Migraine Awareness Month - Local neurologist offers advice on common malady
6/28/2018
BY MEGAN SPRAGUE, msprague@mooresvilletribune.com, The Mooresville Tribune June 27, 2018, Page 4A
June is Migraine and Headache Awareness Month, and according to the American Migraine Foundation, it’s a “dedicated time for migraine doctors, health care providers, patient advocates and the migraine community to unite our voices to advocate for migraine recognition and treatment.”
More than 38 million people suffer from the condition, and the Tribune sat down with Dr. Andrew Gross, neurologist at First In Flight Neurology in Mooresville, to talk about migraines, their effects, and possible treatments.
Tribune: What's the difference between a migraine and a headache?
Gross: A migraine is a specific syndrome that has headache as its most common or notable manifestation. We understand more about it each year, but much of it remains a mystery. One of our brain’s biggest jobs is to decide what is painful. Pain is important, and in fact necessary, for protection and survival. There is something particularly complicated about the pain system to the head and face in that it is prone to dysfunction. The vast majority of headache pain is a malfunction in the pain system and not a response to something horrible happening.
Migraines also change throughout the lifecycle. Children destined to have migraines can have recurrent, unexplained abdominal pain, which only makes sense years later, while the elderly can have just the aura of their long past migraine headaches without the headache.
A headache can describe anything causing pain in the head from migraines to trauma to brain tumors.
Tribune: How do your patients describe having a migraine (what are some of the tell-tale descriptors that lead you to diagnosing the person with a possible migraine)?
Gross: There are gray areas between migraine and other classic headache syndromes, but some of the core features that distinguish migraine headache include pain on one side of the head at a time with a pounding quality that is worse with activity, light and sound sensitivity, nausea, and a desire to be in a quiet dark place.
The last one is most the fascinating in my opinion. Not only do people with migraine headaches (migraineurs) have trouble managing pain, but they have trouble tuning out anything in their environment. Some people have migraine headaches all, or nearly all the time, and can come across as irritable or intolerant. It is really the migraine syndrome that is preventing them from ignoring sensory inputs that their body is giving them that is not important in a particular situation.
Tribune: Who is more susceptible to migraines?
Gross: There does not seem to be a specific single migraine gene, but without a doubt, they are more common in some families, so there is likely a complicated genetic component. Women more often suffer from migraine headaches. This is probably explained mostly a monthly hormonal fluctuation. It is not so much a specific hormone, such as estrogen or progesterone, but the dynamic environment. After menopause, the rates are similar between women and men.
Lifestyle factors are also very important. Diet, exercise, the amount and quality of sleep, and other environmental triggers can bring about migraine headaches.
Tribune: How are migraines diagnosed?
Gross: Most migraine headaches are self-diagnosed or diagnosed by primary care providers just based on the symptoms alone. There is no test for migraines. The real challenge in headache diagnosis is to be certain to know when something else is going on (the pain system is functioning appropriately) that could be mimicking migraine headache.
Tribune: What are some of the treatments (both OTC and prescription)?
Gross: There is no cure for migraine headaches. It is a syndrome that generally affects daily life of people in their prime and in their reproductive years. Before we ever get to medicine, we take a systematic approach to doing everything possible non-medically, particularly in children to manage migraine headaches. Sometimes that is enough. Most of my patients, however, will need pharmacotherapy. We generally divide medications into rescue medications(medications to take as needed) which range from over the counter Tylenol to injections, preventative (medications taken on a scheduled basis) which range from vitamin supplements to our most powerful measure, Botox injections. We are truly excited about a new class of medications that have just been FDA approved that, for the first time, work specifically toward targeting the pathophysiological process of a migraine headache. Until now, all the preventative medications were intended for other conditions, and were found to work by accident.
Tribune: Why is research and innovation necessary for migraine headaches?
Gross: Migraine headache is the epitome of an ‘invisible’ disease. Imagine having a condition that could suddenly and unpredictably incapacitate you. Imagine also that this condition has no tests or outward manifestations. You invariably will miss school, work days, important life events, or just live in fear that you will could develop excruciating pain during an interview, presentation, test, or ceremony. Many intelligent, motivated people live a life less lived, because they are stuck in a state of smoldering headache all the time, and wait for better treatments. Also, it can have bearing on your overall health, as people with certain types of migraine headache have a higher risk of stroke.
People often ask if I find treating headaches unfulfilling. The answer is no, because after treating thousands of headache patients, I have learned that the ‘cookbook’ approach to managing them will satisfy few people. If I listen closely, get a good sense of who they are, learn their preferences regarding medications and alternative therapies, ensure that it is not something serious, and prepare them for a plan rather than a quick fix, the vast majority are going to feel better. Using creative combinations of the tools we have safely and creatively to manage this condition is very gratifying.
My colleagues and I feel fortunate to have the tools we have, but look forward to future treatments with the ultimate goal of a treatment with no toxicity, side effects, interactions, and that is, of course, effective.
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