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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Excedrin Extra Strength And Excedrin Migraine Recommended Doses
Q. Excedrin Extra Strength Gelcaps each contain 250 mg of Acetaminophen, 250 mg of aspirin, and 65 mg of caffeine. Similarly, Excedrin Migraine caplets contain exactly the same amounts of each ingredient.
But the first allows the use of 8 Gelcaps in 24 hours, whereas the latter only allows the use of 2 caplets in 24 hours.
Why the difference in the allowable use of two pills of apparently the same medication.
A. I cant tell you why there are two different label recommendations. What I can tell you is that an advisory committee of the Food and Drug Administration made the following recommendations for the use of acetaminophen : 1) The single adult acetaminophen dose should not exceed 650 mg and 2) The maximum total daily recommended dose should be no more than 2,600 mg/day.
In regards to aspirin and caffeine: 1) the maximum daily dose of aspirin should not be more than 4,000 mg/day and 2) caffeine ingestion should be limited to no more than 1-2 8 oz cups per day in migraineurs in order to minimize the risk of developing withdrawal headaches or medication-overuse headaches.
Barbara Lee Peterlin, D.O. Philadelphia, PA
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.
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Are Migraines Any Different
If youve ever truly experienced one, you know that migraine pain is a whole different animal. Not only can it be an extreme headache, but it can also bring on other symptoms such as nausea, mood changes, visual disturbances , light and sound sensitivity and many many more. For years scientists have studied migraines to determine their cause as well as how to alleviate them.
According to Johns Hopkins University, researchers at one time believed that migraines were brought on by changes in blood flow to the brain. At this point, most experts believe that while this contributes to migraine pain, its probably not the origin
Currently, researchers believe the source of migraines stem from fluctuations in compounds and hormones, such as serotonin and estrogen. As these chemical levels change, they can cause blood vessels to constrict throughout the body. This could be the root of migraine pain
There are other factors that could set off migraines specifically. These include changes in the weather, flickering or glaring lights, fatigue, stress, and certain food and drinks
Breaking: Migraines Change Your Brain 44%
What’s going onand what you can do about it
You can feel it comingthe sensitivity to the fluorescent lighting in your office, the dull throbbing making its way up your neck, and maybe even tunnel vision or blind spots. And then comes the pain, which leads to nausea, and the sudden desire to put your head under the covers and not emerge until its officially tomorrow.
Yep, youre one of the 10-15% of the general population that suffer from migraines. But before you pop that painkiller and wait for the storm to pass, know this: a new study discovered how migrainesespecially ones with aurapermanently alter the structure of your brain.
In a meta-analysis published in Neurology, researchers found that migraine with aura increases your risk of white matter, infarct-like brain lesions by 68% and a 44% increase in risk for change in brain volumethe increase or decrease in brain tissue. No aura? You risk for brain lesions is still rises 34%.
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Before you run to the nearest MRI machine, know that brain structure changes throughout your life, especially during development when youre sculpting your brain, and later in life when youre losing tissue, says Deborah Yurgelun-Todd, PhD, professor of psychiatry at the University of Utah School of Medicine. Structural changes are usually related to the death of brain cells, and the frequency and severity of your migraines contribute to just how much cell death is occurring.
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Migraines And Brain Damage
With so many myths and theories about migraines and why they occur, its really difficult to tell which of them are facts and which are just old wives tales. One of the many migraine myths scientists have busted recently is the theory that people who suffer from chronic and severe migraines are more prone to brain damage and other forms of brain deterioration. Several experts from the British Medical Journal conducted a study on migraines and brain damage or loss of cognitive function. In this extensive study, researchers and analysts took a closer look at the data on more than 6,000 women provided by the Womens Health Study. The women who participated in this study were classified based on their migraine experience and were tested and observed during follow up consultations for a period of two years. By the end of the study, the scientists and experts found no evidence of a link between migraines and cognitive function loss or damage to the brain. This new study dispels any worry caused by a study done in 2007 regarding the occurrence of tiny transient strokes during migraine attacks wherein the flow of blood and oxygen to the brain is disrupted during a migraine which causes long term damage as cells in the brain slowly die.
Contact a Headache Specialist
What Are The Four Stages Or Phases Of A Migraine Whats The Timeline
The four stages in chronological order are the prodrome , aura, headache and postdrome. About 30% of people experience symptoms before their headache starts.
The phases are:
It can take about eight to 72 hours to go through the four stages.
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Do Migraines Have Long
Medically reviewed by Dr. Charisse Litchman, MD, FAHS on January 7, 2021
There are concerning signs that repeated, severe migraines may cause changes in the brain, although there isnt conclusive evidence that people with chronic migraines experience lasting health effects as a result of their migraines. MRI scans of people with migraines have found reduced cortical thickness and surface area on images of the brain. In addition, MRI scans sometimes reveal white matter lesions on the brains of young people with migraines. These white matter lesions resemble ones more typically seen in older people and may be misdiagnosed as multiple sclerosis.
Between 12-47% of migraine patients have these lesions on their brains, in comparison to 2-14% of the general population. Older patients and those who experience migraine with aura are more likely to have white matter lesions, as are those who experience nausea with their headaches, experience severe headaches, and have suffered from headaches for a greater number of years. We dont know for certain, but medical experts believe that these lesions are related to the effects of migraines on blood vessels.
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.
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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.
What Medications Are Used To Relieve Migraine Pain
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.
Three over-the-counter products approved by the Food and Drug Administration for migraine headaches are:
- Excedrin® Migraine.
- Advil® Migraine.
- Motrin® Migraine Pain.
Be cautious when taking over-the-counter pain relieving medications. Sometimes overusing them can cause analgesic-rebound headaches or a dependency problem. If you’re taking any over-the-counter pain medications more than two to three times a week, report that to your healthcare provider. They may suggest prescription medications that may be more effective.
Prescription drugs for migraine headaches include:
Triptan class of drugs :
- Co-enzyme Q10.
Drugs to relieve migraine pain come in a variety of formulations including pills, tablets, injections, suppositories and nasal sprays. You and your healthcare provider will discuss the specific medication, combination of medications and formulations to best meet your unique headache pain.
Drugs to relieve nausea are also prescribed, if needed.
All medications should be used under the direction of a headache specialist or healthcare provider familiar with migraine therapy. As with any medication, it’s important to carefully follow the label instructions and your healthcare providers advice.
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How Migraine Affects The Brain Over Time
Probably the question on every patients mind is whether or not chronic migraine can cause long-term changes or dysfunction within the brain. Do all those attacks associated with a chronic headache disorder harm the physical makeup of our brain over time? The answer is, at best, complicated.
Various studies have confirmed the presence of deep white matter lesions or abnormalities in the brain, which may be associated with an increased risk of stroke and/or cognitive decline.1,2 However, those who have migraine without aura as well as men with migraine may be less susceptible to this long-term damage, and it is unclear whether chronic migraine and/or higher attack frequency also enhances this risk.
In addition, although the physiological changes have been observed repeatedly, the outcomes connected with them are tentative. In fact, the idea that cognitive decline occurs at an accelerated rate in migraine patients over time remains highly controversial within the medical field.
Although this type of mental decline may be unlikely, a history of migraine may increase a persons risk for degenerative brain diseases such as Alzheimers disease or dementia later in life, say researchers.6 Interestingly, men may not have as significant a risk, but more study is needed in this area to verify whether this is truly accurate.
Anxiety Depression And Panic Disorders
The early development of migraine, whether in childhood or as an adult, leads to higher instances of emotional and psychiatric disorders. Usually they occur and progress nearer to the initial diagnosis, but they also persist for years and even decades. Among the most likely are:
- Depression: There are several studies discussing the strong association between major depression and migraine.10,11 Not only is it regularly present at two years after diagnosis, but patients may be 3-times more likely to develop it over the course of their lifetime. Sensory symptoms like photophobia can also increase the depression risk.
- Anxiety and Panic Disorders: The presence of anxiety and panic disorders also remain associated with migraine, and patients have a noticeably-increased risk of having one or more of these concerns in the future.11
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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
How Are Migraines Diagnosed
To diagnose a migraine, your healthcare provider will get a thorough medical history, not just your history of headaches but your familys, too. Also, they’ll want to establish a history of your migraine-related symptoms, likely asking you to:
- Describe your headache symptoms. How severe are they?
- Remember when you get them. During your period, for example?
- Describe the type and location of your pain. Is the pain pounding? Pulsing? Throbbing?
- Remember if anything makes your headache better or worse.
- Tell how often you get migraine headaches.
- Talk about the activities, foods, stressors or the situations that may have brought on the migraine.
- Discuss what medications you take to relieve the pain and how often you take them.
- Tell how you felt before, during and after the headache.
- Remember if anyone in your family gets migraine headaches.
Your healthcare provider may also order blood tests and imaging tests to make sure there are no other causes for your headache. An electroencephalogram may be ordered to rule out seizures.
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When Should I Worry About Migraines
The following headache symptoms mean you should get medical help right away: A sudden, new, severe headache that comes with: Weakness, dizziness, sudden loss of balance or falling, numbness or tingling, or cant move your body. Trouble with speech, confusion, seizures, personality changes, or inappropriate behavior.
Whats The Difference Between Headache And Migraine
Headaches cause pain in the head, face, or upper neck, and can vary in frequency and intensity. A migraine is an extremely painful primary headache disorder. Migraines usually produce symptoms that are more intense and debilitating than headaches. Some types of migraines do not cause head pain, however.
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