Chicago Health | Homepage
Finding Relief for Chronic Migraines

Finding Relief for Chronic Migraines

By Mary Beth Klatt

Marie Syzdek, 54, grew up thinking that migraines were a normal part of life.

Ever since she was a teenager, Syzdek suffered from migraines—a constant low-grade headache, that peaked several times a week into a painful, throbbing, full-blown attack. When she got married and had children, her family often would find her lying on the couch, unable to function. “I work, I have kids, a social life,” says Syzdek, an ambulatory nurse at Evanston Hospital. “It would control my life.”

Migraine and Headache Awareness Month, observed in June, recognizes that constant migraines are not normal.

Migraines affect women more often than men. Boys and girls develop migraines at a similar rate, but at the onset of puberty, the incidence in females increases significantly (as high as 18 percent of all women) while the incidence in males remain unchanged (about 6 percent of men), says Susan Rubin, MD, a neurologist with NorthShore University HealthSystem. “It is felt that estrogen can increase the hyperexcitability of nerves, making it easier to trigger a migraine. That may be why women have more migraines,” she says.

Nearly three out of four people who suffer migraines are women, says Michael Hanak, MD, assistant professor of family medicine at Rush University Medical Center. The highest prevalence tends to be among women in their 30s.

“Menstrual cycles are often tied to episodes of headache, both migraine and non-migraine,” Hanak says. This is likely due to complex pathways in the body involving hormones and their influence over chemicals known as neuropeptides in the brain.”

Triggers and treatments

While some medications can ease symptoms, physicians are exploring preventive therapies, including using anti-inflammatories during times when migraines tend to start, such as during a menstrual cycle. Other therapies involve some high blood pressure medications that can reduce frequency and severity of migraines.

Migraines can also be treated through dietary restrictions. Tyramine, a naturally occurring compound in some foods, is broadly recognized as a potential headache trigger.

“We see high levels of tyramine associated with foods that are aged, fermented or have MSG, nitrates or nitrites added,” Hanak says. “Avoiding things like sausages, preserved meats, aged cheeses, soy sauce, dried fruits and more than one or two beers or glasses of wine can help prevent migraine headaches.”

Other factors are often at play. For example, chocolate is commonly thought to trigger migraines, but it is often eaten when a woman is hungry, tired and premenstrual—all headache triggers on their own. In fact, Rubin says, chocolate is likely to be a craving in response to the onset of a headache. It contains theobromine, a caffeine-like substance, and serotonin, which is often low in the body during a migraine.

Rubin and Hanak both recommend supplements like magnesium, B2 (riboflavin) and butterbur, as studies have shown them to be good preventatives of migraines. In addition, Hanak recommends coenzyme Q10. For some patients, particularly those with frequent migraines, Botox injections can be given every few months to key sites around the head.

Calcitonin Gene-Related Peptide (CGRP) antagonists are also in the testing phase as a once-a-month intravenous infusion to reduce the frequency of migraines. CGRP is a chemical released at the onset of a migraine, and researchers have found that blocking it can reduce the development of migraines.

Hanak is particularly excited about a new drug under development—a CGRP receptor antibody given as an injection every two weeks for people with four or more monthly attacks. The drug, which is still in development and does not yet have a name, could completely stop migraine attacks in one-third of affected patients and bring 75 percent fewer attacks to those who still suffer, he says.

Healthy lifestyle changes also can help reduce migraines. Managing high blood pressure, exercising regularly, getting adequate sleep and keeping stress levels down can all impact headaches of any kind.

Easing the pain

Overtreating migraines can often make them worse, which is why preventing pain is so important. “The more headaches a person has, the more likely they will develop tolerance to their pain medication and develop rebound headaches,” Rubin says. Rebound headaches, she explains, are headaches that occur after the medication wears off, leading to a vicious cycle of migraines. “The primary goal of treatment should be prevention, while providing relief for the occasional headaches that do occur.”

Patients who experience headaches should see their primary care physician before seeking out a specialist.  Specific clinical criteria need to be met for a headache to be classified as a migraine, Hanak says.

“Certain treatments only work for migraines and not other forms of headache, so it is important to be sure before initiating treatment,” Hanak further explains. “Headaches that turn out not to be migraines can stem from a broad variety of causes, which a primary care doctor is trained to recognize and explore. These can range from depression, dehydration, high blood pressure to diabetes.”

Once migraines have been diagnosed and initial treatments have been unsuccessful, then it may be worth connecting with a neurologist to discuss further management.

New treatments include an iontophoretic transdermal patch (which delivers medications through the skin using an electric current), a breath-powered nasal powder (a device placed up to the nose that is activated when the patient blows into it) and a device that delivers medication to the back of the nose to block the sphenopalatine ganglion—a collection of nerve cells that act as pain sensors. These abortive treatments are used to ease the pain of a migraine once one occurs.

As for Syzdek, she found migraine relief eight years ago with the nerve-blocking agent Topamax and Neurontin. Her co-workers noticed an immediate difference. She didn’t constantly look tired at work. Her kids didn’t see her parked on the couch all the time. She wasn’t plagued by the constant fear of a migraine. “I don’t worry that I’m going to get a headache,” she says. “My life is so much improved.”

Originally published June 2, 2016

Similar Articles

Unexplained belly pain? Consider nerve irritation

Unexplained belly pain? Consider nerve irritation

The Medicine Cabinet: Ask the Harvard Experts By Howard LeWine, M.D. Q: I have had persistent pain

The Science of Sciatica Pain

The Science of Sciatica Pain

By Laura Drucker A few years ago, I suffered from a herniated disc. The pain in

New gene shown to cause Parkinson’s disease

New gene shown to cause Parkinson’s disease

Source: Northwestern University Northwestern Medicine scientists have discovered a new cause of Parkinson's disease: mutations in

Are you too young to have a stroke?

Are you too young to have a stroke?

Source: Cleveland Clinic Brain & Spine Team If you're a young or middle-aged adult, you may

Decline in dementia rate offers ‘cautious hope’

Decline in dementia rate offers ‘cautious hope’

By Beverly Merz Harvard Health Blog According to the Alzheimer's Association's 2015 Facts and Figures sheet: "The

Articles By Category

Family Health

In The Know

CH Lifestyle

May 2017
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
April 30, 2017 May 1, 2017 May 2, 2017 May 3, 2017 May 4, 2017 May 5, 2017 May 6, 2017
May 7, 2017 May 8, 2017 May 9, 2017 May 10, 2017 May 11, 2017 May 12, 2017 May 13, 2017
May 14, 2017 May 15, 2017 May 16, 2017 May 17, 2017 May 18, 2017 May 19, 2017 May 20, 2017
May 21, 2017 May 22, 2017 May 23, 2017 May 24, 2017 May 25, 2017 May 26, 2017 May 27, 2017
May 28, 2017 May 29, 2017 May 30, 2017 May 31, 2017 June 1, 2017 June 2, 2017 June 3, 2017

Categories

Recent Comments

Fund a Cure Night | The Griffith Family Foundation

Fund a Cure Night | The Griffith Family Foundation

Enjoy a great night of baseball at Peoples Natural

VIEW ARTICLE
Swing for the fences in the fight to Sideline Pancreatic Cancer

Swing for the fences in the fight to Sideline Pancreatic Cancer

Enjoy a great night of baseball at Peoples Natural

VIEW ARTICLE

Archives