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Posted on 07-20-2017

Chronic migraines ? What to do ?

In the United States alone it is estimated that more than 37 million people suffer from migraines. Some migraine studies estimate that as many as  13 percent of adults in the U.S. population have migraines with up to 3 million of them suffering from chronic migraines.

The International Headache Society defines chronic migraine as more than fifteen headache days per month over a three month period of which more than eight are migrainous, in the absence of medication over use. Episodic migraine is the other migraine sub-type, which is defined as less than 15 headache days per month.

What is a migraine ?
 A  migraine can cause severe unilateral (one side of the head) throbbing pain or a pulsing sensation. It's often accompanied by symptoms including nausea, vomiting, and extreme sensitivity to light (photophobia ) and sound. The migraine attacks can cause severe, significant, disabling pain sometimes lasting for hours to days in duration.   
Warning symptoms known as aura may occur before or with the headache. These can include flashes of light, blind spots, or tingling on one side of the face or in your arm or leg.
A migraine usually lasts from four to 72 hours if untreated. The frequency with which headaches occur varies from person to person. Migraines may be rare, or strike several times a month. During a migraine, you may experience:
•    Pain on one side or both sides of your head
•    Pain that feels throbbing or pulsing

•    Sensitivity to light, sounds, and sometimes smells and touch
•    Nausea and vomiting
•    Blurred vision
•    Lightheadedness, sometimes followed by fainting
Causes of migraines 

Though migraine causes aren't understood, genetics and environmental factors appear to play a role.Migraines are thought to be caused by changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway. 
Migraine triggers
A number of factors may trigger migraines, including:
•    Hormonal changes in women. Fluctuations in estrogen seem to trigger headaches in many women. 
•    Foods. Aged cheeses, salty foods and processed foods may trigger migraines. Skipping meals or fasting also can trigger attacks.
•    Food additives. The sweetener aspartame and the preservative monosodium glutamate (MSG), found in many foods, may trigger migraines.
•    Drinks. Alcohol, especially wine, and highly caffeinated beverages may trigger migraines.
•    Stress. Stress at work or home can cause migraines.
•    Sensory stimuli. Bright lights and sun glare can induce migraines, as can loud sounds. Strong smells — including perfume, paint thinner, secondhand smoke and others — can trigger migraines in some people.
•    Changes in wake-sleep pattern. Missing sleep or getting too much sleep may trigger migraines in some people, as can jet lag.
•    Physical factors. Intense physical exertion, including sexual activity, may provoke migraines.
•    Changes in the environment. A change of weather or barometric pressure can prompt a migraine.
•    Medications. Oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines.

Treatment and their potential cOmplications and side effects 
•    Abdominal problems. Certain pain relievers called nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others), may cause abdominal pain, bleeding, ulcers and other complications, especially if taken in large doses or for a long period of time. 
•    Medication-overuse headaches. Taking over-the-counter or prescription headache medications more than 10 days a month for three months or in high doses may trigger serious medication-overuse headaches.
•    Serotonin syndrome. Serotonin syndrome is a rare, potentially life-threatening condition that occurs when your body has too much of the nervous system chemical called serotonin.
•    Rashes, welts,  asthma symptoms ,  dizziness  and more complicated disorders  neurological such as ALS/ Lou Gehrig disease, Myasthenia Gravis, and Lambert-Eaton syndrome as potential side effects of treatments such as Botox 
Experts  recommend  avoiding common migraine triggers as a first round of prevention. Sometimes however triggers can't be avoided. Here are some other potential  lifestyle changes and coping strategies may help you reduce the number and severity of your migraines:
•    Chiropractic care – yes , studies support the use of chiropractic care to treat migraines . https://www.ncbi.nlm.nih.gov/pubmed/21640251.

•    Learn to cope. Recent research shows that a strategy called learning to cope (LTC) may help prevent migraines. In this practice, you are gradually exposed to headache triggers to help desensitize you to them. LTC may also be combined with cognitive behavioral therapy. More research is needed to better understand the effectiveness of LTC.
•    Create a consistent daily schedule. Establish a daily routine with regular sleep patterns and regular meals. In addition, try to control stress.
•    Exercise regularly. Regular aerobic exercise reduces tension and can help prevent migraines. If your doctor agrees, choose any aerobic exercise you enjoy, including walking, swimming and cycling. Warm up slowly, however, because sudden, intense exercise can cause headaches. Regular exercise can also help you lose weight or maintain a healthy body weight, and obesity is thought to be a factor in migraines.
•    Reduce the effects of estrogen. If you are a woman who has migraines and estrogen seems to trigger or make your headaches worse, you may want to avoid or reduce the medications you take that contain estrogen.
In closing 
Allow me the chance to vent at this point . My irritation is not directed at anyone in particular. It is however aggravating for me to see a few points that no one ever seems to recognize when dealing with migraines , in particular  chronic migraines. 
Point  one- the absolute ridiculousness of the above photo “borrowed” from the makers of Botox , one the newest and fastest growing treatment option for chronic migraine headaches. 
Can you see how what I see? If not,  let me help. 
Remember , Botox is marketed to treat chronic migraines, or migraines that appear 15 plus days a month.  On first glance at the literature to the right of the adorable pug , it states that Botox prevents on average 8 or 9 of these ….sounds great rights . Botox has saved me from 8 or maybe 9 of my 15 or more migraines ….what a godsend! That’s an effectiveness of reducing roughly 60% (9/15) of the months headaches. So what’s  my problem with this picture you may ask. 

My problem is in clear print (in parentheses ). “ As compared to 6 or 7 versus placebo”. 
This means that a placebo, a sugar pill, reduced the amount of migraine headaches as much as 7 days of the 15. This accounts to be an effectiveness of almost 48% for a sugar pill. This ultimately means that on average Botox can save you ONE , yes ONE , migraine a month. An effectiveness of 1/15 or 6%. 
This leads to point 2:
Why would anyone even consider this ineffective treatment if one considers the next slides ( again “borrowed “ from the makers of Botox . 

Yeah that’s right for an effectiveness of 6% , you can potentially even afflicted with rashes, dizziness, welts and potentially Lou Gehrig’s disease. 

Now I completely understand the devastation caused by chronic migraines. If all else fails in treatments and prevention it MAY potentially be an option . However this leads me to my last point of irritation. (And I am sue we are all grateful ) . Most healthcare providers , most websites , most health advisors  rarely if ever recommend what is often considered an effective treatment , namely chiropractic care. 
According to the American chiropractic association, “ Chiropractic is widely recognized as one of the safest drug-free, non-invasive therapies available for the treatment of neuromusculoskeletal complaints. ... Neck manipulation, when performed by a skilled and well-educated professional such as a doctor of chiropractic, is a remarkably safe procedure”.
So is it safe , Yes. One of the safest forms of health care available. Is it effective for migraines ? Well that is another yes according to the experts( check out a few of the provided the links below ) 
- https://www.ncbi.nlm.nih.gov/pubmed/21640251
- https://www.ncbi.nlm.nih.gov/pubmed/22014909
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2051091/

Dr Ray Gaskey 
Bradford Family Chiropractic in Marietta , Ga 

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