More headaches for migraine sufferers

Debilitating migraine headaches are bad enough on their own,
causing millions of Americans to lose valuable workdays and
personal time each year.
Debilitating migraine headaches are bad enough on their own, causing millions of Americans to lose valuable workdays and personal time each year.

But new research could signal deeper troubles for frequent migraine sufferers. A small group of new studies suggests that, at least in some cases, what are thought to be migraines could be ischemic mini-strokes, or small blockages of blood in the brain.

These mini strokes are most frequently found in sufferers who see auras, flashing lights or floating lines before the onset of their headaches, though migraine sufferers of all types are not immune.

And unlike typical stroke patterns, these events create no overt symptoms.

Only with the assistance of an MRI can doctors see the damage they create, tiny lesions in the brain called white matter.

These lesions are most common and most severe in female sufferers, whose risk factors for deep white matter lesions went up in conjunction with the frequency of their headaches.

Over time, neurologists fear the effects of these tiny blockages could add up, leading to some sort of critical mass – a breaking point.

“Migraine was thought to be an acute episodic disease,” said Dr. Anthony Vitto, a Gilroy-based neurologist who sees migraine sufferers on a regular basis. “It may be a chronic progressive disease if these white matter changes lead to long-term effects like stroke or dementia.”

In years past, narcotic pain relievers such as butalbital and vicodin were prescribed to migraine sufferers, but many overused the drugs and developed dependency issues.

With the introduction of triptans, a class of drugs that includes the popular drug Imitrex, the treatment of debilitating headaches entered a new stage.

Most migraines are caused by changes in the dilation of arteries in and around the brain, a problem that triptans were able to halt by constricting the arteries.

Since the white matter observed in the studies is caused by lack of blood flow to certain areas of the brain, it was thought that these medications could be the cause of such problems, but the studies disproved this theory.

Patients who did not take triptans were just as likely to suffer from white matter issues.

More long-term studies will need to be conducted, but the troubling note sounded by these studies, reviewed in December’s “Journal of the American Medical Association,” could lead to much more aggressive treatment aimed at preventing, not just easing, migraine pain.

Several medications have been FDA-approved to prevent the onset of migraine pain, but they are currently prescribed only in extreme cases.

That could change, said Vitto, and treatments considered very extreme by today’s standards could also make their way to the bounds of normalcy for high-risk sufferers.

A study published in January’s issue of the journal “Plastic and Reconstructive Surgery” found that Botox injections could help doctors pinpoint the specific forehead or scalp muscles that triggered migraine pain.

Surgical removal of those muscles eliminated migraines for 35 percent of sufferers tested and led to reduced frequency, duration or intensity in 92 percent of the study population overall.

Correction of a heart defect known as patent foramen ovale, commonly left uncorrected in the small portion of the adult population that has it, can also halt migraines for that subgroup, said Vitto.

But, he said, the biggest key to treatment could lie in better education for doctors and patients.

“Basically, any debilitating headache is a migraine,” said Vitto. “There’s usually nausea associated, sometimes vomiting. It’s sometimes preceded by an aura. When people think of migraine classically, that’s what they think of, but it’s not always there. A lot of (primary care) doctors call them sinus headaches or menstrual headaches, so less than 20 percent of patients with migraines actually know they have them.”

Some of the most common symptoms of migraine aside from aura and nausea are sensitivity to light or sound and throbbing pain. Many are triggered by hormonal fluxuations; changes in the weather, particularly changes in the barometric pressure and exposure to particular food groups.

Common food triggers are aged cheeses, preserved meats, alcohol and chocolate.

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