Migraine headaches are a specific type of headaches, which are caused by a group of nerve cells at the base of the brain producing chemicals that affect blood vessels causing them to be inflamed and dilate producing the headache. The headache is typically described as a throbbing, pulsating, commonly on one side of the headache and typically associated with sensitivity to light and noise, nausea, and vomiting.
The two major types of migraine headaches are the common and classic migraines. Classic migraine is usually preceded by an aura (a group of symptoms (commonly visual) that precede the headache). The typical visual changes the patients describe are flashes of light, zigzag lines, floaters, and occasionally tunnel vision. The aura is felt right prior to the headache, or several hours before. Common migraine is not preceded by an aura. However, the headache symptoms are the same as the classic one.
There are also different types of unusual migraines such as complex migraine where the patient experiences stroke like symptoms (numbness, tingling sensation, weakness, and slurred speech). Another type of migraine is basilar migraine, where the basilar artery is involved at the base of the brain producing a very unique symptoms. Typical symptoms include dizziness, vertigo, nausea, vomiting, altered mental status, gait disturbance and other symptoms.
Migraine headaches are more common in females. Although there is no genetic link identified, typically run in families. It can involve patients at any age; however, commonly in the late 20s to 30s. In certain cases migraine headaches can present as early as two years of age.
There are two types of treatment for migraine headache:
In abortive therapy, the focus is on giving a medication that stops the migraine attack. The classic class of medications used for abortive therapy is the Triptans including Imitrex, Maxalt, Zomig, Relpax, Axert, and Treximet. Other abortive therapies include Acetaminophen, Ibuprofen, naproxen, butalbital with or without codeine and Aspirin. The key in aborting migraine headaches is to take the medication early at the onset of the headache. The longer the patient waits to take the medication, the more difficult it is to stop it.
Migraine prophylactic therapy (a medication that is taken on daily basis to prevent the headache) decreases the intensity and frequency of the headaches. The typical recommendation for taking prophylactic therapy is for patients with more than three headaches a month, a headache that lasts more than 24 hours, or a headache that interferes with the activities of daily living.
Common prophylactic medications for migraine headaches include Topramate, Propranolol, nortriptyline, amitriptyline, Cymbalta, Effexor, Lyrica, Neurontin, and rarely, Keppra.
Interventional procedures are also used to treat migraine headaches. These include sphenopalatine ganglion block, occipital nerve block, dorsal median branch block of the upper cervical spine followed by radiofrequency, stellate ganglion block, and also Botox injection. We have had good success with electrical anesthesia where small pads are placed in the back of the head over the occipital nerves and we send high frequency electrical impulses to stimulate the occipital nerves.