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Migraine



Learning about migraine disorder can be intimidating. Amaal Starling, M.D., a neurologist at Mayo Clinic, walks you through the facts, the questions, and the answers to help you better understand this condition.




migraine



Hi, I'm Dr. Amaal Starling, a neurologist at Mayo Clinic specializing in headache disorders. In this video, we will cover the basics of migraine. What is it? Who gets it, the symptoms, the diagnosis, and most importantly, the treatment. Whether you're looking for answers for yourself or someone you love, we are here to give you the best information available. There is a lot of stigma around migraine. That it's just a headache and that it's no big deal. But migraine is a genetic neurologic disease. It affects each person differently with a wide range of disease severity. Some have infrequent attacks, but others may have frequent disabling attacks. Expecting someone to push through or just take your mind off of it is never good advice.


Migraine is very common, affecting one in five women, one in 16 men, and even one in 11 children. Migraine attacks are three times more prevalent in women, likely as a result of hormonal differences. Certainly genetic and environmental factors play a role in the development of migraine disease. And since it is genetic, it is hereditary. Meaning if a parent has migraine, there's about a 50 percent chance that a child may develop migraine as well. If you have migraine, certain factors can trigger an attack. However, this does not mean that if you get a migraine attack, that it's their fault, that you should feel any guilt or shame for your symptoms. Hormonal changes, specifically fluctuations and estrogen that can occur during menstrual periods, pregnancy and perimenopause can trigger a migraine attack. Other known triggers include certain medications, drinking alcohol, especially red wine, drinking too much caffeine, stress. Sensory stimulation such as bright lights or strong smells. Sleep changes, weather changes, skipping meals or even certain foods like aged cheeses and processed foods.


The most common symptom of migraine is the intense throbbing head pain. This pain can be so severe that it interferes with your day-to-day activities. It can also be accompanied by nausea and vomiting, as well as sensitivity to light and sound. However, a migraine can look very different from one person to another. Some people may get prodrome symptoms, the beginning of a migraine attack. These can be subtle warnings such as constipation, mood changes, food cravings, neck stiffness, increased urination, or even frequent yawning. Sometimes people may not even realize that these are warning signs of a migraine attack. In about a third of people living with migraine, aura might occur before or even during a migraine attack. Aura is the term that we use for these temporary reversible neurologic symptoms. They're usually visual, but they can include other neurologic symptoms as well. They typically built up over several minutes and they can last for up to an hour. Examples of migraine aura include visual phenomena such as seeing geometric shapes or bright spots, or flashing lights, or even loss of vision. Some people may develop numbness or a pins and needles sensation on one side of their face or body, or even difficulty speaking. At the end of a migraine attack, you might feel drained, confused, or washed out for up to a day. This is called the post-drome phase.


Migraine is a clinical diagnosis. That means the diagnosis is based on the symptoms reported by the patient. There is no lab test or imaging study that can rule in or rule out migraine. Based on screening diagnostic criteria, if you have the symptoms of headache associated with sensitivity to light, a decrease in function and nausea, you likely have migraine. Please see your healthcare professional for the possible diagnosis of migraine and migraine specific treatment.


Because there is such a wide spectrum of disease severity with migraine, there's also a wide spectrum of management plans. Some people need what we call an acute or a rescue treatment for infrequent migraine attacks. Whereas other people need both an acute and a preventive treatment plan. Preventive treatment reduces the frequency and severity of migraine attacks. It might be a daily oral medication, a monthly injection, or even injections and infusions that are delivered once every three months. The right medications combined with lifestyle changes can be helpful to improve the lives of those living with migraine. There are ways to manage and minimize the triggers of migraine using the SEEDS method. The S is for sleep. Improve your sleep routine by sticking to a specific schedule, reducing screens and distractions at night. E is for exercise. Start small, even five minutes once a week and slowly increase the duration and frequency to make it a habit. And stick to movement and activities that you enjoy. E is for eat healthy, well-balanced meals at least three times a day and stay hydrated. The D is for diary. Track your migraine days and symptoms in a diary. Use a calendar, an agenda, or an app. Bring that diary with you to your follow-up appointments with your doctor to review. The S is for stress management to help manage migraine attacks triggered by stress. Consider therapy, mindfulness, biofeedback, and other relaxation techniques that work for you.


Migraine attacks can be disabling, but there are ways to manage the disease and to empower yourself to get the care and the support that you need. First. We need to end the stigma around migraine. It is not just a headache, it is a genetic neurologic disease. Next, talk to your healthcare professional about your symptoms. Eradicate the words "I'm fine" from your vocabulary and be honest with your healthcare professional, your employer, your loved ones, about how you're feeling as well as the kind of support that you need. Make yourself a top priority when you're having a migraine attack and reduce the likelihood of attacks through lifestyle adjustments. Have a consistent schedule, get adequate sleep, and learn strategies to cope with the stresses of life using mindfulness and meditation. Empower yourself to manage migraine with lifestyle changes and migraine specific treatment options. Together you and your doctor can manage the disease of migraine. If you'd like to learn more about migraine, watch or other related videos or visit mayoclinic.org. We wish you well.


A migraine is a headache that can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. It's often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can last for hours to days, and the pain can be so severe that it interferes with your daily activities.


For some people, an aura might occur before or during migraines. Auras are reversible symptoms of the nervous system. They're usually visual but can also include other disturbances. Each symptom usually begins gradually, builds up over several minutes and can last up to 60 minutes.


Migraines are often undiagnosed and untreated. If you regularly have signs and symptoms of migraine, keep a record of your attacks and how you treated them. Then make an appointment with your doctor to discuss your headaches.


A migraine headache often begins as a dull ache and grows into throbbing pain. It usually gets worse during physical activity. The pain can move from one side of your head to the other, can be in the front of your head, or can feel like it's affecting your entire head.


Current thinking is that a migraine likely starts when overactive nerve cells send out signals that trigger your trigeminal nerve, which gives sensation to your head and face. This cues your body to release chemicals like serotonin and calcitonin gene-related peptide (CGRP). CGRP makes blood vessels in the lining of your brain swell. Then, neurotransmitters cause inflammation and pain.


Episodic migraine means you get migraine now and then. High-frequency episodic migraine means you have eight to 14 migraine headache days per month. This condition also makes you more likely than others to develop chronic migraine.


Some new devices can also prevent migraine. Cefaly is a headband-like gadget that sends electrical pulses through the skin of your forehead. It affects your trigeminal nerve, which is linked with migraine headaches. You use Cefaly once a day for 20 minutes. When it's on, you'll feel a tingling or massaging sensation. Another stimulator, gammaCore, sends out a mild electrical signal to the fibers of the vagus nerve in your neck to relieve pain and help prevent migraine.


Migraines are more common in the morning; people often wake up with them. Some people have migraines at predictable times, such as before menstruation or on weekends following a stressful week of work.


Certain natural treatments, such as riboflavin (vitamin B2) and coenzyme Q10, may help prevent migraines. If your magnesium level is low, you can try taking magnesium. There is also an herb, butterbur, which some people take to prevent migraines. But butterbur may not be safe for long-term use. Always check with your health care provider before taking any supplements.


An aura is a group of sensory, motor and speech symptoms that usually act like warning signals that a migraine headache is about to begin. Commonly misinterpreted as a seizure or stroke, it typically happens before the headache pain, but can sometimes appear during or even after. An aura can last from 10 to 60 minutes. About 15% to 20% of people who experience migraines have auras.


Migraines tend to run in families. As many as four out of five people with migraines have a family history. If one parent has a history of migraines, their child has a 50% chance of having them. If both parents have a history of migraines, the risk jumps to 75%. Again, up to 80% of people with migraines have a first-degree relative with the disease.


Over-the-counter medications are effective for some people with mild to moderate migraines. The main ingredients in pain relieving medications are ibuprofen, aspirin, acetaminophen, naproxen and caffeine.


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