Migraines can cause debilitating pain


Ask The Expert Dr. Jason Rosenberg Johns Hopkins Headache Center

November 10, 2008|By Holly Selby

Although estimates vary, about 28 million American adults - or about 13 percent of the adult U.S. population - suffer from migraines, says Dr. Jason Rosenberg, director of the Johns Hopkins Headache Center at Johns Hopkins Bayview Medical Center. The chronic disorder affects more women than men and can vary from occasional symptoms to frequently occurring, debilitating pain.

How is a migraine defined?

We now think of migraines as a chronic disorder of a hyper-excitable brain, and the symptom of this brain hyper-excitability is intermittent sickness, including headache.

Migraines are hard to describe because they are thought to involve multiple steps; they are probably caused by a genetic sensitivity in which the brain is easily irritated by outside stimulation.

What are some of the symptoms of a migraine?

In addition to pain, symptoms include sensitivity to light, to sound, to smells and, what is probably the most disabling part, sensitivity to activity. By that I mean participating in day-to-day activities actually makes the person feel worse. And nausea is common.

The pain is at least moderate to severe in nature. Some of my patients will say that the pain can be 10 out of 10. It is often throbbing, so the pain pounds with the heartbeat. It also can be one-sided (on one side of the head), on both sides, in the face or neck. Sometimes it is mistaken for neck pain rather than a migraine.

How do you tell the difference between a migraine and a headache that may be caused by a more serious condition or disease?

There are a whole set of features in what we call worrisome headaches and these include: a new headache that you haven't experienced before or an unusual headache for you, a sudden "thunder clap" headache that reaches maximum intensity in five minutes vs. headaches that creep up slower, or the worst headache of your life.

Other things to watch for are new headaches in the elderly or anyone with a history of cancer or HIV, anyone who has headache and fever or stiff neck, or anyone with stroke-like symptoms.

The good news is that the vast majority of headaches are benign, caused by tension or migraine and very few are actually dangerous.

You mentioned that migraines affect more women than men. Why is that?

About 18 percent of women [in the U.S.] and 6 percent of men have migraines. No one is exactly sure why. The brains of men and women are different in terms of hormonal exposures and probably that affects the wiring of the brain. So, partly it is because women have menstrual cycles, but in general, men's and women's brains are just a little different and that may contribute to why more women have migraines.

Migraines often start in women just before menstruation and can stop after menopause and can get better during pregnancy.

Do children have migraines?

Migraines have been recognized in children down to about age 3. They may not be recognized until they have been having them for some time because the child cannot articulate what is wrong. A child may not hold his head, he may just vomit or have a bellyache or be very sick. And when they hit 10 or 11 you realize, "Oh, they have been having migraines." Before adolescence, migraines are evenly divided between girls and boys.

When should you consult a doctor?

More than 90 percent of people who go to the doctor thinking that they have recurring tension headaches or sinusitis are wrong and have migraines.

There is no hard call, though, about who goes to the doctor: We have patients who tough it out, and we have patients who come after their first one.

If the headaches are of sufficient intensity or frequency, or if they are interfering with life, then go see a doctor.

You often hear about "auras" accompanying migraines. What is an aura?

About 25 percent of all patients have some neurological symptoms before a headache - most frequently, sparkling light, or patchy blind spots. Some patients will have creeping neurological symptoms across the skin. Rarely the symptoms will be scary such as a patient having trouble speaking or getting confused.

Some people get many auras, but few headaches. In some, every single aura comes with a headache.

How are migraines diagnosed?

There is no test for migraines, only tests for other things that cause headaches. If the patient meets the definition of [migraine] symptoms and the patient otherwise looks normal neurologically, then we say it is a migraine by definition.

How are migraines treated?

The treatment consists of three parts: Lifestyle modification, medication to be given before a headache, and medication that prevents the headaches.

There are certain things people do that can bring on a headache such as drinking alcohol, getting irregular sleep, high periods of stress followed by crashing, certain foods. So we recommend an "even-Steven" lifestyle to avoid rocking the boat. Obviously, there are some things that are unavoidable such as some stress or menstruation.

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