Another rough start

Today started rather early. Wife woke up with a migraine. It was bad enough to wake her (and me) up. For me it involves playing nurse. Rub muscles, get meds, run bath water, get heating pad, get ice packs etc … my job is to try to make her comfortable. It’s not easy caring for someone with a migraine. You feel helpless. There is nothing you can do to ease the pain. Well I take that back, if we catch it early, we can treat it with several different things. But once it’s full-blown the only thing you can do is manage the environment and the pain. I’m tired and crabby and don’t have much else to say. So today’s post is a PSA for migraines.


Migraine headache triggers
Whatever the exact mechanism of headaches, a number of things may trigger them. Common migraine headache triggers include:

  • Hormonal changes. Although the exact relationship between hormones and headaches isn’t clear, fluctuations in estrogen and progesterone seem to trigger headaches in many women with migraine headaches. Women with a history of migraines often have reported headaches immediately before or during their periods. Others report more migraines during pregnancy or menopause. Hormonal medications, such as contraceptives and hormone replacement therapy, also may worsen migraines.
  • Foods. Certain foods appear to trigger headaches in some people. Common offenders include alcohol, especially beer and red wine; aged cheeses; chocolate; fermented, pickled or marinated foods; aspartame; caffeine; monosodium glutamate — a key ingredient in some Asian foods; certain seasonings; and many canned and processed foods. Skipping meals or fasting also can trigger migraines.
  • Stress. A period of hard work followed by relaxation may lead to a weekend migraine headache. Stress at work or home also can instigate migraines.
  • Sensory stimulus. Bright lights and sun glare can produce head pain. So can unusual smells — including pleasant scents, such as perfume and flowers, and unpleasant odors, such as paint thinner and secondhand smoke.
  • Physical factors. Intense physical exertion, including sexual activity, may provoke migraines. Changes in sleep patterns — including too much or too little sleep — also can initiate a migraine headache.
  • Changes in the environment. A change of weather, season, altitude level, barometric pressure or time zone can prompt a migraine headache.
  • Medications. Certain medications can aggravate migraines.

Complications

Sometimes your efforts to control your pain cause problems. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) and aspirin, may cause side effects such as abdominal pain, bleeding and ulcers, especially if taken in large doses or for a long period of time.

In addition, if you take over-the-counter (OTC) or prescription headache medications more than two or three times a week or in excessive amounts, you may be setting yourself up for a serious complication known as rebound headaches. Although these drugs can give you temporary relief, they not only stop relieving pain, but actually begin to cause headaches. You then use more pain medication, which traps you in a vicious cycle. If you’re caught in the rebound headache trap, talk to your doctor.

Treatment

At one time, aspirin was almost the only available treatment for headaches. Now there are drugs specifically designed to treat migraines. Several drugs commonly used to treat other conditions also may help relieve migraines in some people. All of these medications fall into two classes:

  • Pain-relieving medications. These stop pain once it has started.
  • Preventive medications. These reduce or prevent a migraine headache.

Choosing a preventive strategy or a pain-relieving strategy depends on the frequency and severity of your headaches, the degree of disability your headaches cause and other medical conditions you may have. You may be a candidate for preventive therapy if you have two or more debilitating attacks a month, if you use pain-relieving medications more than twice a week, if pain-relieving medications aren’t helping or if you have uncommon migraines.

Some medications aren’t recommended if you’re pregnant or breast-feeding. Some aren’t used for children. Your doctor can help find the right medication for you.

Pain-relieving medications
For best results, take pain-relieving drugs as soon as you experience signs or symptoms of a migraine headache. It may help if you rest or sleep in a dark room after taking them:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications, such as ibuprofen (Advil, Motrin, others) or aspirin, may help relieve mild migraines. Drugs marketed specifically for migraine, such as the combination of acetaminophen, aspirin and caffeine (Excedrin Migraine), also may ease moderate migraines, but aren’t effective alone for severe migraines. If taken too often or for long periods of time, NSAIDs can lead to ulcers, gastrointestinal bleeding and rebound headaches.
  • Triptans. Sumatriptan (Imitrex) was the first drug specifically developed to treat migraines. It mimics the action of serotonin by binding to serotonin receptors and causing blood vessels to constrict. Sumatriptan is available in oral, nasal and injection form. Injected sumatriptan works faster than any other migraine-specific medication — in as little as 15 minutes — and is effective in most cases. But injections may be inconvenient and painful.Side effects of triptans include nausea, dizziness, and muscle weakness and, rarely, stroke and heart attack.
  • Ergots. Drugs such as ergotamine (Ergomar) and dihydroergotamine (D.H.E. 45) and dihydroergotamine nasal spray (Migranal) help relieve pain. These drugs may have more side effects than do triptans.
  • Medications for nausea. Metoclopramide (Reglan) is useful for relieving the nausea and vomiting associated with migraines, not the migraine pain itself. It also improves gastric emptying, which leads to better absorption and more rapid action of many oral drugs. It’s most effective when taken early in the course of your migraine or even during the aura before your headache begins. The drugs prochlorperazine (Compazine), chlorpromazine (Thorazine), promethazine (Phenergan) and hydroxyzine (Vistaril) also may relieve nausea, but don’t affect gastric emptying.

Preventive medications
Preventive medications can reduce the frequency, severity and length of migraines and may increase the effectiveness of pain-relieving medicines used during migraine attacks. In most cases, preventive medications don’t eliminate headaches completely, and some can have serious side effects. For best results, take these medications as your doctor recommends:

  • Cardiovascular drugs. Beta blockers — which are commonly used to treat high blood pressure and coronary artery disease — can reduce the frequency and severity of migraines. These drugs are considered among first-line treatment agents. Calcium channel blockers, another class of cardiovascular drugs, especially verapamil (Calan, Isoptin), also may be helpful. In addition, the antihypertensive medications lisinopril (Prinivil, Zestril) and candesartan (Atacand) are useful migraine prevention medications. Researchers don’t understand exactly why all of these cardiovascular drugs prevent migraines. Side effects can include dizziness, drowsiness or lightheadedness.
  • Antidepressants. Certain antidepressants are good at helping prevent all types of headaches, including migraines. Most effective are tricyclic antidepressants, such as amitriptyline, nortriptyline (Pamelor) and protriptyline (Vivactil). These medications are considered among first-line treatment agents and may reduce migraines by affecting the level of serotonin and other brain chemicals. Newer antidepressants, however, generally aren’t as effective for migraine prevention. You don’t have to have depression to benefit from these drugs.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). Regularly taking over-the-counter NSAIDs such as ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve) may reduce the frequency of migraines. If these medications don’t help, your doctor may suggest a stronger, prescription-only version of the same drug. However, NSAIDs may increase your risk of cardiovascular events, such as heart attack and stroke. In addition, long-term use of these medications can lead to ulcers and other gastrointestinal problems, such as stomach bleeding. Talk to your doctor before taking these medications regularly — even the nonprescription varieties.
  • Anti-seizure drugs. Although the reason is unclear, some anti-seizure drugs, such as divalproex sodium (Depakote), valproic acid (Depakene) and topiramate (Topamax), which are used to treat epilepsy and bipolar disease, seem to prevent migraines. Gabapentin (Neurontin), another anti-seizure medication, is considered a second-line treatment agent. Taken in high doses, however, these anti-seizure drugs, depending on which one you take, may cause side effects such as nausea and vomiting, diarrhea, cramps, hair loss and dizziness.
  • Cyproheptadine. This antihistamine specifically affects serotonin activity. Doctors sometimes give it to children as a preventive measure.
  • Botulinum toxin type A (Botox). Some people receiving Botox injections for their facial wrinkles have noted improvement of their headaches. However, it’s unclear what effect Botox actually has on headaches. It may cause changes in your nervous system that modify your tendency to develop migraines. Additional research is necessary.

Prevention

Whether or not you take preventive medications, you may benefit from lifestyle changes that can help reduce the number and severity of migraines. One or more of these suggestions may be helpful for you:

  • Avoid triggers. If certain foods seem to have triggered your headaches in the past, eat something else. If certain scents are a problem, try to avoid them. In general, try to establish a daily routine with regular sleep patterns and regular meals.
  • Exercise regularly. Regular aerobic exercise reduces tension and can help prevent migraines. If your doctor agrees, choose any aerobic exercise you enjoy, including walking, swimming and cycling. Warm up slowly, however, because sudden, intense exercise can cause headaches.
  • Reduce the effects of estrogen. If you’re a woman with migraines and estrogen seems to trigger or make your headaches worse, or if you have a family history of stroke or high blood pressure, you may want to avoid or reduce the amount of medications you take that contain estrogen. These medications include birth control pills and hormone replacement therapy. Talk with your doctor about the best alternatives or dosages for you.
  • Quit smoking. If you smoke, talk to your doctor about quitting. Smoking can trigger headaches or make headaches worse.

Self-care

Self-care measures can help ease the pain of a migraine headache. Try these headache helpers:

  • Keep a diary. A diary can help you determine what triggers your migraines. Note when your headaches start, how long they last and what, if anything, provides relief. Be sure to record your response to any headache medications you take. Also pay special attention to foods you ate in the 24 hours preceding attacks, any unusual stress, and how you feel and what you’re doing when headaches strike. If you’re under stress, tell your doctor.
  • Try muscle relaxation exercises. Progressive muscle relaxation, meditation and yoga don’t require any equipment. You can learn them in classes or at home using books or tapes. Or spend at least a half-hour each day doing something you find relaxing — listening to music, gardening, taking a hot bath or reading.
  • Get enough sleep, but don’t oversleep. The average adult needs seven to nine hours of sleep a night.
  • Rest and relax. If possible, rest in a dark, quiet room when you feel a headache coming on. Place an ice pack wrapped in a cloth on the back of your neck and apply gentle pressure to painful areas on your scalp.

Complementary and alternative medicine

Nontraditional therapies may be helpful if you have chronic headache pain:

  • Acupuncture. Among other benefits, acupuncture may be helpful for headache pain. This treatment uses very thin, disposable needles that generally cause little or no pain or discomfort.
  • Biofeedback. Biofeedback appears to be especially effective in relieving migraine pain. This relaxation technique uses special equipment to teach you how to monitor and control certain physical responses, such as muscle tension.
  • Massage. Although massage is a wonderful way to reduce stress and relieve tension, its value in treating headaches hasn’t been fully determined. For people who have tight, tender muscles in the back of the head, neck and shoulders, massage may help relieve headache pain.
  • Herbs, vitamins and minerals. There is some evidence that the herbs feverfew (Tanacet, Tenliv) and butterbur (DoloMed, Petadolex, Petadolor) may prevent migraines or reduce their severity. A high dose of riboflavin (vitamin B-2) also may prevent migraines by correcting tiny deficiencies in the brain cells. Oral magnesium sulfate supplements may reduce the frequency of headaches in some people, although studies don’t all agree on this issue. In addition, infusions of magnesium sulfate seem to help some people during an acute headache, and they seem to relieve migraine pain in people with magnesium deficiencies. Ask your doctor if these treatments are right for you. Don’t use feverfew or butterbur if you’re pregnant.
  • Cervical manipulation. There are no scientifically valid studies that prove that chiropractic or other spine-manipulation treatments are effective in the treatment of migraine.

Source in whole or in part for this information comes from: http://www.mayoclinic.com/health/migraine-headache/DS00120/DSECTION=1

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1 Comment

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One response to “Another rough start

  1. holycowirock

    I feel for you. In my household, I’m the one with the severe migraines, often having them wake me and my husband up. He’s so good about getting me what I need and trying to help me get comfortable. I feel bad that I can’t help him when I am down with the excrutiating pain, I can’t get his dinner like usual, I can’t keep him good company, I can’t carry on a coherent conversation.

    Its husbands like you and him that make our lives better and get us through the times when we think we want to die from all the pain. So thank you. : )

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