Migraine Headaches

It's one of the most common of headaches and can cause intense pain and even blurred vision. During this National Headache Awareness Week, we take a look at Migraine headaches. MPB's Karen Brown talked with a doctor who suffers from migraines himself: Dr. Kevin Young of Flowood Family Medicine.

Karen: Is a migraine headache the grandfather of all headaches; the worst kind of headache?

Dr. Young: That’s the way that people generally think about it, that it has to do with severity and that is true. Part of the criteria for diagnosing a migraine headache has to do with pain intensity. But it’s not a requirement and that actually is part of the reason that people will often go undiagnosed with a migraine headache. The common idea is that a migraine has to be really bad to be a migraine but that’s not true.

Karen: Does the diagnosis come about because the symptoms are so specific or is it a condition that leads to a migraine headache?

Dr. Young: The diagnosis of migraine headaches is clinical, meaning there is no specific test. There are certain features that suggest migraine headache. Some people have what we call an aura which is visual phenomena. They’ll either lose vision in one eye is how they usually describe it or they’ll see flickering lights or spots and that’s an aura but that’s actually less common with migraine. The more common type is just a one sided pulsatile type headache and made worse by physical activity. People often have nausea and vomiting. They have what we call photophobia and phonophobia meaning light and sound makes it worse. You don’t have to have all those criteria to be diagnosed with a migraine but those are the things that we’re generally looking for.

Karen: Is it true if you’ve never had a migraine headache you probably never will and if you have had one you’re predisposed to have them later in life?

Dr. Young: People who have previous migraines in their life are much more likely to have them later on. There’s also a strong family history connection. Generally, if someone’s gotten to age 50 and they’ve never had migraines, they’re probably never going to have migraines. As a matter of fact, new headache presentation after age 50 is definitely a little more concerning. The age of first migraine can be pretty variable. Some people are children. Often times as people go through puberty they’ll start having headaches. They may go away as they move out of puberty. Some people won’t develop headaches until after puberty or early adulthood. And there are sometimes medicines that tend to promote migraines or stressful situations in life. Females have a much higher incidence of migraines than males. But migraines are so complex physiologically that it’s hard to pin it on any one thing. Oral contraceptive pills will sometimes make women who have never had a problem with headaches suddenly start having migraines.

Karen: What are the most effective treatments for migraines or does it depend on a person’s age?

Dr. Young: Generally, the majority of patients with migraines can take common medications such as acetaminophen, ibuprofen, and naproxen. If they can identify a specific trigger and try to avoid that that can often be very helpful.

Karen: Mention what those triggers might be.

Dr. Young: Some of the most common triggers are stress and sleep deprivation. There are certain foods that trigger it. The most common ones are alcohol, caffeine and chocolate and certain kinds of cheeses for some patients.

Karen: Does a migraine, for everyone, last a matter of minutes or hours? Can it last for days?

Dr. Young: It can. We think of the typical migraine lasting anywhere from four to 72 hours. If over the counter medications and behavioral interventions don’t work there are several prescription medications. One set of medications are used to arrest a headache you’re having right now but for patients who are having frequent headaches (more than two a month), we’ll sometimes use prophylactic medicines, meaning a medicine they’ll take every day to try to reduce the frequency and intensity of those headaches. New headaches or a different type of headache or headaches that seem to be constant and worsening, those always need to be evaluated by your physician.