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Migraine is a common clinical problem described as episodic attacks of head pain with symptoms of nausea, light and sound sensitivity, and also head movement. Migraine was first characterized as severe headache problems but many patients suffer migraine symptoms that don’t exhibit headaches as the primary cause. These patients may have complaints of dizziness, ear pain, ear or head fullness, “sinus” pressure, as well as fluctuating hearing loss. There are various treatments in handling “classic” migraine headaches and are generally effective against these “atypical” migraine symptoms.
- Stress – Your brain releases chemicals during stress that can cause the blood vessel changes, unhealthy doses of these can lead to a migraine.
- Food Composition – Some food and drinks like alcohol, and food additives like nitrates (processed meat) and monosodium glutamate (MSG) may be responsible for up to 30% of migraines.
- Caffeine – When the chemical level in your body abruptly drops it can also cause migraines. This is why too much caffeine or changing your usual intake may trigger a migraine as blood vessels seem to get used to caffeine. Caffeine itself can be a treatment for some migraine attacks.
- Changes in weather like storms, changes in barometric pressure, or abrupt altitude changes can all trigger a migraine.
- Lack of sleep
- Skipping meals
Migraine Treatment: A strict control diet is a priority, eliminating common migraine triggers including chocolate, wines, caffeine, certain cheeses, monosodium glutamate (MSG) as well as less frequently recognized problem foods containing yeast (yoghurt, sourdough, freshly made bread), and nuts.
The backbone of treatment for migraine headache and atypical migraine symptoms is trigger identification and prevention. This requires education about migraine triggers which is why you should always consult a doctor. The use of a migraine diary is also prescribed where they are asked to record their symptoms and the probable trigger for that particular occurrence. Dietary triggers can be avoided unlike many environmental and physiologic triggers. Improving lifestyle habits by reducing stress, sleep habits, and adding regular exercise are overall beneficial factors that are significant in the long run. When practiced fully, many patients will already see positive results and even the complete removal of migraines.
Some suggested medicinal regimens when above treatments have little to no effect:
Calcium channel blockers: Diltiazem CD 120 mg/d increasing as tolerated to 240-480 mg total/d, regularly in two divided doses. Constipation and hypotension are the most common side effects, but this is often the best-tolerated course of therapy.
Anticonvulsants: Topiramate has been shown to be a very effective migraine prophylactic agent. Begin at 25 mg daily and increased weekly to a goal of 100-200 mg twice daily. Patients often report cognitive slowing or brain fogs when they start this medication, but this subsides after a few weeks with this plan for a slow increase in the dose.
Antidepressants: Nortriptyline starting at low dosage (10 mg/d) and slowly increasing to 50-100 mg at night. Higher doses (100-200 mg) may occasionally be needed. Most common side effects are dry mouth, weight gain, and sedation. Patients with associated poor sleep often benefit the most from these agents.
Dr. Kanwar Kelley is located at Orinda California and if you need Migraine Treatment, don’t hesitate to make an appointment (925) 254-6710. He is an experienced physician in many illnesses who can guide your health in the right direction.