June is Migraine and Headache Awareness Month

June is Migraine and Headache Awareness Month, but those who suffer from it are most likely already aware of it.

Migraines can be debilitating, but doctors say there are new ways to help, and many hope headaches can be controlled.

Ideopathic, used as a medical term, means that there is no clear reason for a condition to occur. Dr. Geoffrey Starr said migraines fall into this category because there are many probable causes.

“We know that some people are susceptible to migraines, about 6% of men and 18% of women in adults,” Starr said. “Curiously, in young people, boys tend to have more than girls. We know there is a hormonal link and probably a genetic link.”

Dr Matt Robertson, neurologist at Portsmouth Regional Hospital.

“Migraines refer to the classic type of debilitating headache, not your typical type of headache,” said Dr Matt Robertson, a neurologist at Portsmouth Regional Hospital. “Migraines are the lights out, don’t talk to me, a dark room, a throbbing headache. They can be severe and last for hours or even days. Most people are out of work when they have one without good treatment.”

Dr Alexandra Filippakis, a neurologist at Wentworth-Douglass Hospital, said migraines are caused by abnormal brain activity that affects nerve and blood signals in the brain.

“It’s a really bad headache,” she said. “People can suffer from nausea. They vomit. There are light and sound impacts. They can have vertigo, dizziness. Some see an aura, a passing attack. It’s not pretty. It’s the one of the most common reasons people see a neurologist More than a billion people worldwide suffer from migraines.

There are good treatments. Robertson said there are preventatives and treatments to use when you feel a migraine coming on.

Traffic signs

People prone to migraines have signs warning them of the impending illness.

“Some people see a shimmer or halo effect and they know it’s happening,” he said. “After a while, many people can identify triggers that can cause a headache. These can be red wine, aged cheese, or chocolate, or foods like soy, gluten, or MSG. Sleep deprivation is a big trigger for some Menstrual cycles, even barometric pressure changes can be triggers The reason can be multiple and people can’t live in a bubble.

Dr Geoffrey Starr, neurologist at Exeter Hosp

Starr said the hardest part was identifying the trigger.

“It could be anything,” he said. “Perfume, stress, certain smells or sleep deprivation can be the cause. It’s like solving a little medical riddle. We look for the trigger, or what the person is doing wrong, like taking ‘Excedrin which can cause rebound headaches.’

Filippakis said she likes a phased approach to treatment.

“I start with behavior/lifestyle modifications,” she said. “Sometimes a good night’s sleep can make a difference. By that I mean restful, uninterrupted sleep. It’s important to stay hydrated, as not doing so can be a trigger. Stress/Emotional Disorders mood can trigger migraines, so I want to treat Keeping a diary of what they eat and drink can help them understand what’s going on.

Filippakis said there is good evidence to support regular aerobic exercise as a way to prevent migraines.

Dr Alexandra Filippakis, neurologist at Wentworth-Douglass Hospital

“Are they taking medication that triggers migraines,” Filippakis said. “We go over what they’re doing, and maybe they don’t need to be.

Robertson said the field of medications surrounding migraines has changed dramatically over the past few years.

“If a person has frequent migraines, we tend to seek prevention rather than treatment when it occurs,” Robertson said. “There’s the use of blood pressure medication, Botox, or anti-epileptic drugs. Botox, used to reduce wrinkles, is also effective for migraines.”

The new line of migraine drugs is based on the CGRP (calcitonin gene-related peptide) pathway in the brain.

“We’ve known about the pathway involved in migraines for some time,” Robertson said. “If we stop it quickly, the headache is less severe. Think of it like a wildfire. A spark can ignite a tree (causing a visual aura or flicker), but it can cascade from there and as the fire spreads, the pain intensifies, more debilitating and harder to put out.It is better to put out a fire with a tree and a bucket of water, than to put out a forest fire.

Previously, triptans like Imitrex were used for migraines. Robertson said they work, but the side effects are often undesirable. The new group of CGRP drugs like Ajovy, Aimovig, and Emgality work better, with fewer side effects.

Filippakis said CGRP drugs are usually self-injected monthly as a preventive measure.

“As long as you can get past the needle part, these are generally well tolerated,” she said.

Starr said the good news is that this is a whole new era for migraine sufferers. He said progress makes a difference.

“The loss of time, the loss of productivity with migraines is real,” Robertson said. “The good news is that we have drugs that can help.”

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