Analysis of Migraine Headache Treatments - Essay Example

Migraines It has been estimated that well over 20 million Americans suffer from migraine headaches, making it one of the costliest and most incapacitating medical conditions in contemporary society. The number of women who suffer from this condition is roughly triple the number of men who suffer migraines and overall almost one-tenth of the population must deal with the devastating effects. There are two different types of migraines. The overwhelming majority—as much as 80%--experience the type known "migraine without aura" The other category is known "migraine with aura” and is accompanied by sensory disturbances that may include hallucinations, limited obstruction of the visual field, a numb or tingling sensation, or a feeling of heaviness. Much of the research into migraines today focuses on the theory that an attack is caused when nerve cells in the brain known as nociceptors release chemicals called neuropeptides. It is theorized that one or more of the neurotransmitters raises the sensitivity to pain of the proximate nociceptors and that other neuropeptides operate on the muscles that envelop cranial blood vessels utilized in the regulation of blood flowing to the brain by contracting and constricting the vessels. When a migraine attack begins, it is thought that these neuropeptides cause muscle relaxation, permitting vessel dilation and increased blood flow. Additional neuropeptides augment the permeation of cranial vessels and thereby allow extra leakage of fluid while also promoting inflammation and tissue swelling (Pain Management 2002). The discomfort that accompanies a migraine attack is assumed to result from this arrangement of increased pain sensitivity, tissue and vessel swelling, and inflammation. The aura that is frequently associated with migraine is thought to be related to constriction in the blood vessels that open in the headache phase. Vulnerability to migraine attacks may also be genetic in nature. Offspring of a parent who suffers from migraines may be at as much as twice the risk for developing migraines themselves. When both parents are migraine sufferers the chance rises to 70%. However, the gene or genes responsible have not been identified, and many cases of migraine have no obvious familial basis. It is likely that whatever genes are involved set the stage for migraine, and that full development requires environmental influences, as well (Montagna, 2002, pp. 144-146). The classic migraine develops in four phases: prodrome, aura, headache, postheadache. Symptoms of migraine include health problems such as exhaustion, irritability, and lack of concentration occur during the prodrome stage, the first of the four stages. The prodrome phase commences roughly twenty-four hours prior to the aura phase. The aura phase may start with flashing lights or blind spots accompanied by a tingling sensation in the arms or legs. These indicators transpire usually 15 to 30 minutes before the headache actually kicks in. Migraines can differ from person to person and may even differ from day to day for one person. The fourth stage is postheadache, which includes but is by no means restricted to extreme tiredness. A common cause of almost all migraines are things that are collectively known as “migraine triggers.” Migraines can be triggered by an extensive assortment of foods, drugs, environmental and even acutely personal incidents. While it is not yet understood how most migraine triggers are released or why they affect individuals in the way that they do, many of the most common triggers are well known and even avoidable. Food triggers: chocolate caffeine alcohol foods that are extremely high in sugar content dairy products Smoked, cured, or pickled fish or meat (bologna, pepperoni, salami, meat tenderizer, meat extracts, caviar) Aged Cheeses (American, blue, brie, camembert, cheddar, mozzarella, parmesan, Romano, sour cream, Swiss citrus fruits nuts processed foods, especially those containing nitrites, sulfites, or monosodium glutamate (MSG) Caffeine is the leading food-related trigger of migraines. Just two cups of coffee delivering 200 mg per day can result in the onset of frequent headaches. In addition to caffeine, another primary food trigger is MSG. Studies have indicated that caffeine, MSG, and tyramine have the effect of stimulating the blood vessels in the brain, which in turn causes them to contract, triggering the pain associated with migraine headaches. Some people also seem to have a greater propensity for migraines because their bodies lack an essential enzyme that the body requires to successfully break down tyramine. Tyramine is an amino acid that may cause blood vessels to constrict and is often found in foods that are aged or preserved. Tyramine is not actually put in to foods; the increased levels are the natural result of aging. The lack of proper disposal by the body results in tyramine lasting longer in the system and having a greater negative effect. The time between when a person ingests a food product that can trigger the migraine to the actual onset of the migraine can be vary from just a few hours to almost an entire day (Tepper, 2004, pp. 68-71) . Environmental and event-related triggers include: menstrual periods, menopause strong glare or flashing lights stress or time pressure sleep changes or disturbances, including oversleeping prolonged overexertion or uncomfortable posture odors, smoke, or perfume hunger or fasting Fifteen percent of women experience migraines and of those as many has half can pinpoint the onset to either just before and after menstruation. In addition some women even suffer migraines during ovulation. The current theory places the trigger for migraines associated with the menstrual cycle at the fluctuations in the hormone levels, and not the actual hormone levels themselves. Women who suffer premenstrual migraines typically describe them as being far more intense than what are considered to be regular migraines, but many researchers attribute this intensification to other symptoms associated with menstruation such as nausea, mood swings and fatigue. Drug triggers: oral contraceptives estrogen replacement therapy Reserpine Nifedipine benzodiazepine Indomethicin Cimetidine overuse of decongestants Theophyline analgesic overuse Weather is regarded as one a common yet unavoidable trigger for migraines that typically begin with a change in the air pressure. Barometric pressure is a measurement of the weight exerted by the air that surrounds us. When the barometric pressure falls, it is usually followed by precipitation or even a storm, and it also affects the actual amount of oxygen that is in the air. Blood vessels must compensate by constricting to adjust the amount of oxygen use, thereby increasing the potential for migraine pain. Many migraine researchers contend that atmospheric changes also produce a change in electrical activity in the brain that brings on an attack. Humidity is also thought to be a culprit with research indicating strong relationship between dry, cold air and the migraine, and with changes in humidity aggravating headache pain. Migraines and sinus headaches are both at risk for being triggered by climate changes and both types of headaches bring on intense pain. Considering that both sinus and migraine headaches result in severe pain in the same area of the head, and both produce copious drainage of the sinuses along with red and watery eyes, it comes as little surprise that migraines and sinus headaches are very often misdiagnosed. This is especially true because the same nerves transmit both sinus and migraine pain. On the other hand, the sinus headache is usually accompanied by a fever, cough, fatigue and pain over the cheek or forehead. Migraine without aura may be heralded by an uplift in mood or the energy level of the migraine sufferer up to 24 hours before the commencement. Other symptoms include fatigue and depression. Aura typically begin with iridescent and jagged arcs of white or colored light moving across one’s field of vision for about 20 minutes. This may be either accompanied or substituted by dim areas of vision or other less common visual disturbance. It is common to experience some tingling sensations or numbness in the hands or even the face, and occasionally this unpleasant sensation can expand into a more profound heaviness experienced in the extremities. Migraine pain is very often only experienced on one side of a person’s head, although it certainly isn’t limited to just one side and can not only affect both sides at once, but also switch back and forth them both. The pain is typically throbbing, and may range from mild to incapacitating. It is often accompanied by nausea or vomiting, excruciating sensitivity to light and sound, and extreme intolerance of food or odors. Blurred vision is also frequently experienced. The pain can usually be expected to get more intense over the first half hour and this may from several hours to as much as a day. Afterward, the affected person is usually weary, and sensitive to sudden head movements (Tepper, 2004, p. 6) . Many pharmacological treatments for migraine relief are currently marketed across a wide swath of medication class These include prophylactic medications like as SSRIs, NSAIDs, beta blockers, serotonin antagonists, tricyclic antidepressants, anticonvulsants, and abortive medications such as steroids, analgesics, butalbital compounds, sedatives, and opiods. The downside is that so far none of these medications in particular work without fail for all migraine sufferers. The problem is that that the headache associated with migraines arrive accompanied by a multitude of differing degrees of pain resistance and intractability. In addition, there also exists a significant amount of side effects, many of which may be considered even less welcome than the pain (Dominici, Parmigiani, Wolpert & Hasselblad, 1999, p. 16). Melatonin is now more and more being considered as a possible prophylactic treatment for those suffering from migraines. Melatonin is a hormone that is manufactured in the pineal gland of the brain. This hormone is accountable for sleep regulation and keeping one’s sleeping cycle in check. As a result, melatonin is produced in greater quantities after dark while production declines during the day. Due to the connection between sleep and melatonin, it is being more commonly utilized as a treatment for such disorders as jet lag, seasonal affective disorder, and insomnia (Grazzi, Leone, D'Amico, Usai & Bussone, 2002, pp. 264-265). One hypothesis for the outcome of melatonin on those suffering from migraine headaches is the possibility of a correspondence with an irregularity of the pineal gland. It is assumed that this may result in migraine sufferers producing inferior levels of melatonin than non-migraine sufferers. The delivery of melatonin to these patients would correct their deficiency which serves to decrease the frequency headaches. So far, few side effects have been linked to the use of melatonin. In addition, studies have confirmed the safety of melatonin as a treatment, with side effects limited to those generally associated with most medications such as drowsiness and nausea. Nonsteroidal anti-inflammatory drugs (NSAIDs) acetaminophen (Tylenol), ibuprofen (Motrin), and naproxen (Aleve) have also been proven effective in some cases, especially in the early stages of the onset of a mild migraine attack. In the case of the more extreme or unresponsive migraine attacks, treatment that might be considered moves into the realm of such medications as ergotamine (botulinum toxin), meperidine, dihydroergotamine, antidepressants (SSRIs), sumatriptan (Imitrex), beta-blockers and calcium channel-blockers, antiseizure drugs, or metoclopramide. Many of these medications are available in the form of nasal sprays and intramuscular injections. In addition, some also can be taken rectally if the side effect of vomiting proves prohibitive. A disadvantage involved in the use of medication to treat migraines can be experienced in the paradox of the rebound headache which is characterized by chronic headaches that tend to commence early in the morning. A rebound headache can often be treated through the use of anti-migraine drugs prescribed and administered under a the supervision of a physician. The use of the minimum required dosage is normally given. Many migraine sufferers put their faith in alternative treatments involving herbal medicines and supplements. One of the most popular herbal treatments is feverfew, which is an herb that originally was used to treat fever but now is used by many to provide relief from the pain of migraine headaches. Several studies have confirmed that in some people feverfew taken a daily supplement was effective in reducing not only pain but also the nausea and sensitivity to light and noise associated with auras. It wasn’t until the 20th century that feverfew became the a topic for modern day medicinal use. Feverfew is thought to be effective because it reduces swelling, pain and blood vessel contractions that are a primary cause of the soreness. Feverfew appears to accomplish this by restraining histamine, serotonin and hormone-like material called prostaglandins. In addition, researchers think that parthenolide, a compound found in feverfew, normalizes the slightly irregular blood cell activity sometimes seen with migraines (Forshaw, 2004, p. 66). Migraine sufferers have also turned to another herb known as butterbur (DoloMed, Petadolex, Petadolor) for relief. Buttuerbur gets its unusual name as a result of the German practice of using its large leaves to prevent butter from melting in warm seasons. In addition, it has long been used in Germany to treat migraines. Researchers hypothesize that butterbur's active ingredients, petasin and isopetasin, restrain the production of leukotriene, a material that inflames blood vessels. Lacking that inflammation, migraines occur less frequently. Butterbur also slow down the manufacture of histamine, keeping nasal passages open and alleviating allergic congestion (Eaton 22-24). Another alternative treatment gaining in popularity is acupuncture. Depending on the migraine sufferer’s uniquely individualized triggers, the specific line of attack undertaken by the acupuncturist will vary to suit the needs of the patient. Acupuncture can help to reinforce resistance to the beginning of migraine triggers and to soothe the body’s response to stressors. Acupuncture can also enhance the level of vigor in the body, facilitating the patient’s desire to remain active during the day, and assisting to keep the energy flowing liberally throughout the body while avoiding stagnation. In those cases where the headache is already in attendance, acupuncture will be employed to achieve pain control. Most prominently, the body releases endorphins during acupuncture, those chemicals that make one feel good and fight off pain. Immediately subsequent to the acupuncture treatment, many patients report feeling both tranquil and energetic and in a much more positive mood (Forshaw, 2004, pp. 65-66). Another non-traditional approach gaining interest in the treatment of migraines is the use of Botox. To treat migraines, Botox is injected directly the forehead, many migraine sufferers report a significant decrease in the frequency and severity of migraine pain and also note, when suffering from a migraine, that vomiting episodes are much less frequent. The findings of this medical research indicates that low doses of Botox, in eight regular injections, can lessen the frequency of migraine pain for up to three months (Tepper, 2004, p. 94) Biofeedback is also taking a front seat in the fight to ward off migraines. A biofeedback session is essentially concerned with providing the migraine suffer in instruction on how to become more accustomed to physical change that take place within the body as how one can go about making incredibly subtle modifications to those responses as a way to circumvent any physical conditions associated with them. A biofeedback session to treat migraines typically last a half hour to an hour. The number of sessions necessary can vary considerably and is dependent entirely upon the individual’s progress. Once biofeedback therapy has been successful in treating a patient’s migraines, it is then up to the individual to learn to manage the process without the benefit of the machinery. During biofeedback muscle tension is measured using electromyogram and the sensors are utilized to alert the patient to that tensing of your muscles so that they can augment their ability to identify that sensation more rapidly and therefore actually learn to control it. Biofeedback migraine therapy still has the stigma of seeming offbeat and a little too alternative for some people, but its efficacy has been well established (Miller, 1989). Massage therapy is also finding mass acceptance as migraine sufferers become more and more wary of traditional medicine’s lack of a sustained treatment. The purpose of massage during a migraine attack is inducing comfort. A massage treatment that lasts between thirty and forty-five minutes will reduce the potential for exhaustion. Massage treatment for migraines aims for relaxation, therefore deep, vigorous massages should be avoided. For years physicians believed that have thought that a magnesium deficiency could cause migraines. In the past few decades, however, theoretical differences have arisen over the validity of the claim that there is a correlation at work. While the conventional view is to make the assumption that magnesium more than likely does play at least some part migraine treatment and prevention, there also exists a very vocal opposition who place magnesium at the forefront in dealing with migraine treatment. Many patients for whom not other treatment has worked often turn to magnesium as a last ditch effort only to find a payoff at the end with their frequency subsides. Very likely magnesium will be administered in conjunction with a high dose pain relief medication if the migraine is resulting in extreme pain. Each migraine patient has a unique body chemistry and the result won’t be the same for all, but many sufferers assert that increasing their magnesium has been helpful (Zuddas, Lilliu & Del Zompo, 2002, p. 25). As many as 50% of those who suffer chronic migraine headaches report a magnesium deficiency. The recommended quantity of magnesium varies from 300-600 mg a day and it is vital to wait at least a few months to see complete results. Several forms of magnesium are utilized to facilitate the absorptions into the body, including gluconate, glycinate, lactate, and orotate. Many migraine patients find it useful to take one dose in the morning and one in the evening while others prefer to take the recommended daily amount at the same time. Magnesium supplements that are combined with calcium are avoided because they tend cancel out the benefits of the other. Still another method for increasing magnesium involves changes in the diet; eating whole foods instead of processed foods that may contain additives is recommended. One type of migraine that is less publicized is the ocular migraine, one that normally occurs in one eye. At the onset of an ocular migraine, the patient typically begins to comprehend that something is amiss with his vision such a small spot that gradually gets enlarges and is often followed by shimmering effects or possibly the presence of a colored, zig-zagged border. Vision will ultimately become patchy, as the iridescent pattern expands to the center and outer part of the field. This deformation will remain on for roughly half an hour before it journeys to the extreme edges of the field of vision and disappears. The exact cause of an ocular migraine is still to be discovered, but it is believed to be triggered by an abnormal stimulation of the nerves at the back of the brain. In a classic migraine, the surface of the brain is affected by the tremor, but during an ocular migraine, the blood supply to the eye or the brains vision area is affected. Ocular migraines often arise with no set pattern, much like a classic migraines. It is quite possible to experience a series of ocular migraines within a very constricted time frame and then experience a total alleviation for years. The number one choice for treatment of migraines in the United States is Imitrex which is the brand name for a group of drugs known as triptans. Imitrex is widely distributed in dosages of 25, 50, and 100 mg tablets. Should the headache pain last longer than another two hours after the initial dose, a secondary amount of up to 100 mg can be taken. Imitrex is also offered in the form of a nasal spray of up to 20 mg for the first dose, followed by secondary administration of another 20 mg after two hours if necessary. Still another alternative is subcutaneous injection of 6 mg that may be repeated exactly one hour later if necessary. It is practical to first consider all the various forms of administering Imitrex to find out if any of them work before moving on to the less studied alternative forms. Imitrex has been found to be effective in eliminating an acute migraine attack in 34 to 70% of patients within 2 hours (Tepper, 2004, pp. 54-59) . Other treatments may be successful for acute migraine when Imitrex fails to bring about relief. Aspirin is not effective for the treatment of migraines because the absorption of aspirin is postponed during the migraine attack. In order to address this failure medications that increase absorption are added to the aspirin or it may be administered via a suppository. An amalgamation of indomethacin, prochlorperazine, and caffeine in suppository form were evaluated against Sumatriptan rectal suppositories for acute migraines with the result that 49% of patients were pain free at 2 hour mark the first treatment compared to just 34% with the Sumatriptan. Another study concluded that using Imitrex prior to the onset of pain around the eyes is effective in almost 95% of cases. On the other hand, if the pain has already begun by the time the Imitrex is ingested the success rate falls below the 15% range. Clearly this study indicates that the time at which Imitrex is taken as a defense against migraines is very important to its ultimate efficacy (Wilner). Migraines are neurobiological disorder that have estimated to affect almost thirty million Americans, making it a more common health problem asthma or diabetes. Despite this, it is also estimated that less than half of those suffering from migraines have been officially diagnosed. Migraines are a debilitating disorder with a cost in lost production and wages that is incalculable. That is not even to mention the affect it has on the enjoyment of life for sufferers who often must deal with extraordinary pain several times a week. And yet, more and more migraines are being managed with efficiently. With the assistance of a knowledgeable physician who can help patients identify the particular headache triggers migraine suffers are no longer relegated to wandering in the wilderness, even if there is not necessarily yet a route toward universal relief for everyone who suffers. Medications by and large fall into two categories, the prophylactic and acute. When taken daily prophylactic medications serve to diminish the frequency and severity of migraine attacks in those people prone to having more than two migraines per month. Acute therapy addresses the symptoms of migraine following the onset of the attack. Medications available to treat an acute attack ideally need to be administered immediately following onset. Many headache experts agree that treating migraine when pain is mild is the most favorable strategy. The frequency of migraine headaches may be lessened by avoiding triggers. While both over-the-counter and prescription drugs can benefit some patients and offer relief, they cannot be considered a panacea. Preventive measures include a regular meal schedule, a reduction reducing the use of caffeine and pain-relievers, restricting physical exertion (especially on hot days), and keeping regular sleep hours, but not oversleeping. It is of primary importance to understand the particular triggering events that cause an individual’s migraine and then to deal with eliminating or at the very least substantially reducing the potential for coming into contact with those triggering events. Many migraine patients can effectively be treated with over the counter medications, while others must put their trust in prescription medications. Many more are turning to the variety of alternative treatments that have been utilized throughout history as folk medicines. And yet others are putting their faith in new age treatments that focus on patients retaking control of their lives. If there is one thing that is for certain in the world of treating migraines it is that no single treatment is a cure-all for everyone and every other possibility is open. Works Cited Dominici, F., Parmigiani, G., Wolpert, R. L., & Hasselblad, V. (1999). Meta-Analysis of Migraine Headache Treatments: Combining Information from Heterogeneous Designs. Journal of the American Statistical Association, 94(445), 16. Eaton J. "Butterbur -- herbal help for migraine." Natural Pharmacy, 1998; 2:23-4. Forshaw, M. (2004). Understanding Headaches and Migraines. Hoboken, NJ: Wiley. Grazzi, L., Leone, M., D'Amico, D., Usai, S., & Bussone, G. (2002). 21 Cluster Headache. In Headache and Migraine in Childhood and Adolescence, Guidetti, V., Russell, G., Sillanpää, M., & Winner, P. (Eds.) (pp. 259-272). London: Martin Dunitz. "Migraine Headache." Encyclopedia of Nursing & Allied Health. Ed. Kristine Krapp. Thomson Gale, 2002. Miller, L. (1989, November). What Biofeedback Does (and Doesn't) Do. Psychology Today, 23, 22+. Montagna, P. (2002). 11 The Genetics of Migraine Headaches. In Headache and Migraine in Childhood and Adolescence, Guidetti, V., Russell, G., Sillanpää, M., & Winner, P. (Eds.) (pp. 143-157). London: Martin Dunitz. "Pain Management." Encyclopedia of Medicine. Ed. Jacqueline L. Longe. Thomson Gale, 2002. Tepper, S. J. (2004). Understanding Migraine and Other Headaches. Jackson, MS: University Press of Mississippi. Wilner AN. Pain Medicine News. Vol 1 #4 p1 & 5, 2003. Zuddas, A., Lilliu, V., & Del Zompo, M. (2002). 3 Neurochemistry. In Headache and Migraine in Childhood and Adolescence, Guidetti, V., Russell, G., Sillanpää, M., & Winner, P. (Eds.) (pp. 19-31). London: Martin Dunitz. Read More