Migraines
 It
is estimated that 22 million Americans suffer from migraines and this
can be a debilitating condition for up to 85% of them. New research
regarding the brain's processing of pain has lead to a discovery of new
medications that can help restore a pain free state.
Migraines come in many forms. The common element
is that they are a result of a blood vessel spasm. These spasms
can be within the brain or within the eye itself. Not all migraines
result in a severe headache and many have visual complications.
Migraines are classified as to their type of presentation. The common
migraine is a headache without visual symptoms. The classic migraine
is one in which there is visual aura followed by the headache. Other
migraines can simply give the visual symptoms without the headache and
these are called acephalgic migraines. Migraines can occur in clusters
as well and affect the eye alone. We will discuss each of the types
of migraines and then their treatment in the subsequent paragraphs.
The common migraine is a migraine that does not have
visual symptoms. This is the type of migraine most people think
of when someone describes a migraine. Although, these headaches
are not immediately preceded by the visual symptoms, they are often preceded
by some poorly defined symptoms such as yawning, depression and irritability
for hours prior to the occurrence of the headache. The headaches
often occur on awakening or during hours of relaxation after a stressful
period. The headaches are initially throbbing on one side of the
head. They often feel that they are behind the eye. As the
pain intensifies over several hours, it becomes more constant and spreads
over the entire head. Some specific circumstances may precipitate
a migraine. These include sleep deprivation, hunger, nauseous odors, bright
fluorescent lighting, medications such as oral contraceptives, red wine,
chocolate, Monosodium glutamate (MSG), processed meats, artificial sweeteners
and aged cheeses. Sometimes, patients can identify the causative
agent and avoid this substance or situation in the future.
The classic migraine is a migraine that is preceded by visual symptoms.
These visual symptoms often involve a scintillating blind spot in the
visual field. It typically begins as a small C shaped, luminous
zig-zag near the center of the vision and then slowly expands and drifts
toward the side vision involving one-half of the visual field. The
entire phenomenon can last 20 to 40 minutes and it results in a headache
that is most often on the opposite side of the head when compared to the
visual field defect. These classic migraines are somewhat less common
than the common migraine described above. Many patients feel they
have a visual problem and often attribute it to the eye on the same side
as the visual field defect. However, these visual field defects
are usually in both eyes which can be determined by covering one eye,
then the other.
An acephalgic migraine is one in which the individual gets the visual
symptom described above, but it is not followed by the headache.
Most of these patients feel they have an eye problem and often end up
in the eye doctor's office because of the scintillating blind spot.
Ophthalmic migraines are a very rare condition. They occur most
often in children with transient paralysis of the muscles that move the
eye. This diagnosis is often difficult and one of exclusion of other
serious central nervous system problems.
A retinal migraine is a temporary loss of vision in one eye that is accompanied
by a headache in an otherwise young and healthy patient . Examination
of the eye during the attack would demonstrate constriction of the arteries
and veins within the eye. This temporary reduction of blood flow
causes the decrease in vision.
Cluster migraines are episodes of pain around the eye on one side of
the head that are accompanied by redness, droopy eyelid, and a constriction
of the pupil. Sometimes, these can occur more than once a day and
they are usually clustered with multiple episodes over a six to twelve
week period. After this period, the patient often receives resolution
for quite sometime, however, they may return later. The pain
tends to be very severe in this form of migraine.
Migraines are most often treated with pain medications; however,
patient with significant debilitating migraines can now have quicker relief
with some of the newer drugs that block receptors that lead to the pain.
One such drug is called Sumatriptan. This drug is administered by
a subcutaneous injection with a response rate up to 77% at 60 minutes.
There are oral forms and intranasal forms as well. However, these
routes of administration take somewhat longer to alleviate the pain.
There are some newer drugs developed along the same lines to treat the
immediate migraine pain.
More long standing treatments would include drugs such as Midrin with
two capsules. These drugs provide significant relief for many patients
without having to perform an injection. For patients with frequent disabling
migraines, there are medications that can be used to prevent migraines.
Beta blockers that are also used to treat heart disease, such as
Propranolol can prevent frequent migraines. Patients with significant
migraines should consult their medical physician for the best form of
preventative therapy available for them. The form of therapy chosen
may depend on their medical history.
In summary, migraine is not a curable disease, but current treatment
modalities to relieve and abort the symptoms are very helpful. Although
our current treatments are not perfect, there are certainly more options
today than ever before in both the treatment of acute symptoms of the
migraine and long term prevention of migraine occurrence.
|
