Wednesday, December 12, 2018
Wisdom Wednesday: Migraine Headaches (Part 1)
Migraine is a common disabling primary headache disorder. Many epidemiological studies have documented its high prevalence and socio-economic and personal impacts. In the Global Burden of Disease Study2010 (GBD2010), it was ranked as the third most prevalent disorder in the world. In GBD2015, it was ranked third–highest cause of disability worldwide in both males and females under the age of 50 years.
Migraine has two major types: Migraine without aura is a clinical syndrome characterized by headache with specific features and associated symptoms. Migraine with aura is primarily characterized by the transient focal neurological symptoms that usually precede or sometimes accompany the headache.
This week we will focus on migraine without aura. Previously, called a common migraine, it is a recurrent headache disorder manifesting in attacks lasting 4-72 hours. Typical characteristics of the headache are unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity and association with nausea and/or sensitivity to light and sound.
Diagnosis requires a history of at least 5 attacks, lasting 4-72 hours with a least two of the following: unilateral location, pulsating quality, moderate or severe pain, or aggravation by routine physical activity. During the headaches the patient must exhibit nausea and/or vomiting or light and sound sensitivity.
Migraine headache in children and adolescents (aged under 18 years) is more often bilateral than is the case in adults; unilateral pain usually emerges in late adolescence or early adult life. Migraine without aura often has a menstrual relationship. Very frequent migraine attacks are now distinguished as a Chronic migraine. When there is associated medication overuse, both diagnoses, Chronic migraine and Medication-overuse headache, should be applied. Migraine without aura is the disease most prone to accelerate with frequent use of symptomatic medication.
While the disease was previously regarded as primarily vascular, the importance of sensitization of pain pathways, and the possibility that attacks may originate in the central nervous system, have gained increasing attention over the last decades. It is now clear that migraine without aura is a neurobiological disorder; clinical as well as basic neuroscience has advanced our knowledge of migraine mechanisms, and continues to do so.
I “dummied down” this information from the International Classification of Headache Disorders 3rd Edition published earlier this year. The classification of headaches began 30 years ago with the 1st Edition.
Clinically, I see this type of migraine headache quite frequently. Unfortunately, these patients all too often have become chronic migraine patients from over medication as noted above. I also agree that it is a neurobiological disorder and often is associated with hormone fluctuation during the menstrual cycle.
Migraine headaches without aura readily respond to nutritional support, especially if has not become chronic from over medication. Bio-available vitamin B12 and vitamin D are often helpful but balancing the endocrine system with herbal support is the real key to prevention. Chaste tree, Bacopa, Ashwaganda and other adrenal adaptogens are often needed to resolve these headaches.
Source: Cephalalgia 2018
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