How Are Headaches Treated
Provided one of the serious conditions noted above is not present, relatively simple treatment options can be considered. To treat symptoms and prevent the frequency and severity of headaches, physicians may try to identify headache “triggers,” such as stress or certain foods, and recommend treatment options including:
- preventive medications and treatments.
- lifestyle changes, including stress management and relaxation techniques.
- pain-relieving medication, such as acetaminophen;or ibuprofen. Children and adolescents should avoid taking aspirin. In rare cases, aspirin;can cause Reye Syndrome, a serious and potentially fatal condition.
If your headache is the result of an underlying medical condition or injury, your physician will discuss treatment options with you.
Who Gets Migraines What Are The Risk Factors
Its difficult to predict who may get a migraine and who may not, but there are risk factors that may make you more vulnerable. These risk factors include:
- Genetics: Up to 80% of people who get migraine headaches have a first-degree relative with the disease.
- Gender. Migraine headaches happen to women more than men, especially women between the ages of 15 and 55. Its likely more common in women because of the influence of hormones.
- Stress level. You may get migraines more often if youre high-stress. Stress can trigger a migraine.
Headaches: Do They Really Cause Brain Tissue Damage
Many people who experience chronic headaches and migraines feel like there is no real solution to their problem. So, why not just learn to live with it? The following information may give you a very good reason to try to resolve this situation. Also, to get an easy way to do just that.
Chronic headaches are those occurring more than 15 days in a months time. As many as 5 percent of the global population experience these headaches. Chronic headaches include medication overuse headaches and migraines. For the sake of this article, we are just going to refer to them as headaches.
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Migraine Headaches May Cause Brain Damage Mouse Study Shows
- University of Rochester Medical Center
- Migraines may be doing more than causing people skull-splitting pain. Scientists have found evidence that the headaches may also be acting like tiny transient strokes, leaving parts of the brain starved for oxygen and altering the brain in significant ways.
Migraines may be doing more than causing people skull-splitting pain. Scientists have found evidence that the headaches may also be acting like tiny transient strokes, leaving parts of the brain starved for oxygen and altering the brain in significant ways.
The scientists say the work makes it crucial for migraine sufferers to do everything they can to prevent their headaches. While avoiding severe pain has long been a motivating factor, the scientists say the risk of brain damage makes it imperative to prevent the headaches, by avoiding a person’s triggers for the headaches and by using medications prescribed by doctors to prevent them.
In short, the team found that the brain develops a voracious demand for energy as the organ attempts to restore the delicate chemical balance that is lost in the initial throes of a phenomenon known as cortical spreading depression, which is thought to underlie many migraines.
Friedman, a member of the board of directors of the American Headache Society who has treated thousands of headache sufferers, echoes Nedergaard’s call for a greater emphasis on prevention.
Treatment Of White Matter Lesions Associated With Migraine
- Bashir, A., et al. . “Migraine and structural changes in the brain: a systematic review and meta-analysis.” Neurology 81: 1260-1268.
- Bayram, E., et al. . “Incidental white matter lesions in children presenting with headache.” Headache 53: 970-976.
- Brownlee WJ. Misdiagnosis of multiple sclerosis. If you have a hammer, everything looks like a nail ? Editorial. Neurology, 2019;92:15-16.
- Candee, M. S., et al. . “White matter lesions in children and adolescents with migraine.” Pediatr Neurol 49: 393-396.
- De Benedittis, G., et al. . “Magnetic resonance imaging in migraine and tension-type headache.” Headache 35: 264-268.
- Hamedani, A. G., et al. . “Migraine and white matter hyperintensities: the ARIC MRI study.” Neurology 81: 1308-1313.
- Palm-Meinders, I. H., H. Koppen, et al. . “Structural brain changes in migraine.” JAMA 308: 1889-1897.
- Sacco, S. and T. Kurth . “Migraine and the risk for stroke and cardiovascular disease.” Curr Cardiol Rep 16: 524.
- Sprint MIND investigators . “Association of Intensive vs Standard Blood Pressure Control With Cerebral White Matter Lesions.” JAMA 322: 524-534.
- Toghae, M., et al. . “The Prevalence of Magnetic Resonance Imaging Hyperintensity in Migraine Patients and Its Association with Migraine Headache Characteristics and Cardiovascular Risk Factors.” Oman Med J 30: 203-207.
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Significance Of Brain Lesions In Migraine
The data from the population-based CAMERA study support and extend the results from earlier studies, and indicate that migraine is associated with a significantly increased risk of subclinical and clinical ischemic brain lesions. The robustness of the methods and the validity of the findings have been acknowledged.;
Our cross-sectional findings suggest migraine attacks may lead to brain lesions and iron depositions. Our conclusions regarding the temporality of the associations are supported by the finding of a higher risk of lesions in those with higher attack frequencies or longer migraine history. To show ongoing migraine attacks lead to progression of lesions, we need follow-up data showing that there is a higher rate of developing new lesions, and more lesion progression over time in migraine cases, compared to progression of lesions in controls. In addition, identification of a linear relationship between migraine severity and volume of lesions , will increase the likelihood of a causal relationship.
Confirmation that recurrence of migraine attacks is indeed associated with an increasing risk of brain lesions and/or brain dysfunction, will change migraine from an episodic disorder to a chronic-episodic or chronic progressive disorder. Such a shift in conceptualization of the disease also will change goals of treatments, and prevention of migraine may then potentially need to become an important target for secondary prevention in the general population.
Neuroimaging Neurophysiological And Pharmacological Studies
The predominant involvement of processing speed, sustained attention and memory suggested prefrontal and temporal cortical dysfunction during the attacks , also supported by functional imaging studies . A positron emission tomographic study showed activation of prefrontal cortex and temporal lobe during migraine attacks , and an fMRI study revealed significantly greater activation in the medial temporal lobe . In the latter study, temporal lobe showed increased functional connectivity with several brain regions in migraineurs relative to controls in response to painful heat, and fMRI activation in temporal lobe was exacerbated during migraine headache attacks.
The functional organization of brain networks associated with pain and cognitive processes may be altered in migraine. De Tommaso et al. showed that episodic or chronic migraine patients have deficits in cognitive task-related suppression of laser evoked potential amplitudes during acute pain . fMRI studies reveal blunted cognitive-related neural activity in migraine patients . While healthy subjects have strong task-related deactivation in the left dorsolateral prefrontal cortex, dorsal anterior midcingulate cortex, and cerebellum that is decreased with acute pain, migraineurs show blunted task-related deactivation with no change in response to acute pain. These changes were not associated with pain catastrophizing or pain intensity.
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Theories About Migraine Pain
Older theories about migraines suggested that symptoms were possibly due to fluctuations in blood flow to the brain. Now many headache researchers realize that changes in blood flow and blood vessels don’t initiate the pain, but may contribute to it.
Current thinking regarding migraine pain has moved more toward the source of the problem, as improved technology and research have paved the way for a better understanding. Today, it is widely understood that chemical compounds and hormones, such as serotonin and estrogen, often play a role in pain sensitivity for migraine sufferers.
One aspect of migraine pain theory explains that migraine pain happens due to waves of activity by groups of excitable brain cells. These trigger chemicals, such as serotonin, to narrow blood vessels. Serotonin is a chemical necessary for communication between nerve cells. It can cause narrowing of blood vessels throughout the body.
When serotonin or estrogen levels change, the result for some is a migraine. Serotonin levels may affect both sexes, while fluctuating estrogen levels affect women only.
For women, estrogen levels naturally vary over the life cycle, with increases during fertile years and decreases afterwards. Women of childbearing age also experience monthly changes in estrogen levels. Migraines in women are often associated with these fluctuating hormone levels and may explain why women are more likely to have migraines than men.
Why Do Headaches Happen After Brain Injury
Right after a severe TBI, people may have headaches because of the surgery on their skulls or because they have small collections of blood or fluid inside the skull.
Headaches can also occur after mild to moderate injury or, in the case of severe TBI, after the initial healing has taken place. These headaches can be caused by a variety of conditions, including a change in the brain caused by the injury, neck and skull injuries that have not yet fully healed, tension and stress, or side effects from medication.
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Overestimating The Implications Of Lesions
Goadsby and many other headache specialists say they are confident that the risk of long-term damage is not a cause for concern. Another study they cite to support this is a population-based study from The Netherlands called the CAMERA Study. In this study, researchers compared the brain scans of healthy control subjects and the scans of people with migraine with aura. They re-examined the same subjects nine years later to determine whether people with migraine developed new lesions and whether these lesions were associated with changes in concentration, memory, information processing, and other cognitive tasks, and found that people with migraine had a slight increase in the number of lesions but that there was no evidence of neurological impairment related to these changes.
These same changes can occur in children and adolescents. In addition, age is a known factor that increases the risk of these tiny white matter lesions. The EVA study, a French population-based study on migraine and cognitive decline, conducted brain scans and cognitive function tests on subjects with and without migraine who were born between 1922 and 1932. Again, they found no correlation between the observed brain changes and any evidence of cognitive dysfunction.
Dysfunctional Cognitive Domains In Migraine
Cognitive impairment in cross sectional, clinic-based studies showed that migraine affected certain cognitive domains in particular, such as processing speed, attention, memory, verbal skills and executive function . Migraine had a moderate to marked effect on processing speed and visuomotor scanning speed , whereas basic attention and delayed verbal memory were mildly affected, and more complex psychomotor processing speed tasks were not significantly affected . Some studies observed mild to moderate impairments in non-verbal memory whereas others found no effect or better performance in migraineurs . Verbal skills were mildly impaired . In terms of executive function, migraine had a moderate to marked effect on sustained attention and working memory . There was slight dysfunction in the inhibition domain in migraine patients . In the domains of mental flexibility and set shifting, several studies reported that migraine patients exhibited a moderate or marked impairment . One study that included problem solving and decision making also found a marked impairment in these domains in migraine patients .
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Dispelling Common Misconceptions About The Lasting Effect Of Migraine On The Brain
The intensity of a migraine attack can be so severe, people with migraine sometimes question whether their headaches may be causing permanent damage. While there is evidence that brain scans of people with migraine will sometimes detect changes in the form of white matter lesions, a systematic review of migraine and structural changes in the brain from 2013 indicates that these lesions are generally not associated with any neurological issues, and dont indicate any increased risk of cognitive decline.
Peter Goadsby, M.B., B.S., a neurologist and professor of neurology at the NIHR Wellcome Trust at Kings Clinical Research Facility in London and the University of California, San Francisco, who led the 2013 study and continues to examine migraines lasting neurological effects, says many migraine patients he sees are unnecessarily concerned about long-term brain damage.
To the best of our understanding, thats completely wrong, he says. Theres no association with cognitive function or thinking problems associated with these changes.
What Are The Types Of Headaches What Type Of Headache Is A Migraine
There are over 150 types of headaches, divided into two categories: primary headaches and secondary headaches. A migraine is a primary headache, meaning that it isnt caused by a different medical condition. Primary headache disorders are clinical diagnoses, meaning theres no blood test or imaging study to diagnose it. A secondary headache is a symptom of another health issue.
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Other Primary Headache Disorders
Cluster headache primarily affects men and has only one-tenth the incidence of migraine, but causes disability comparable to migraine . There are few studies on cognitive performance in cluster headache. Although patients display a reversible cognitive decline during the cluster attacks, their cognitive performance was detected as normal between the attacks .
In TTH, acute headache was associated with reversibly impaired cognitive function . In a longitudinal birth cohort study, childhood headache was related to worse performance on cognitive measures such as verbal and performance IQ, receptive language, and reading, whereas cognitive performance of adults with TTH was similar to headache-free controls or headache-free tinnitus sufferers . TTH, known as the most common headache disorder, is often misdiagnosed in patients with probable migraine, and chronic migraine, resulting in a highly varying prevalence of TTH between 5.1â78% . It is likely that majority of TTH studies are not conducted on pure TTH patients and that may be at least partially responsible for cognitive problems detected in TTH studies. Indeed, STD test was intact during headache attacks in pure TTH patients , while STDTs were significantly elevated in migraine attacks. STD differentiates the central pathology of migraine from TTH and, normal STDTs in TTH could suggest a better cognitive status in pure TTH attacks.
Can You Prevent Brain Lesions
Scientists are still looking for ways to protect against brain lesions. They think keeping your migraines in check can help. Having frequent attacks is linked with a higher risk of lesions, so fending off migraines or treating them early on may help lower your risk. These simple steps could help:
- Talk to your doctor. You may need to take medicine or get treatments, like Botox injections, to head off migraines.
- Know your triggers. Bright lights, weather changes, and certain foods could set off your migraines. Once you know your triggers, you can learn to avoid them.
- Keep a lid on stress. Make time to unwind and do things you enjoy every day.
- Get moving. Exercise eases tension and boosts blood flow to the brain, which can help stave off headaches. Research also shows that physical activity may prevent white matter lesions.
- Practice good sleep habits. A bad night could set off an attack. Try to go to bed and wake up at around the same time.
American Migraine Foundation: âMigraine and Brain Lesions.â
Cleveland Clinic: âBrain Lesions.â
Mayo Clinic: âBrain Lesions,â âMigraine,â âMigraine with Aura,â âMigraines: Simple steps to head off the pain,â âPatent foramen ovale.â
Neurology: âMigraine and Structural Changes in the Brain,â âPhysical Activity, Motor Function, and White Matter Hyperintensity Burden in Healthy Older Adults.â
Dana Foundation: âWhy the White Brain Matters.â
American Stroke Association: âSilent Stroke.â
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Focus On Symptoms Not Perceived Risks
Dr. Goadsby says patients are often concerned that brain changes correlate with stroke or cognitive dysfunction later in life. This is not the case, and Goadsby says in fact, the stroke risk for migraine sufferers become less prominent after the age of 45.
Patients with migraine with aura face a small risk of stroke compared to population controls , or patients with migraine without aura, he says. Because of the low risk, Goadsby says migraine patients who have regular normal physical examinations do not need to get regular brain scans. He says that the pain of migraine attacks is the symptom that patients and their care teams should prioritize, not the possibility of lesions or the fear of increased stroke risk. It should also be noted that the presence of these lesions should not influence the use of any particular medication.
Migraine is an inherited episodic brain disease, Goadsby says. It doesnt shorten life: it ruins it. Migraine patients do not have to be worried about long-term brain damage. It simply doesnt happen.
To learn more, visit the American Migraine Foundation, where neurologists like Dr. Goadsby and others share information and resources about the disease, including the various treatment options available to people living with migraine and head pain.
Studies Of Volumetric Changes
We identified 9 clinic-based studies that used VBM and DTI to assess GM and WM regions in migraineurs and controls ., Seven studies reported reduced GM density in brain regions in migraineurs compared to controls., In addition, one study found increased GM density in the periaqueductal gray and the dorsolateral pons, but only in patients with MA. In 5 studies, attack frequency and disease duration,,, were correlated with GM reduction in migraineurs in the frontal,,, temporal,, and parietal lobes, the limbic system, the cingulate cortex,,, the brainstem,, and the cerebellum., One study reported that patients with chronic migraine had a volume loss mainly in the anterior cingulate cortex and in several other areas, compared to patients with episodic migraine , indicating an association between attack frequency and GM reduction, especially in the ACC.
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