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Migraine: Causes & Treatment

Queen Roly

It’s the second most common cause of missed work in this country after back pain. About 30 million or more people in America suffer from migraine – often in the form of debilitating headaches. But in a KERA Health Checkup, Deborah Friedman of UT Southwestern Medical Center said the types of migraine can vary.

Friedman: It’s generally a severe headache, its usually throbbing or pounding, moderate to severe in intensity, associated with nausea, perhaps vomiting; sensitivity to light, sensitivity to noise, sometimes sensitivity to odors. Migraines in adults usually last at least four hours if they’re not treated or if they’re unsuccessfully treated. In children they can last an hour or less. You can have other neurological symptoms, usually visual. They’re called the aura, and there are some people that only get the aura and never get the headache

Baker: What causes them? What triggers them?

Friedman: About 50 percent of people with migraine can identify some type of migraine trigger. Often it’s a food trigger. Common triggers include chocolate and food that contains a chemical called tyramine. Tyramine is a natural substance. It occurs in food as it ages, so aged cheese, aged meat, smoked meat, cured meat. MSG – it’s used as a flavor enhancer. It makes food more salty. Aspartame or NutraSweet can be a trigger in some patients. Caffeine can be a trigger even though we use it to treat migraine. Alcohol is a common trigger. There’s a whole host of foods that can potentially do this. Other headache triggers can include odors, particularly perfume; gasoline, Kerosene, cleaning products can sometimes do it. Bright light, loud noise. A lot of things in the environment; change in sleep pattern.

Baker: Are you born with this problem or is it something that can develop late in life?

Friedman: It can develop almost at any time. Migraine is pretty common in children. It affects seven percent of children, seven percent of men and 18 percent of women. It is probably hereditary in most cases. There are some genes that have been identified for the most unusual types of migraine. But for the type of migraine that most people get, we haven’t quite found the gene yet.

Baker: How do you go about treating a migraine?

Friedman: It really depends on how frequent they are and how severe they are. One step is to try to, first of all,  prevent them by eliminating triggers. We have really good symptomatic treat for migraine so there are medications that have been developed over the past 20 years that specifically treat migraine and there are other medications that we use to treat the other symptoms – so antiemedics for nausea. If people are having frequent migraines or really incapacitating migraines and they’re missing time out of their life, then we’ll start talking about preventative therapy. And that usually means taking medication ever day to reduce the frequency and severity of migraine.

Baker: But I understand there is concern about how much medication you take to try to prevent migraine, isn’t there?

Friedman: The bigger concern is actually medications people take to treat an individual headache. Because many people will self-medicate, they’ll pick up something at the drug store that is marketed for migraine, and think, well if I just take it, maybe I won’t get so many of them. They can cause a situation that’s called medication overuse headache, where it creates a vicious cycle. People are constantly taking some kind of pain medicine, it may be prescription or over the counter, and their headache frequency actually increases and their headaches become harder to treat. Part of the approach to these patients is getting them off of their medication which can be difficult.

Baker: When the medication does not work, what then?

Friedman: There are a lot of different medications to try so we almost always find something for everybody.

Baker: In looking at this on the internet, some suggested that even surgery is possible, botox –

Friedman: Botox is FDA-approved for the treatment of chronic migraine. It probably works by actually affecting the little nerve fibers that go from the scalp and cut through the skull in very tiny little holes and then go into the brain. So it’s a neuronal mechanism by which it works.

Baker: Surgery would involve what?

Friedman: There are different types of surgery and none of them have been very well studied. Probably the one that is most frequently performed is occipital nerve simulation, strip of electrodes that goes underneath the scalp in the back of the head over a nerve that’s called the greater occipital nerve, its attached to a little generator that’s implanted under the skin. Many people get improvement with that. This is something we really use as a last resort.

Baker: So is there a cure for migraine?

Friedman: When I see patients who have migraines that are difficult to control, I tell them we’re going to aim for very infrequent headaches and you have good symptomatic treatment to take when you get one. Many people as they go through life will have a change in their migraine pattern. Often migraine gets better throughout life, particularly in women after they go through menopause, migraine often gets better. So the natural history is optimistic but I think cure is probably an overstatement at this point.

Tag:  Deborah Friedman is a Professor of Neurology and Neurotherapeutics at U-T Southwestern Medical Center. There are links to more information about migraine at

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