, sound, smell.” Neurology. , 2000. Volume 55. Number 9. Supplement 2. 2. Symptoms of migraine. According to the Headache Assessment Quiz in the Journal of Family Practice. December 2006. Vol. 55. No 12. some symptoms significant for migraine include: 1. Moderate to severe pain 2. Pulsating, pounding, or throbbing pain 3. Pain worse on one side of your head, 4. Have worse pain when you move or bend over 5. Have nausea 6. Have sensitivity to or are bothered by light (photophobia: sensitivity to light) 7. Have sensitivity to or are bothered by sound (phonophobia: sensitivity to sound) 8. Need to limit or avoid daily activities 9. Want to lie down in a quiet, dark room 10. See visual disturbances, spots, or light flashes 11. Some headaches come just before or during your monthly menstrual cycle 12. Feel headaches coming on before they become headaches 13. Feel drained or too tired to want to do daily activities 14. Feel a reduced ability to concentrate Other symptoms not on headache Assessment Quiz include: 15. Hyperalgesia: increased sensitivity to pain. (lowered pain of threshold) 16. Sensitivity to smells 17. Ringing or high pitch sound in ears (tinnitus) 18. Irritable bowels: reduced digestion, gas, bloating, constipation and/or diarrhea. American Family Physician. January 1, 2000. Vol 61, Number 1. “High prevalence of gastroparesis during the attack. (AWW. A slight degree of paralysis of the muscular coat of the stomach.).” 19. Fibromyalgia symptoms such as muscular aches, pains and tender points, sleep irregularities and chronic fatigue consistent with fibromyalgia. “It has been suggested that migraine may be a part of a ‘fibromyalgia syndrome’” which could also include irritable bowel syndrome, each related by abnormalities in pain transmission or sensitivity.” Excellence in Migraine Management. November 2006. Vol. 1, No. 4. “Patients suffering from migraine-FMS had lower quality of life scores and higher levels of mental stress. A high incidence of FMS was found among female migraine patients but not males.” Cephalagia. April 2006; 26(4):451-6. 20. Sinus headaches- Sinus headaches not caused by infection and migraines have similarities. “The number one symptom cited by subjects was moderate to severe pain (97%). Other symptoms consistent with migraine included photophobia, pain worsening with activity, and pulsating headache. The second and third most common symptoms, however, were nasal stuffiness (73%) and drainage (67%), and many patients first noticed the changes occurring in the area around their eye-all symptoms associated with sinus headache…there’s more to it than just sinuses, that these patients have symptoms of both.”” Neurology Reviews. July 2001. Some migraineurs report sinus drainage which accompanies migraine. 21. Sleep Irregularities. Some scientists speculate that sleep abnormalities may be an indicator of, the cause of or the result of pain perception abnormalities in illnesses such as headaches, migraine, fibromyalgia, chronic pain, irritable bowel syndrome and chronic fatigue. E. TRIGGERS: According to the Headache Assessment Quiz in the Journal of Family Practice. December 2006. Vol. 55. No 12. some triggers significant for migraine include: 1. intense lights 2. intense smells 3. intense sounds 4. weather changes 5. allergies or sinus pain/pressure 6. stress or tensions 7. monthly menstrual cycle/hormonal changes (The Female Patient 2001 Patient Handout. ) 8. too little sleep or too much sleep 9. missed meals 10. lack of caffeine or too much caffeine or chocolate 11. changes in mood/excitement 12. foods or alcoholic beverages Not mentioned in Headache Assessment Quiz but reported elsewhere: 1. allergies or unusual sinus drainage not typical of colds 2. food additives: MSG, certain food dyes, nitrites (hot dogs, sausages, possessed meats), 3. foods: hard cheeses, fish, chocolate, citrus fruits 4. relaxation after stressful situation 5. head trauma Food And Headaches “Is there a connection between food and headaches? According to Dr. Silberstein, ‘Still, there are some proven food-related headache triggers: skipping meals, consumption of alcohol or monosodium glutamate (MSG), and caffeine withdrawal. If you eat a lot of carbohydrates, your blood sugar goes up and then it crashes and you become hypoglycemic, which is also what happens when you skip meals. And that can cause a headache.’ It can be deduced that, really, carbohydrates are not a trigger. Traditionally those with headaches have been told to avoid dairy products especially aged cheese, sausage, bologna, pepperoni, hot dogs, red dyes, some fruit and vegetables, caffeine containing drinks, chocolate, hot fresh breads, yeast breads, pizza. While these foods may be triggers, it may be that a person with a developing migraine does not process any number of foods.” Neurology Now. July/August 2006. Diet and Headache. “MSG has several aliases such as sodium caseinate, hydrolyzed oat flour, texturized protein, and calcium caseinate. An ‘MSG-free’ product may not actually be so. Nitrates used to cure meat can be found hot dogs, bacon, ham, bologna and smoked meats. They can also be found in food colorings and brined vegetables. In general, migraine patients should avoid processed, chemically laden foods.” Holistic Primary Care. Summer 2005. (underlined by AWW) “Many of the triggers that we thought were migrainous triggers, such as craving for food, may actually be a prodrone, or the first sign of migraine, which strongly suggests that things are happening in the parts of the brain involving emotion, appetite and sexual behavior…Migraine is a process involving the whole brain'. Medical World News. December 15, 1993. Vol 34. No. 12 Dr. Silberstein. F. MIGRAINE THERAPIES SEE TABLE ABOVE for nutritional therapies offered by AWW!! Contact AWW for Prescription Medications, Botanical and Alternative therapies, Lifestyle Changes, Coping Strategies, and Nutritional Support (Whole Foods, Herbs, Essential Nutrients and Supplements) “Practical Strategies for Headache Management: Healthy lifestyle changes should also be promoted and should include a focus on diet, exercise, and sleep patterns.(bold by AWW)” “Effective management of migraines must include proper diagnosis, effective communication between patient and physician, and appropriate, individualized behavioral therapy and pharmacotherapy. When all of these components of treatment come together, migraine patients will experience considerable improvement.” CNS News. May 2001. (central nervous system) Key Nutritional therapies that help overall health and that may help manage migraines include nutrients that address the following areas: *Brain and Nerve Health *Sleep Quality *Mood Support *Pain Management *Hormone Balance *Bowel and Digestive System Health. Key Nutrients include the following: Whole Foods Diet, B Vitamins (especially B6, B12, Folate), Vitamin C, Magnesium, Ginkgo, Phospatidyl Serine, Acetyl L Carnitine, Choline, Inositol, Omega Fatty Acids (DHA, Evening Primrose, Gama Linolenic Acid or Borage Seed Oil), C0enzyme Q10, Feverfew, Passion Flower, Valerian Root, Skullcap, Hops, Melatonin, St. John’s Wort, Griffonia (5-HTP), Fiber, L-Glutamine, N-Acetyle Glucosamine, Vitamin E. SEE TABLE ABOVE! G. RELATED DISORDERS: Discussions * Depression/Anxiety/Personality * Pain * Fibromyalgia * Hormones (Check with us at AWW for information on the relationship of migraine and sleep disorder, weather, epilepsy, stroke, exercise, irritable bowel syndrome and Practical Migraine Management Strategies.) *Migraine and Depression/Anxiety/Personality “Depression and migraine often occur together. Many who experience migraines will say that migraines can cause one to feel depressed, because of the pain and disability they cause. It is important to address both depression and migraine and not assume that treating depression will reduce migraines. A summary of treatment of chronic headaches with antidepressants reported that '…antidepressants are effective in preventing chronic migraine or tension headaches'.” American Journal of Medicine. 2001;111:54-63. Migraine and Perfectionist Personality: “The present study indicates that there is a relationship between perfectionism experiencing more frequent headaches. This investigation confirmed the relationship between daily hassels and chronic headache in this population. The results also suggest that perfectionists may generate their own stress through their tendency to appraise more situations as hassels. This, in turn, may explain their tendency to experience chronic headaches.” - Headache. 2004 September; 44(8):772-9. Bottos S, Dewey D. “Chronic pain may lead to personality alterations, but some features of craniofacial pain correlate with specific personality disturbances.” Cephalalgia. 1992 April:12(2):68. *Migraine and Pain Somatization: “is the experiencing of physical symptoms ( like pain. AWW) in response to emotional distress. Successful treatment of somatization requires giving an acceptable explanation of the symptoms to the patient, avoiding unwarranted interventions and arranging brief but regular office visits so that the patient does not need to develop new symptoms in order to receive medical attention. Antidepressants may be helpful in many patients, as well as cognitive psychotherapy when patients are willing to participate in it." American Family Physician. March 1, 2000. Volume 61, Number 5. Somatizing Patients: Part II. Practical Management. “ 'Children with migraine often have frequent episodes of pain other than headache.', said Dr. Pirjo Anttila and associates at the University of Turku (Finland). In a study reported in J. Pediatr. 138 [2]:176-80, 2001 involving 513 children aged 7 years and older with primary headache, 53 had migraine and 460 had various nonmigrainous forms of headache. Children with migraines particularly those who had an aura with their headaches, were prone to recurrent neck, shoulder, abdominal, ear, and back pain-but not limb, throat, tooth, or chest pain. 'It could be that children with migraine are more prone to have pain as a psychosomatic symptom than other children,' Dr. Antilla and associates said. Or migraineurs could be more sensitive to pain of any kind than children without migraine.” Family Practice News. July 15, 2001. *Migraine and Fibromyalgia “In fact, it has been suggested that migraine may be part of a ‘fibromyalgia syndrome,’ which could also include irritable bowel syndrome, each related by abnormalities in pain transmission or sensitivity. Fibromyalgia is defined by widespread bodily pain, tenderness of certain “tender point” areas, and constitutional symptoms of fatigue and sleep disturbances. Fibromyalgia affects up to 6 million adults in the United States, and a female to male ratio is about seven to one. Central nervous system sensitization and allodynia (perception of pain. AWW) are hallmarks of fibromyalgia. Patients with this disorder exhibit lower pain thresholds, increased allodynia, enhanced temporal summation, and prolonged aftersensations-in general, pain sensitivity is increased. …Interestingly, about 75% of all patients who experience fibromyalgia have headaches and 60% experience migraine. These patients tend to improve with treatment, which includes education about the disorder and lifestyle issues, aerobic exercise, and other pain management modalities.” Excellence in Migraine Management. November 2006 Vol. 1, No. 4 A study of the prevalence of fibromyalgia syndrome in migraine patients by Ifergane, Simiseshvely, Zeev, and Cohen concluded, “Patients suffering from migraine-FMS had lower quality of life among female patients but not in males. The coexistence of FMS should be considered when choosing a prophylactic migraine therapy.” Cephalalgia. April 2006. Vol. 26(4):451-6. *Migraine and Hormones Ninan Matthew, MD relates, “It is well known that hormonal fluctuations influence migraines a great deal. For, example, menstrual migraine, just premenstrual or the first day of menstruation, is extremely common. It is known that estrogens influence the serotonin receptors on the blood vessels. The majority of the 5-HT1 receptors are located intercranially. Estrogens probably modulate the receptors and that may explain some of the influence of hormones on headaches. Silberstein, MD says, “The headache that occurs with menstruation is probably due to falling estrogen levels... But, in addition, with menstruation, prostaglandins are liberated from the uterine lining and it may be high levels of prostaglandins serve to sensitize the receptors in the brain to cause the pain of migraines." Medical World News. December 15, 1993. Vol 34. No. 12. An opposing view is reported in The Female Patient. Vol. 26, No. 9. Menstrual Migraine. Family Practice News may 15, 2001. “Women who get migraines tend to overestimate the association between their headaches and menstruation, Dr. Elizabeth W. Loder, director of the headache management program at Spaulding Rehabilitation Hospital, Boston, said at the annual meeting of the American Headache Society. Even when there is a link between menstruation and migraines, the headaches are neither more severe nor more difficult to treat than migraines occurring at other times of the month, contrary to popular belief. Patient self-reports are 45-65% higher than actual rates of menstrual associated migraine found in carefully controlled studies, Dr. Loder said. Many headache diaries will show that migraines do regularly occur around menstruation but also occur at other times of the month.” Contact us at AWW for an appointment and personalized help. Ongoing research studies investigating effective medications, natural medicines and causes of migraine offer hope to those who suffer. AWW offers individualized care by an M.D. to help customize the management of migraines. We do this by integrating prescription medications and botanical medicines as well as holistic therapies focusing on whole body care to improve your quality of life. 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