Migraines

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Migraines

• Adam Smith

2
Migraine Defined

• Migraine Disorder where frequent extreme
  headaches can occur from a few times in a
  lifetime to almost every day.
• Average occurrence is 1-3 times per month
• Associated with
• nausea
• blurred vision
• Extreme headacheusually isolated to one side of
  the head
• Sensitivity to light and sound

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Phases

• Prodromal Phase Anytime from a few hours to a
  few days before the headache. Does not occur in
  all cases.
• Aura Phase Comes just before the headache.
  Does not occur in all people
• Headache Phase Excruciating pain(Maybe)
• Postdromal Phase After the pain phase.
  Sufferers can still feel ill and fatigued but
  some feel well rested and even euphoric.

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Triggers

• Commonly, factors known as triggers can cause a
  headache and may include
• Food specific to a person
• Weather high humidity with extreme
  temperatures. Chinook winds in Canada.
• Stress

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Prodrome

• Occurs in about half of people who have migraines
• Symptoms are specific and usually consistent to
  an individual. They may include
• Altered mood
• Irritability
• Depression
• Euphoria
• Fatigue

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More Prodromal Symptoms

• Yawning
• Food Cravings
• Stiff Muscles
• Constipation
• Diarrhea
• Increased Urination
• Can be considered the 'warning phase'

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Aura Phase

• The Aura Phase occurs just before the headache
  phase.
• Includes many types of sensations and
  hallucinations.
• Occurs in less than 1/3 of migraine sufferers.

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Visual Aura

• Most common of Aural events
• Include
• Flashes of white light
• Photopsia Flashes of colored light
• Fortification Spectra lines that look like the
  battlements of a castle
• Tunnel vision
• Blurred or cloudy vision

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Somatosensory Aura

• Pins and needle feeling begins in a hand or arm
  and then spreads to the face
• Vertigo
• Aphasia - Inability to understand language
• Touch Sensitivity

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Other hallucinations

• Auditory
• Olfactory

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The Pain Phase

• The pain phase usually begins about 1 hour from
  the end of the aura phase, if one is present.
• Pain can be unilateral or bilateral and will
  usually change
• Unilateral pain will usually switch sides from
  migraine to migraine
• Slow increase in pain and then a slow decrease
• Lasts 4-72 hours in adults and 1-48 hours in
  children

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The Pain Phase continued

• Most people do not eat and experience nausea but
  only 1\3 experience vomiting
• During the pain phase most people are
  hypersensitive to light, smell, and sound and
  will occupy a dark quiet place for the duration
  of this phase.
• Signs of illness such as cold clammy extremities,
  sweating, diarrhea, nasal discharge and
  congestion, sore muscles, blurred vision, fever,
  and lightheadedness have been seen.

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Postdrome phase

• During this phase the victim of the migraine may
  feel many of the symptoms of the pain phase to a
  lesser degree as they recover.
• In some cases, people have reported that they
  feel euphoric and energized afterward.

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Treatments

• Avoid Triggers people report success but it
  hasn't been proven.
• Treat Symptoms Home remedies or medication
• Preventative Drugs many different variations

• Symptoms and treatments vary greatly, increasing
  the difficulty to perform research and to develop
  treatments.

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Phsyiology

• Two different theories...

1. Vasodilation Migraines are caused by the
dilation of blood vessels in the brain. These
dilated blood vessels fill with blood and this
swelling causes the pain. 2. Neuronal
Migraines are caused by the trigeminal nerve and
cortical spreading depression.
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Vasodilation

• Vasodilation the increase of the diameter of
  the blood vessels. The dilation of the
  superficial cranial arteries is believed to cause
  migraine.
• The increased dilation of the blood vessels in
  the brain cause pressure on the brain and the
  throbbing pain is a result of that pressure.
• As the dilation spreads across the brain, the
  pain also spreads.

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Vasodilation studies

• Sargent et al. 1972
• Treated 62 migraine patients using biofeedback
  for warming the hands.
• 74 showed improvement
• Theory Warming the hands relaxes the parts of
  the sympathetic nervous system that controls the
  blood flow to the hands. This increases blood
  flow. This relaxation of the SNS is then assumed
  to spread to other parts of the body, including
  the head, increasing blood flow and thus
  alleviating the migraine

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Another Study

• Blanchard, Theobald, Silver, Williamson, and
  Brown. 1978
• Three groups 1. Skin temp. BFT and relaxation
• 2. Relaxation only
• 3. No treatment
• Both of the treatment groups saw improvement.
  There was no correlation between expectancy and
  effectiveness of treatment.

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Cooling vs Warming

• Blanchard et al., 1997
• 4 groups
• 1. Stabilize Temperature
• 2. Hand Warming
• 3. Hand Cooling
• 4. Suppress Alpha in EEG
• All but group 1 showed improvement and groups 2
  and 3 lessened medication.

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Another Test

• Gauthier et al. 1983
• Suggested that BFT for vasoconstriction would
  alleviate migraines better than BFT for
  vasodilation
• Results showed that both vasodilation and
  constriction showed same improvements, while the
  control showed no change.
• Gauthier theorized that both groups allowed for
  greater regulation of vasomotor activity, which
  decreased the variability of vessel dilation
• Low variability correlates with less migraines

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Neuronal model

• Cortical Spreading Depression
• Functioning in the cortex is depressed which
  leads to the release of inflammatory mediators.
• These inflammatory mediators irritate the
  trigeminal nerve.

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New Theory

• Schwerzmann M, Wiher S, Nedeltchev K, Mattle HP,
  Wahl A, Seiler C, Meier B, Windecker S. 2004
• Migraines may also be caused by a lack of oxygen
  due to a patent foramen ovale.
• Needs more research

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Conclusion Haiku

• Inconclusive tests.
• Migraines are hard to study.
• Interlinked theories.

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References

• Holzhammer J, Wober C (2006). "Alimentary
  trigger factors that provoke migraine and
  tension-type headache". Schmerz 20 (2) 151-9
• Low Tyramine Headache Diet (116 Kb PDF) pp. 2.
  National Headache Foundation (October 2004).
  Retrieved on 2006-10-12.
• Prince PB, Rapoport AM, Sheftell FD, Tepper SJ,
  Bigal ME (2004). "The effect of weather on
  headache". Headache 44 (6) 596-602.
• Cooke LJ, Rose MS, Becker WJ (2000). "Chinook
  winds and migraine headache". Neurology 54 (2)
  302-7
• Schwerzmann M, Wiher S, Nedeltchev K, Mattle HP,
  Wahl A, Seiler C, Meier B, Windecker S (2004).
  "Percutaneous closure of patent foramen ovale
  reduces the frequency of migraine attacks".
  Neurology 62 (8) 1399-401
• Young, William B. and Silberstein, Stephen D.,
  Migraine and Other Headaches. St. Paul, Minn AAN
  Press, 2004.
• Evans, Randolph W., MD, and Matthew, Ninan T.,
  MD. Handbook of Headache, Second Edition.
  Philadelphia Lippincott Williams Wilkins.
  2005.
• Silberstein, Stephen D. Lipton, Richard B.
  Goadsby, Peter J. Headache in Clinical Practice
  Second Edition. Andover Thomson Publishing
  Services. 2002.