Migraines: An Introduction And Treatment Options

By: Dr. Mark Gallant and Dr. Colin Bartoe

At a recent neurology seminar, a colleague presented a new technique that was discovered.  We now have the ability to significantly reduce the pain of a migraine within 2 to 5 minutes without drugs in many patients!  This is the reason that we are functional neurologists.  We are constantly finding new ways to help people as we learn more of how the brain works.  So, this leads us to this week’s discussion – migraines.

Let’s talk a little about different headaches.  I have heard many people talk about their “migraines”, when in actuality, they had a completely different kind of headache.  First, there is the tension headache.  This is often described as a hatband distribution, as there is a feeling of pressure or pain all the way around the head – especially at the temples, like the feeling of where a hat sits on your head.  Next there are cluster headaches, which happen more commonly with men than with women.  They tend to have a group of intense headaches on one side of the head, and then they can go for a long period of time before the next group or cluster of headaches occur.  Then we have sinus headaches, which are caused by inflammation of the sinuses during a cold, flu, or allergies.  The pain is felt generally in the cheeks and forehead. Another type is the cervicogenic headaches, which are caused by structural problems in the neck. This can mean tight muscles, vertebral misalignments, or injuries to different tissues can cause these headaches.  Finally, we have migraines. Migraines are intensely painful, throbbing headaches, where a person may become nauseas, and/or have sensitivity to light in sound. The person may or may not see an aura, which can be colors or black and white waves or lines, before their migraine.

There are different phases to a migraine headache.  The first phase that may occur is called the prodrome phase.  This phase often lets the individual know that a migraine will be coming on soon.  Many different things can happen during this phase, such as: mood changes, fatigue, sensitivity to smells, muscle stiffness, bowel changes (constipation/diarrhea), and/or food cravings.  The next phase that may or may not happen is the aura phase.  An aura presents as flickering lights or zig zag lines across the visual field.  The next phase is the throbbing pain that gets worse with activity, and often with lights and sound.  During this phase, a person may be able to do nothing but lie down in a quit dark room.  Finally, there is something called the postdrome, which is a hangover-like feeling of fatigue and mental fogginess that can occur for up to 24 hours after the pain subsides.

So why do we have migraines?  Well, that’s a much debated topic right now.  There are those who say that it’s neurological, and there are those who say that it’s vascular.  More than likely, it’s a combination of the two.  The vascular people say that there is a problem with the sympathetic nervous system (called dysautonomia) that leads the blood vessels in the brain to first constrict, which deprives the brain of some oxygen, and then dilate, which causes the pain.  The neurology people say that migraines are due to something called cortical spreading depression.  This is where neurons are overactive and firing incorrectly, which in turn leaves them completely inactive for a time.  This usually starts in the part of the brain involved with vision, which is why there are auras, and it spreads out throughout the brain like a ripple in a pond.  This would be a very slow ripple that moves at a rate of about 2 millimeters a minute.  The pain is said to come from the stimulation of a nerve called the trigeminal nerve which “feels” what is going on with the outer membrane that covers the brain.  This nerve goes to the brainstem, and then on to other parts of the brain that experience pain.  The brainstem is also in control of your sympathetic system, which controls your blood vessels.  We know that both the cortical spreading depression and the vascular changes happen.  The big debate is over which starts the other and which actually causes the pain.  In our office, we apply the new technique to get rid of the migraine, as well as to treat the blood flow and neurological issues to help keep the migraines from coming back. It is also important to understand that there are migraines that can be caused by autoimmune diseases, or an imbalance in hormones (these usually coincide with the menstrual cycle).  So you may need to manage an autoimmune condition or get your hormones back in balance.

There is one thing that we need to mention that is extremely important.  There are a couple of heart conditions that are associated with migraines.  The first is something called patent foramen ovale.  This is a hole between two of the four chambers of the heart that may prevent some of the blood from picking up the oxygen it needs in the lungs before it goes back out into the rest of the body.  This happens in about half of all people that have migraines.  There is also something called a mitral prolapse that can cause blood clots to form.  This happens in about one quarter of people who have migraines.  Both of these heart problems can lead to stroke.  If you have migraines, then it is important that you talk to your doctor about whether or not you should get screened for these conditions.

So what can you do about migraines?  Well, there are a number of medications that can be taken with varying amounts of success.  Some people find relief and others do not. We are excited to announce that our office now has access to a new technique that can greatly diminish an active migraine in about 2 to 5 minutes in most patients. When combined with a functional neurological approach to improving blood flow control and brain activity, we have a technique that can help address migraines more completely and more permanently. For more information, please contact Dr. Bartoe or Dr. Gallant at Back N’ Balance. (727)-733-6501 or like us on facebook at www.facebook.com/backnbalance.