By Doug Eaton
Most people who suffer from a migraine headache (often referred to as “migraineurs”) think they may be merely experiencing a severe headache. In actuality, migraine is a disease and the headache is only a symptom.
“Most people equate the term migraine with the term headache and truly headache is a component of a migraine,” said Dr. Dimitry Fomin, a neurologist with Mercy Medical Specialties in Rogers.
Another little-known fact is that the cause of migraine pain is the opposite of the cause of headache pain.
Migraine pain is caused by vasodilation in the cranial blood vessels (expansion of the blood vessels), while headache pain is caused by vasoconstriction (narrowing of the blood vessels). During a migraine, inflammation of the tissue surrounding the brain, i.e., neurogenic inflammation, increases the level of pain. Therefore, medicine often prescribed to treat a headache, such as beta-blockers, dilate the blood vessels and consequently can actually make a migraine worse.

Headaches
Almost all people experience a headache at some time in their lives. One study estimates that more than
50 million people in the U.S. suffer from headaches. Although most headaches do not indicate serious illness, they are a major cause of suffering and missed work, and rank as one of the most common reasons people consult a doctor. The International Headache Society has actually classified 129 different types of headaches. The most common headaches come from the muscles (muscle tension), blood vessels (migraines), joints (from the neck, called cervicogenic), or systemic conditions (such as with fevers or low blood sugar). Doctors of Chiropractic have had considerable success in relieving the cause of headache pain. State-of-the-art techniques not only rid you of your headaches, but eliminate them from your life. These techniques include chiropractic, acupuncture and rehabilitation. If you suffer from headaches, you owe it to yourself and your family to have them evaluated for their cause. The only thing you have to lose is your pain.

Impact
According to the Migraine Awareness Group, A National Understanding for Migraineurs (M.A.G.N.U.M.), migraine disease affects approximately 30 million Americans, with perhaps up to 38 million Americans having a genetic propensity to suffer from migraines. M.A.G.N.U.M. is a nonprofit health care public education organization conceived in 1993 and incorporated in 1994 in order to bring public and government awareness to issue and study of the migraine disease.
Those who suffer from the most disabling type of migraine, intractable migraine, often face an uphill battle just to hold jobs and to support families.
The corresponding cost to industry and the health care system because of migraine is estimated to be between $5 billion and $17 billion dollars a year.
Although most migraine sufferers attempt to continue to work despite their affliction, many people who are inflicted often suffer as their income and productivity decrease over time. In one of the latest studies on the economic cost of migraine, the unemployment rate in individuals with severe migraine is 10 percent to 20 percent, which is several times higher than the general population.

Symptoms
Unlike a headache, the migraine disease has many symptoms, including nausea, vomiting, auras (light spots), sensitivity to light and sound, numbness, difficulty in speech, and severe semihemispherical head pain. One migraine attack can last for up to eight hours, several days, or even weeks.
Although a headache is a common symptom of migraine, it is not always a symptom.
“There are also some migraines that even don’t have a headache,” Fomin said. “So you have all of those other symptoms, but no headache.”
Like many other diseases, symptoms can vary from person to person and from migraine to migraine. Therefore, what a patient experiences before, during and after an attack cannot be defined exactly. The four phases of a migraine attack listed below are common but not necessarily experienced by all migraine sufferers.
Prodrome: A variety of warnings can come before a migraine. These may consist of a change in mood (for example, feeling “high,” irritable, or depressed) or a subtle change of sensation (for example, a funny taste or smell). Fatigue and muscle tension are also common.
Aura: This is commonly a visual disturbance that precedes the headache phase.
Some migraineurs develop blind spots, see geometric patterns or flashing, colorful lights or lose vision on one side.
Headache: Although migraine pain usually appears on just one side of the head, as much as 40 percent of migraines may occur on both sides of the head. Throbbing pain may be present. More than 80 percent of migraineurs feel nauseated and some may vomit. About 70 percent become sensitive to light and sound. This phase may last anywhere from four to 72 hours.
Postdrome: These signs of the migraine (such as fatigue, inability to eat, or problems with concentration) may linger even after the pain has gone.
Triggers
Identification and management of what causes a migraine is an important component of managing migraine disease. Migraine triggers are physical things that, when exposed to a migraineur, bring on a migraine attack.
“Not everyone knows what their triggers are,” Fomin said. “Those people that can identify triggers are better off than those that cannot because if you know what your trigger is, you can avoid it.”
There are a wide range of migraine triggers. Once triggers are identified, it is often possible to reduce the likelihood of migraine attacks by avoiding those triggers.
Food triggers are common. Not everyone who suffers from migraines may have food triggers, but it should be investigated. Often migraineurs can identify food triggers easily by noting that every time they eat something, they have a migraine. Other migraineurs employ an elimination diet to investigate food triggers. To do an elimination diet, eliminate all the potential trigger foods from your diet, then add them back to your diet one food at a time, with at least a week between adding each food.
Potential trigger foods include vegetables, beans, pickles, chili peppers, olives, fruits, bananas, avocados, red plums, breads, any fresh yeast product straight from the oven, pretzels and pizza. Meats and seafood, any preserved or processed meat, bacon, hot dogs and sausage are also triggers for many people.
Dairy products, including aged cheeses, sour cream, and whole milk and beverages, such as alcoholic beverages (especially red wine), chocolate beverages and caffeinated beverages often bring on a migraine. Other triggers can include food products containing artificial sweeteners, MSG and even vinegar.
often underdiagnosed
Many top neurologists admit migraines are greatly misunderstood and often misdiagnosed.
According to noted neurologist Dr. Joel Saper, “Migraine is a serious and underestimated health problem. Patients with migraine are shunted along an assembly line of misdiagnosis, undertreatment or frank mismanagement. They are subjected to unnecessary procedures and preventable consequences.”
It has been estimated that 60 percent of women and 70 percent of men with migraine have never been diagnosed with migraine. It has been reported that more than 60 percent of migraine sufferers have encountered unfavorable experiences with physicians, and often never return.
However, much of the genetic and other research on migraines has been done in the last few years. General practitioners and others receive continuing education, but little or any of the training may involve migraine. Overall, many physicians simply do not have updated information about migraine.
Fomin said physicians “still don’t know the exact nuts and bolts” about migraines, but what they do know is some migraines tend to run in families, are more common in women than in men, can occur in children and typically become less common with age. “There are some benefits to getting older,” he said.
This seems to be particularly true for women who have a strong correlation between migraines and their reproductive cycle. “As the woman goes through menopause, for most women with migraines, that’s usually the end of migraine,” Fomin said. “Not uniformly, but more so than not.”
If a family member has a history of headaches, it doesn’t necessarily mean the headaches are connected to migraines. Some headaches are related to other conditions such as blood pressure, diabetes or are a result of the medications someone has taken for another condition, Fomin said. To help get an accurate diagnosis, he suggested visiting a general practitioner.
Treatment and prevention
Obviously, the first line of defense is identifying and avoiding migraine triggers. Making individual lifestyle changes as appropriate is very important. Changes as simple as avoiding certain types of foods and certain emotional situations may help.
Simply managing care at home can often control migraines. Many migraineurs are able to manage mild-to-moderate attacks at home by the following treatment: using a cold compress to the area of pain; resting with pillows comfortably supporting the head or neck; resting in a room with little (or even no) sensory stimulation, such as light, sound or odors; withdrawing from stressful surroundings; sleeping; or drinking a moderate amount of caffeine.
Other treatments that don’t involve medication involve avoiding common biological triggers like sleep deprivation, dehydration and overheating, Fomin said.
When a pharmacological approach is taken, physicians can prescribe two types of medications: prophylactics and abortive. Prophylactics are usually taken on a daily basis in hopes of keeping headaches from occurring, while abortive medication is taken during a headache in order to stop it, Fomin said.
Certain over-the-counter headache medications may also provide relief. Nonsteroidal anti-inflammatory drugs, including medications like aspirin, ibuprofen (Motrin, Advil) and naproxen (Naprosyn, Aleve). Stomach ulcers and bleeding are serious potential side effects. Therefore, this type of medication should not be taken by anyone with a history of stomach bleeding. Talk to your doctor or pharmacist and ask about possible medicine interactions if the migraineur is taking other drugs.
Acetaminophen (Tylenol) may be safely taken with nonsteroidal anti-inflammatory drugs for an additive effect. Taking acetaminophen by itself is usually safe, even for those with a history of stomach ulcers or bleeding. Be aware that acetaminophen should not be taken if the migraineur is suffering from liver problems or imbibes with three or more alcoholic drinks daily.
“Maintaining a headache diary is particularly important,” said M. Gabriela Gregory, a neurologist at Nevada Neurosciences Institute at Sunrise Health. “This can identify patterns.” Some patients have clusters of headaches in the spring and summer, and allergy medications can sometimes clear this up.

The Morning News’ correspondent Antoinette Grajeda contributed to this report.