A woman aged 56 visited the Samaritan House Clinic, where I work as a volunteer internist and was complaining of frequent headaches. I first thought she was suffering from migraines.
My experience has shown me that my experience is that migraine headaches tend to be the most common reason for severe headaches. While they are most prevalent in people between the ages of 18 and 44 old, they can occur at any time in the course of life. As per the National Institutes of Health, migraines are twice as common for women than men and be more prevalent in populations with lower socioeconomic status.
Migraine headaches are believed to be the result of genetic brain mutations. Patients report migraines as throbbing, painful headaches typically in one part of the head. These could last for anywhere between 4 and 72 hours. They can be enough severe that one might not be able to carry out the normal activities of daily life. Other signs could include vomiting, nausea and the sensitivity to light.
The three major kinds of migraines that include migraine that has aura in which indications such as flashing lights appear prior to the headache onset migraine without aura that is a condition without specific warning signals which is by far the most prevalent kind and the silent migraine in which the aura or other symptoms like flashing lights or nausea can occur, but without headache.
What triggers can cause migraine? In an investigation of retrospectively 1,750 patients suffering from migraines in the journal Cephalgia 76% of them reported that they had at least one trigger which included emotional stress (80 percent) hormones in women (65 percent) and not eating (57 percent) weather (53 percent) sleep disturbances (50 percent) and odors (44 percent) and neck pain (38 percent) Lights (38 percent) and alcohol (38 percent) smoking (36 percent) sleep late (32 percent) and heat (30 percent) food (27 percent) and exercise (22 percentage) and sexual activities (5 percent). I counsel that my patients suffering from migraine keep a migraine journal to track the triggers that cause them.
The most important factors to determine the cause are an exhaustive health history and neurologic examination. The indicators that trigger me to schedule a brain scan to rule out other causes that could be more severe for headache are the complaint of “the most painful headache I’ve experienced” A increase in the intensity or frequency of headaches and new neurological findings; headaches unresponsive to treatment that always occur in the exact same direction new-onset headaches at the age of 50 or new headaches for patients who have cancer history; or headaches caused by symptoms of stiff neck, fever and changes in behavior. memory loss. If patients don’t exhibit any of these symptoms or warning signs I assure them that they don’t require a scan of the brain.
The majority of migraine headaches are treated with prescription medicines. The treatment can be more effective when it is administered early during the course of the headache. Additionally, a single dose of medicine is likely to be more effective than smaller frequent doses. The prescription migraine medication is accessible for those who aren’t responding well to OTC medicine. It is recommended to consider non-oral medicines for those suffering from nausea as well as vomiting. There are also medications to treat migraine headaches.
One of the things I emphasize to my clients is that they should be mindful of the possibility of medication-overuse headaches, which is headaches result from taking pain relievers, frequently. Neurologist Dr. Scott Abramson shared that during his 40 years in practice, he had at most one of these patients each day where the diagnosis was not recognized by the doctor who was referring the patient. Dr. Abramson explained that all it takes to get one in an analgesic relapse condition is to apply any painkiller, like Tylenol or Advil for 15 days per month over the duration of 3 years or greater.
Let’s go back the patient. Her neurological and physical exams were all normal, which allowed my to eliminate significant causes for headaches. Since her headaches were associated with nausea and other visual symptoms I identified migraine as the reason for her issue.
There were three factors that contributed in the cause of her headaches: (1) She experienced a lot of emotional stress due to her lifestyle; (2) she took cocaine and had at minimum 6 shots of whiskey each time she went to bar (alcohol or cocaine could trigger headaches directly or via withdrawal); (3) she often had to refill the beta-blocker medication metoprolol that reduces hypertension and helps prevent migraine headaches.
She was happy to understand the probable cause to her headaches and was pleased with the recommendations for treatment.
Miflars are painful but, with the right education and the usage of medications they can be successfully treated.
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