Saturday, 18 July 2015
25 March 2023
Koocheh Salamati – Migraine

”The most costly disorder”

2011 January 14

Dr. Avideh Motmaen-Far, Osteopath D.O. / Radio Koocheh

9000 years ago, people practiced Trepanation, the deliberate non-fatal drilling of holes into a skull to treat migraines.  Around 1200 BC, in ancient Egypt, a written description consistent with migraines is contained in the Ebers Papyrus. In 400 BC, Hippocrates described the visual aura that can precede the migraine and the relief that can occur through vomiting. In the Middles ages, migraine was treated with hot irons to bloodletting and even witchcraft.

Ebn Sina(Avicenna) described migraine in his textbook “El Qanoon fel teb” as “…small movements, drinking and eating, and sounds provoke the pain… the patient cannot tolerate the sound of speaking and light. He would like to rest in darkness alone.”  Zakariya Râzi wrote the relations between headaches and different events in the lives of women, “…And such a headache may be observed after delivery or abortion or during menopause and  dysmenorrhea.” Today, Migraine attacks are a significant source of medical costs and lost productivity. It has been estimated to be the most costly neurological disorder in the European Community, costing more than €27 billion per year. Let us find out what migraine attacks really are.

Migraine is a complex disorder involving the brain and the blood vessels in the brain and head area. There are three stages in the classic form of migraine: The aura, The headache, The post-headache stage. Migraine headache consists of neurological symptoms that last from 15 to 30 minutes. They usually include numbness, visual disturbances, dizziness, ringing in the ear and or weakness on one side of the body. The headache may be limited to one-half of the head, but can spread to the other side. Nausea, sensitivity to light, diarrhea, vomiting, excessive perspiration and or chills can be signs of headache phase. This phase can last from hours to days, and the person affected often looks ill. During the post-headache stage, the skull on the affected side remains  painful and the person may feel physically and emotionally exhausted.

It was once thought that migraines were initiated exclusively by vascular changes but we know today that Migraines are initiated by a neuro-vascular disorder. Although the initiating factor of migraine remains unknown, there are irrefutable evidence to show that the pain of migraine is in some patients related to painful dilation of the terminal branches of the external carotid artery. Cortical spreading depression associated with the aura of migraine was also considered to be the cause of Migraines. In this theory, it was suggested that this situation, release inflammatory mediators that irritate cranial nerves roots specially the trigeminal nerve that conveys the sensory information to the face and head. But we know that only one third of people suffering from migraines experience an aura and secondly, most migraineurs have a prodrome occurring up to three days before the aura.

Migraine is a enfeebling condition characterized by severe headaches affecting about 3 times more women than men. The pain is usually unilateral and lasts from 4 to 72 hours. Nausea, vomiting, photophobia, and phono phobia accompany very often this condition. Perceiving an aura, is also an unusual visual experience that in one third of people suffering from this condition signs the beginning of migraines. While migraine does seem to run in families, a clear genetic cause has only been nailed down for one rare type of the disease called familial hemiplegic migraine.

Although the precise causes of migraines are still unknown, but there are a number of triggers associated with the onset of migraines. Hormonal changes seem to be the most important of them. Two third of women who suffer from this condition get their headaches around the time of their period. Migraines are generally worse during puberty and tend to disappear around the menopause. Other triggers are alcohol, especially red wine and beer, tobacco, aged cheeses, chocolate, fermented, pickled, or marinated foods, monosodium glutamate (MSG), aspartame, caffeine withdrawal, stress, hunger, menstruation, changes in sleeping patterns and changes in barometric pressure. You can eventually decrease the number of migraine attacks by avoiding potential triggers. Identifying migraine triggers is not an easy task. I recommend keeping a headache diary and record the circumstances such as emotions, weather, and foods eaten surrounding your migraines.  Also, avoiding sleep deprivation and stress and maintain a regular exercise program and good nutrition are very helpful to prevent migraine attacks.

Abortive medications control the pain of an existing migraine headache, while prophylactic medications are taken to prevent migraine headaches. The choice of treatment depends on the severity and frequency of migraine attacks and other eventual medical problems. Symptomatic migraine therapy alone, although helpful for many patients, is not adequate treatment for all. Overuse of symptomatic headache medications is considered by headache specialists to make migraine therapy less effective.

Migraine is a complex disorder involving the brain and the blood vessels in the brain and head area. There are three stages in the classic form of migraine: The aura, The headache, The post-headache stage

According to a study published on the British Medical Journal website, migraine with aura (temporary visual or sensory disturbances before or during a migraine headache) is associated with a twofold increased risk of ischemic stroke. More risk factors for stroke among patients with migraine are being a woman, being under 45, being a smoker, and using estrogen containing contraceptives. The absolute risk of stroke for most migraine patients is low, so a doubling of risk is not cause for panic, However, at a population level, this risk deserves attention because the prevalence of migraine is so high(20% of the population). A recent study also used a sample of migraine sufferers who were examined before, during and after an aerobic exercise intervention. The program was designed to improve oxygen uptake without worsening the patients’ migraines. After the treatment period, not only patients’ maximum oxygen uptake increased significantly but also there was no worsening of migraine status at any time during the study period there was a significant decrease in the number of migraine attacks, the number of days with migraine per month, in headache intensity and amount of headache medication used.


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