Migraine

What is a Migraine?

A migraine is a neurological condition with varying intensity. While migraines and headaches both affect the nervous system, migraines usually produce symptoms that are much more intense and debilitating compared to headaches. 

Common headaches symptoms include pain in the head, face, or upper neck and can vary in intensity and frequency. On the other hand, in addition to those symptoms, common migraines may cause nausea, numbness, tingling, vomiting, and sensitivity to light and sound.

Migraine Treatments & Remedies

People who suffer from migraines are well aware of how debilitating this condition can be. Fortunately, there are several migraine treatments and remedies available.

Migraine Medications

• Preventative – Involves taking medications that will help prevent the onset of a migraine
• Abortive – Involves taking medications immediately after the onset of a headache

While preventative medication doesn’t typically eliminate the occurrence of headaches, it helps reduce the severity, frequency, and length of the condition.

Antidepressants, anti-seizure medications, and beta-blockers have been found effective to prevent the onset of migraines, especially with people who suffer from this condition frequently. Over-the-counter NSAIDs (non-steroidal anti-inflammatory drugs) such as Aleve or Naproxen may help relieve a sufferer’s moderate migraine. With severe migraines, triptans are usually prescribed to help with pain relief as well as the alleviation of nausea, light, and sound sensitivity. In some cases, a doctor may also recommend Botox. Regardless of the type of medication, make sure you consult with a doctor for your prescription. 

Neurostimulation Surgeries

For migraine sufferers who can’t find relief with medication, there is the option of neurostimulation surgery. It is generally not meant to be used as a first option or even for regular, routine migraine headaches but meant to be used as a worst-case scenario option. There are two main pathways for neurostimulation with headaches. The most common pathway is occipital nerve stimulation (ONS). The other pathway is

sphenopalatine ganglion stimulation (SPG) and involves a more complicated procedure.

Due to the complexity of the procedure, some researchers suggest that only migraine sufferers who experience daily migraine headaches in the last one to two years and have not responded positively to medication should be candidates for invasive neurostimulation procedures.

TMJD Treatments

In patients who present with comorbid migraines and TMD, both disorders should be treated together but separately. TMD treatment includes patient education, self-care, behavioral therapy, pharmacologic interventions, appliance therapy and physical therapies including trigger point injections and TMJ injection. 

Migraine Remedies

If you prefer to try some at-home remedies, here are a few things that can help relieve the pain from your migraine headaches:

• Massage your temples or scalp
• Turn off the lights and lie down in a dark, quiet room
• Place a cold or hot cloth behind your neck or over your forehead
• Drink a caffeinated beverage (in small amounts, caffeine can help alleviate migraine pain)

Remember, at the first sign of a migraine headache, be sure to stop what you’re doing and relax.

Vitamins and Supplements for Headache Treatment

For patients that would prefer a natural approach to treating migraine headaches, there are some alternative options like vitamins, minerals, supplements and enzymes. 

Vitamin B2

Also known as riboflavin is one of eight B vitamins that can help reduce the migraine frequency. The recommended dose is 200-400 mg daily.

Feverfew

Feverfew is a member of the daisy family and has been used for many decades to treat headaches. The recommended dose is 50-100 mg daily.

CoQ10 enzyme

CoQ10 enzyme acts as an antioxidant and has shown to help reduce the headache frequency. The recommended dose is 100-300 mg daily.

Magnesium 

Magnesium is a mineral that is crucial to nerve transmission. People with migraines may have lower levels of magnesium. The recommended dose is 400-800 mg daily.

Ginger

The root of ginger can be used to relieve nausea associated with migraine headaches.

The recommended dose is a quarter teaspoon of ginger powder mixed with water. Some patients find ginger candy effective.

Lavender oil

This essential oil is used to treat pain and boost mood. Lavender has soothing, calming and sedative effects. The recommended dose is two to four drops for every two or three cups of boiling water when inhaling; two to four drops without dilution when applying.

Different Causes of Migraines

Migraine causes can be the result of a combination of environmental, lifestyle, and genetic factors. 

Environmental Factors

Migraine sufferers often describe environmental factors as a cause of their headaches. Common environmental factors include bright light or sunlight, flickering lights, severe heat or any other type of extreme weather, changes in barometric pressure, or extreme stress. Other sufferers also have reported that unusual smells or smoke to be contributing factors. Some environmental aspects of indoor spaces and workplaces have also been reported to have contributed to migraine headaches.

Lifestyle Factors

Lifestyle factors can also cause migraine headaches. Commonly reported factors include intense physical activity, meal skipping, changes in sleep patterns, smoking, alcohol consumption, and traveling.

Genetic Factors

Differences in various genes are associated with the growth of migraines with or without aura. These genes likely have varying levels of impact among migraine sufferers. Most of the genes associated with migraines are active in the muscles that surround blood vessels in the brain. The genes help regulate blood flow by controlling the expansion and narrowing of blood vessels.  It’s likely that many variants disrupt blood flow in the brain which may contribute to migraine development. Variants in genes that regulate levels of the activity of certain nerve cells or glutamatde in the brain have been found in migraine sufferers.

TMJD

Although migraine pain is typically felt at the side of your head, the pain may actually start at the bottom of your skull. The temporomandibular joint (TMJ) is the hinge joint between your temporal bone and the lower jaw. Your TMJ allows you to chew, yawn, and speak. However, the joint’s supporting muscles may be a source of your migraines. It’s possible that the migraine pain could be a result from the muscles that move your jaw.

Medication Overuse

Excessive use of painkillers may also trigger migraines. Severe headaches may occur if you take ibuprofen (such as Advil or Motrin IB) or aspirin for more than 14 days. You may also suffer from migraines if you take triptans, rizatriptan (such as Maxalt or Maxalt-MLT), or sumatriptan (such as Imitrex or Tosymra) or for more than nine days each month. When the medications stop relieving pain and start to cause headaches, it’s a sign of medication overuse. People often will use more pain medication for relief which subsequently continues the medication use cycle

Different Migraine Triggers

Migraines can be triggered by hormonal, physical, emotional, environmental, and dietary triggers. Triggers will vary depending on the individual– it may help to keep a journal to try and identify a consistent trigger.

Hormonal changes

• Some women have reported having suffered from migraines around the time of their period.
• Migraine headaches typically occur between two days before the start of the period to three days after.
• Women who only experience migraines around the time of their period are said to suffer from pure menstrual migraine

Physical triggers

• Poor quality sleep
• Poor posture
• Strenuous exercise
• Shoulder or neck tension
• Low blood sugar
• Tiredness
• Jet lag

Emotional triggers

• Anxiety
• Stress
• Tension
• Shock
• Excitement
• Depression

Environmental triggers

• Loud noise
• Bright lights
• Smoke
• Strong smell
• Stuffy atmosphere
• Change in climate (such as humidity)
• Flickering screens (such as from a computer or television screen)
• Allergies

Dietary triggers

• Alcohol
• Chocolate
• Some fruits or nuts
• Monosodium glutamate (MSG)
• Caffeinated products (such as coffee or tea)
• Food containing tyramine (includes smoke fish, yeast extracts, cured meats, pickled herrings, or cheese)
• Missed, irregular, or delayed meals

In some cases, excessive use of pain relief medicine can also worsen or trigger migraine headaches.

Are Migraines Hereditary?

Although migraines may occur more frequently in some families, it’s difficult to track the specific genes related to this condition as migraine symptoms and triggers vary significantly among individuals.

Early epidemiology studies and research have suggested that migraines and aura migraines have their own hereditary characteristics.  

Here’s what one early study found when exploring family history:

• First-degree relatives of migraine without aura sufferers had a 1.9 times greater risk of developing migraines and a 1.4 greater risk of developing migraines with aura.
• First-degree relatives of aura migraine sufferers had almost four times the risk of suffering from aura migraines.
• First-degree relatives of individuals who did not suffer from migraines did not have an increased risk of migraine (with or without aura).

However, recent studies using Genome-Wide Association Study (GWAS), a gene-sequencing technology, helped researchers start to identify certain genes that may affect the development of migraines.

Migraine Symptoms

Symptoms of migraines can progress through four stages which include prodrome, aura, attack, and post-drome. It’s possible that suffering won’t necessarily go through all four stages.

Prodrome

About one to two days before the onset of a migraine, suffers may begin to notice subtle changes that serve as a warning sign which may include:

• Food cravings
• Fluid retention
• Stiffness in the neck
• Changes in mood
• Frequent yawning
• Increased urination
• Constipation

Aura

Some suffer may experience an aura during or before migraines. Migraines with aura are often described as a recurring headache that strikes at the same time or after sensory disturbances but can include other disturbances. Each symptom typically starts gradually and builds up over several minutes– which can last up to one hour. Common examples of migraine auras include:

• Loss of vision
• Difficulty speaking
• Tingling sensations (such as pins and needles) in the arm or leg
• Visual sensations such as seeing bright lights, blind spots, or shapes
• Numbness or weakness in one side of the body or the face

Attack

Left untreated, migraines can last anywhere from four to 72 hours. Migraines may occur several times per month or rarely occur at all. The frequency and duration of a migraine will vary from person to person. During an attack, suffers may experience:

• Nausea or vomiting
• Throbbing or pulsing pain
• Pain on both or one side of the head
• Sensitivity to sound, light, smell, or touch

Post-drome

Following a migraine attack, sufferers may feel tired and confused for up to one day. Some people have reported feeling delighted. However, sudden head movements may cause pain to temporarily reoccur.

Types of Migraine Pain

While each person experiences pain differently, migraines sufferers have described the pain as:

• Debilitating
• Throbbing
• Pulsating
• Pounding
• Throbbing

People have also said that it can feel like a severe, steady, and dull headache. They have described the pain to have started as mild but will progress to moderate or severe without treatment. Migraine pain generally affects the forehead and while it usually affects one side of the head, it’s possible to affect both sides.

Most migraine headaches last about four hours. Left untreated or if treatment doesn’t help, migraines can last from 72 hours and up to seven days.

Migraines and Nausea

More than half of migraine sufferers have reported nausea as a symptom. Many suffers also indicate that they experience vomiting. While these symptoms may start simultaneously with a headache, they usually start about one hour after the onset of headache pain.

Nausea and vomiting present their own unique set of challenges for sufferers. If you only experience nausea, you may take your regular migraine medications. However, vomiting may prevent you from taking or keeping the pills long enough in your body for you to feel the effects of the medication.

When to See a Doctor for Migraines

Migraines are frequently undiagnosed and untreated. If you repeatedly experience signs and symptoms of migraines, keep track of your attacks and how you treat them. Next, make an appointment with your doctor to discuss your migraine headaches so you can obtain proper treatment.

If you experience any of the following symptoms and signs, see a doctor or go to the emergency room immediately:

• A headache after a head injury
• A severe, abrupt headache
• New headache pain after age 50
• A lingering headache that worsens after exertion, coughing, straining, or sudden movements
• A headache with a stiff neck, fever, seizures, confusion, double vision, weakness, or numbness in any part of your body (this could be a sign of a stroke)

The signs and symptoms mentioned above could indicate a more serious medical problem so it’s advisable to seek medical help right away.

Migraine Prevention Methods

Those who have suffered migraine headaches know how painful and debilitating the experience can be. If you get migraines often or if you experience severe headaches, you’ll probably want to avoid them in the future. There are several ways to prevent migraines including the use of migraine medications and making lifestyle changes.

Migraine Medications

Preventative migraine medication can help you experience fewer migraines, make your headaches less severe, and help shorten the duration of your migraine headaches.

Preventative migraine medicine includes:

• Anti-seizure drugs – Blocks channels in the body that delivers electrical impulses to the brain, nerve, and muscle cells. Medications include valproic acid (Depakote or Depakene) and topiramate (Topamax).
• Antidepressants – May help prevent migraines by maintaining a healthy level of serotonin which may be linked to migraines. Medications such as venlafaxine and amitriptyline can help prevent migraine headaches.
• Beta-blockers – Typically treat heart disease and high blood pressure but can also help prevent migraines. Medications include metoprolol (Lopressor or Toprol XL), propranolol (Inderal or Innopran XL), and timolol (Blocadren).
• Botulinum toxin (Botox) – Commonly used to treat wrinkles, this medication can also help sufferers with chronic migraines (people who experience migraines at least 15 days a month). It’s also beneficial for people who suffer from long-lasting migraines which last four or more hours. Doctors believe that botulinum toxin helps by preventing the brain from producing chemicals the body uses to send pain signals.
• CGRP inhibitors – Calcitonin gene-related peptide (CGRP) inhibitors are a new type of medication approved by the Food and Drug Administration (FDA) to prevent and treat migraine headaches. CGRP is a molecule found to have played a role in causing migraine pain. CGRP inhibitors help by blocking the effects of CGRP. The medication must be injected once per month with a pen-like device. The most common side effects are redness at the injection site and mild pain. Drugs include eptinezumab (Vyepti), erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality).
• Triptans for menstrual-related migraines – These types of drugs help relieve migraine pain once it’s already started. However, frovatriptan (Frova) may help prevent migraine headaches with women who suffer from it due to their menstrual cycle. Triptans affect serotonin levels which may also help relieve pain in various ways.

You may want to consider taking preventative medications if you have four or more migraines each month. If the drugs you’re currently taking to relieve migraines don’t help or if you experience bad side effects, a preventative medication may be a good option for you.

Lifestyle Changes That Help Reduce Migraines

Your daily habits can greatly help to reduce the frequency and severity of migraines. Some helpful lifestyle habits for migraine relief you may want to consider include getting quality sleep, exercising regularly, eating meals regularly, and limiting stress.

Getting Quality Sleep

A poor night’s sleep can trigger a migraine. Help prevent the onset of migraines by following these tips for a good night sleep:

• Unwind before bed – Do something that helps you relax such as reading your favorite book, listening to soothing music, or soaking in a warm bath.
• Put down your electronics devices – Stop using your cellphone, laptop, or other electronic devices at least 30 minutes before bedtime. Studies show that these devices can negatively affect your sleep by suppressing the production of melatonin, a hormone released in the evening that helps you feel tired and ready for sleep.
• Establish a regular sleep routine – Sleeping and waking up at the same time every day (even on weekends) can help you sleep better. If you nap during the day, make sure it’s no more than 30 minutes or it can interfere with your ability to fall asleep at night.
• If you can’t sleep, get out of bed – Sometimes trying to force yourself to sleep just makes it worse. If you can’t fall asleep, get out of bed to read or talk a short walk until you feel tired enough for bed.
• Avoid caffeine – Depending on the amount, caffeine before bed can significantly disrupt sleep. Sources of caffeine include but are not limited to coffee, tea, soda, and energy drinks. Some medications also have caffeine and may affect your sleep quality.

Exercising Regularly

Regular physical activity can help reduce the intensity and frequency of migraines. While exercising, your body releases endorphins– the body’s natural painkillers. Exercise not only helps reduce stress but also helps you sleep better at night. Poor quality sleep and stress are two of the most common migraine triggers.

Obesity increases the risk of chronic migraine headaches and exercising can help with maintaining a healthy weight. Some good options for exercising include:

• Walking
• Jogging
• Running
• Cycling
• Swimming
• Any other physical activity you may enjoy

Build your stamina gradually and try to avoid intense or vigorous physical activity as it may trigger migraines. Also, be sure you stay hydrated before, during, and after your workout. Migraine sufferers may experience an attack if they’re dehydrated.

Eating Regular Meals

Eating habits can affect your migraines. Here are some healthy eating habits that can help you prevent or reduce the frequency of migraines:

• Don’t skip meals – When your body goes for long periods without food, the risk of a migraine increases.
• Establish a regular eating routine – Eat around the same time each day.
• Keep a food journal – Track the food you eat and when you experience a migraine to help identify potential food triggers.
• Avoid food that triggers your migraines – Certain foods and drinks such as caffeine, alcohol, chocolate, and aged cheese can trigger migraine headaches. If you suspect it triggers your migraines, remove it from your diet and see if it helps.

Managing Stress

Many sufferers have reported that stress triggers or makes their migraines worse. While everyone experiences stress, here are a few helpful ways to help you manage it:

• Do deep breathing exercises – Breathe breathing is one of the best ways to reduce stress. When you breathe deeply, it sends a supply of oxygen to your brain which promotes a state of calmness.
• Take a break – When you feel tired or overwhelmed, stop what you’re doing and take a break. Stretch or go for a quick walk so you can come back re-energized.
• Make time for hobbies – Set aside time to do things you enjoy. Even if it’s just 10 to 20 minutes a day, doing something that makes you feel good can help manage your stress level.
• Think positively – Avoid negative self-talk. Positive thinking can help reduce your stress level, help you feel better about your situation, and improve your overall outlook on life.

You may also want to try complementary techniques by combining medication with acupuncture, massage, or talk therapy.

Call an Experienced Migraine Doctor Today to Schedule an Appointment

If you or a loved one is dealing with migraines, call the Headache TMJ Los Angeles Pain Clinic to have a consultation to determine the best strategy to treat your muscle pain. Call (310) 422-4246 today to schedule an appointment so Dr Kathy Omrani can help identify the problem and provide an effective treatment solution.