By JOANNE PALLOTTA, Beth Israel Deaconess Medical Center Correspondent
“It feels like my head is just getting crushed!” That’s how Julianne Hertz, an art therapist, describes the excruciating pain of a migraine. While most people with migraines suffer attacks one or two times a month, chronic migraine sufferers experience pain at least 15 days per month. That’s Hertz. She experiences this pain nearly 20 days out of every month along with other symptoms like nausea and light and sound sensitivity. “It’s really terrible!”
A migraine is much more than a bad headache. It is a condition that occurs from the hyper-excitability of cells that trigger many other symptoms, including nausea and/or vomiting, light and sound sensitivity, numbness, and tingling. For some, the migraine – a severe throbbing on one side of the head – can last anywhere from four to 72 hours of moderate to severe intensity.
Migraine pain affects roughly 36 million Americans a year – impacting family time, quality of life, and for some, the ability to work. It is a condition that often goes undiagnosed. “A lot of people have migraines and never actually seek medical attention,” says Dr. Carolyn Bernstein, a neurologist specializing in headache medicine in the Department of Anesthesia, Critical Care and Pain Medicine and Neurology as well as the Clinical Director of the Comprehensive Headache Center at Beth Israel Deaconess Medical Center in Boston. “For some people, they really can’t function. They are just completely down for the count,” says Dr. Bernstein. “Other people will push through because they really have no choice. But, they are quite incapacitated.”
Hertz says living with migraines is hard. “It can make me feel more isolated. At times I do get depressed, angry and frustrated. At times I feel like I’m not doing my part and that I’m not a whole person,” she says. “Migraines can limit my ability to work, and I will sometimes need to cancel or reschedule social engagements, often at the last minute.”
Impact on Women
Migraines have a huge impact on women. They are disproportionately affected; three to one over men. Why? Dr. Bernstein says that up until about the age of twelve, the age of puberty, boys tend to outnumber girls in the frequency of migraines. But that changes when girls start their menstrual cycles. “Hormonal changes and fluctuations can be a profound trigger for a number of women,” says Dr. Bernstein.
The prevalence of migraines seems to drop off for women after menopause, when again, hormones fluctuate. However, it was quite the opposite for Hertz. She developed migraines after menopause and has been living with them for more than eight years.
Some of the major migraine triggers include changes in, lack of or poor sleep; poor hydration; lack of or certain exercises; stress and tension; and even certain foods. It was once thought that cheese, chocolate, red wine and preservatives were the main causes. It turns out, there are variations among people. “There is no blanket set of food triggers that are true for everybody,” says Dr. Bernstein. “But, recognizing your own and trying to avoid those triggers can be really important.” She says even the most meticulous people can’t avoid migraines, but they can minimize them to some degree with medications and various treatments or therapies.
Treating the Pain
There are, of course, medications to ease the pain of a migraine. Triptans, which work on the neurotransmitters to stop the migraine process, may be prescribed. But, Dr. Bernstein cautions against using prescription medications too often – especially narcotics and painkillers. She calls them the choice of last resort. “The problem is that if you use them too much, the headache begins to get used to the medicine and then it becomes harder to treat,” says Dr. Bernstein. “It’s kind of counterintuitive. It is a better choice to try and do something preventative.” And by preventative, she means identifying the triggers and using common and uncommon therapies, such as:
- Cognitive Behavioral Therapy (CBT) focuses on teaching patients how to recognize and manage the causes of stress that may trigger a migraine. “It’s learning to modulate one’s own response to anxiety and stress.” It might include biofeedback, a technique to reduce stress by providing information about tension, skin temperature and brain waves; meditation; and thermo-regulation.
Dr. Bernstein also recommends that her patients try restorative yoga. The yoga poses used in restorative yoga focus on breathing and deep relaxation. They can help restore and revitalize a person’s body and mind in a passive, soothing way.
- Exercise is part of the prescription for Dr. Bernstein’s patients and she emphasizes that it should be an exercise they enjoy. “There have been some studies that show that people who do regular cardiovascular exercise have fewer migraines.” But, she cautions that it has to be the right kind of exercise. The up and down pounding of running may actually trigger a migraine.
One of Dr. Bernstein’s favorite exercises is spinning. There’s no pounding, and there’s the camaraderie of the group, but everyone can go at their own pace. Because lights and loud sounds can be triggers for some, she suggests classes with a dark room and gentle music as a great way to release stress and get a great workout at the same time.
- Acupuncture is a safe option for people who don’t want to take medication or for those who don’t tolerate medication for any reason. Dr. Bernstein says the effectiveness of acupuncture may be due to how it stimulates the release of neurotransmitters that may be involved in pain transmission.
- Botox doesn’t just smooth the skin, it can also have a dramatic impact on lowering the number of migraines a person has each month. “When we prescribe Botox, it’s for people who have chronic migraines,” says Dr. Bernstein. “That means people who have at least 15 days of headaches and migraines a month.” Something to consider, if insurance doesn’t cover the treatment, it could be expensive.
- Quieting the brain can help reduce triggers. Hertz uses biofeedback and meditation, but her favorite thing to do is art therapy. “I really do find that if I can get involved in an art process, often times the migraine will go away. Many times it will be reduced,” says Hertz. Art therapy is a form of psychotherapy using art media and the creative process to explore feelings, emotional conflicts, and increase awareness of self and others.
What to do if you think you are getting migraines
Migraines are more prevalent than first thought. If a person gets pain often, he or she should get it checked out.
Dr. Bernstein has a philosophy: First and worst, new and different. That’s when you want to run it by a medical professional. What she means is if you get pain that you’ve never experienced before and it is the worst you’ve ever had, it’s time to see a physician. “I really encourage people who think they get migraines to get a proper diagnosis and review treatment options with a medical provider as opposed to just trying to treat things with whatever they can procure over the counter or from the Internet.”
She says keeping track of the pain in a diary timeline or with an app can give a physician a much better way to diagnose the condition.
Hertz says the intensity of her migraines varies. With so many a month, she’s learned to work through some of them. Her advice to anyone who thinks they’re suffering from migraines is to see a specialist, track the suspected triggers, and talk to other people who experience migraine about what works for them.
You can learn more about migraines, the triggers and the treatments available by clicking on the BIDMC website here
Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
Posted May 2015