Am I At Risk For Chronic Daily Headache
Anyone who has recurrent acute headaches and who uses short-acting medication or techniques to treat them is at risk of developing chronic daily headache, which is characterized by headache symptoms 15 or more days of the month over three months, notes an article published in February 2020 in Global Advances in Health and Medicine on Integrative EastWest Medicine Intervention for Chronic Daily Headache.
The two most common types of chronic daily headache are chronic migraine and chronic tension-type headache, although the two types often overlap. In other words, people diagnosed with chronic migraine often also have symptoms of chronic tension-type headache, and vice versa.
Individuals with chronic daily headache often also have a diagnosis of medication-overuse headache.
If your head pain or other symptoms cause you to frequently take short-acting medication, talk to your doctor about being referred to a headache specialist, who should be able to identify medical treatments as well as lifestyle or behavioral changes that can help to relieve your symptoms while also reducing your reliance on acute medications.
Who Should Take A Medicine To Prevent Migraine Attacks
There is no definite rule. For example, you may wish to consider this option if you have:
- More than two migraine attacks per month that cause significant disruption to your life.
- Less frequent, but severe, migraine attacks.
- The need to use a lot of painkillers or triptan medicines to treat migraine attacks.
- Painkillers or triptans for migraine attacks not working very well, or you are unable to take them because of side-effects or other problems.
Before embarking on preventative treatment, it is probably best to keep a migraine diary for a few months to assess:
- How often and how bad your migraine attacks are.
- Your current use of medication to treat the migraine attacks.
This may help you to decide if preventative treatment is worth a try, and also to help assess if you may have medication-induced headache. See the leaflet called Migraine trigger diary, including a migraine diary that you may like to print out and use.
Home Remedies To Ease A Headache Or Migraine Attack
Many headache symptoms can be at least partially alleviated without medication. Here are some tips for homemade headache and migraine relief:
Apply an ice pack to your head and neck. Cold compresses on the head and neck are a common home remedy to ease the pain of a migraine attack. Some people also find it helpful for tension headaches. To avoid skin injury, wrap the ice or cold pack in a cloth and apply it for no more than 15 to 20 minutes at a time.
Apply heat to the head, neck, or hands and feet. Applying heat may help relieve a tension headache or dull the pain of a migraine attack, according to the Mayo Clinic. Use a heating pad set on low, a hot-water bottle, a warm compress, or a hot towel. A hot bath or shower may also be helpful, or simply run warm water over your hands and feet.
Have a big glass of water.Dehydration can trigger a migraine attack or lead to a nonmigraine headache, says the National Headache Foundation. Replacing the liquids your body needs may help to relieve the pain.
Practice a relaxation technique. Meditate, breathe deeply, and try to visualize a peaceful image. “Various relaxation techniques can significantly help patients who suffer from ‘muscle contraction’ headaches,” says Rozental.
Give yourself a massage. Massage eases muscle tension, and sometimes helps to reduce headache pain, according to the Mayo Clinic. Gently massage your temples, scalp, neck, and shoulders with your fingertips, or gently stretch your neck.
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Whats The Relationship Between Hormones And Headaches
Headaches in women, especially migraines, are related to changes in the levels of estrogen. Levels of estrogen drop immediately before the start of your menstrual flow .
Premenstrual migraines regularly occur during or after the time when the female hormones, estrogen and progesterone, drop to their lowest levels.
Migraine attacks usually improve during pregnancy. However, some women have reported that their migraines started during the first trimester of pregnancy, and then went away.
Migraine Home Remedies And Lifestyle Measures
There are several things you can do on your own that may help relieve your migraine symptoms once an attack has started, including:
- Applying hot or cold compresses to your head and neck may help, notes the Mayo Clinic.
- Taking a warm shower or bath can have a similar effect to hot compresses.
- Resting in a dark, quiet room can also help if you feel a migraine attack coming on.
- Meditating or doing yoga may help to reduce symptoms and can also help to prevent attacks when done regularly.
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How To Treat Patients For Migraine During Pregnancy
Its important for providers who treat women during their reproductive years to be aware of treatment options that are safe during pregnancy. Many women with migraine who are pregnant or considering pregnancy stop taking their migraine medications and assume they dont have safe treatment options availablebut this is simply not true.
Women typically start to experience migraine attacks during adolescence, which aligns with when menstruation begins. The highest incidence of migraine is between ages 18 and 44, which are also the year many women experience pregnancy. The rate of migraine among women is three times higher than it is for men. Because of these figures, it is believed that fluctuations in estrogen levels play a role in migraine development.
Dr. Tracy Grossman, an obstetrician-gynecologist who has completed a fellowship in maternal-fetal medicine and earned a masters in neuroscience, shares the range of treatment options available for pregnant patients with migraine.
Medication For Migraine Prevention
There are several drugs that can be taken to prevent migraine attacks or reduce their frequency or severity. You may be a candidate for preventive therapy if:
- You have four or more migraine attacks per month.
- Your migraine attacks last longer than 12 hours.
- Pain-relieving medication is ineffective.
- You regularly experience prolonged auras or numbness and weakness.
- Your migraine attacks are disabling or adversely affect other medical conditions you have.
In general, your doctor may recommend that you take preventive medication daily or only when a predictable migraine trigger is approaching.
Many of the drugs that have been used in preventive therapy have not been specifically studied in clinical trials to target migraine. But that has recently been changing.
If taking a preventive medicine succeeds in stopping your migraine attacks, your doctor may recommend tapering off the medication to see if your attacks return without it.
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What Are The Symptoms Of Migraine
Some people notice a migraine aura before the headache starts, and this can alert them that a migraine attack is coming. The symptoms of an aura may be different for everyone. Examples include:
- feeling tired, fatigue
- sensitivity to light or sound
- problems with vision
- tingling or numbing feelings in your body.
When the headache starts, it is a strong pain, usually on one side of your head. You may feel sick or vomit , get tingling around your mouth, have trouble talking or feel dizzy or weak.
Complementary And Alternative Treatments
Interest in the use of complementary and alternative medicine by headache patients is widespread. A 2002 survey showed that more than 85% of headache patients use CAM therapies and 60% felt they provided some relief. Overall, more than 70% of patients who use CAM do not tell their doctors about it.
Some CAM techniques have good scientific evidence of benefit and have been proven by studies to be effective in preventing migraine. Biofeedback and behavioral therapy should be part of the standard of care for a difficult migraine patient.
Good studies have demonstrated the effectiveness of the herb butterbur in preventing migraines. A guideline from the American Academy of Neurology and the American Headache Society recommends offering butterbur to patients with migraine to reduce the frequency and severity of migraine attacks . Patients on butterbur require monitoring of liver enzymes.
The AAN/AHS found moderate evidence of effectiveness for riboflavin , magnesium, and feverfew. A 3-month, randomized, controlled trial of high-dose riboflavin found that riboflavin was superior to placebo in reducing attack frequency and headache days.
A variety of other CAM techniques are not bolstered by solid scientific data, but they may be perceived to be of benefit to patients. Techniques that some patients use for headache relief include the following:
Body work – Eg, chiropractic, massage, and craniosacral therapy )
Nutritional/herbal supplements – Eg, vitamins and herbs
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Acute Treatment For Cluster Headaches
Given the severity and also the relative brevity of cluster headaches, acute treatments need to work quickly to relieve the pain and suffering caused by them. According to neurologist and headache expert and researcher Peter J. Goadsby, MBBS, writing for the American Headache Society, effective acute treatments for cluster headaches include:
- Inhaled oxygen
- Injected dihydroergotamine
- Topical lidocaine nasal drops
Another option, the drug Emgality , was approved in 2019 to treat cluster headaches, becoming the only drug specifically approved for this type of headache. Its also approved for the prevention of migraine attacks.
When used to treat cluster headaches, Emgality is self-administered using three, 100-milligram prefilled syringes, which are taken one after the other at the start of a cluster period and then every month until the end of the cluster period.
Emgality belongs to a class of drugs known as calcitonin gene-related peptide antibodies. Drugs in this class are either targeted against CGRP receptors or against CGRP itself.
When Are Opioids Or Butalbital Useful For Migraines
Your doctor may suggest an opioid if none of the treatments listed above help, or if you have bad side effects.
It is not clear if butalbital should be used at all for treating migraines. If your doctor prescribes butalbital for your migraines, ask why. And ask if there are any other drugs that would work.
Limit The Use Of All Pain Medicines
- Do not use prescription pain medicine for headaches for more than nine days in a month.
- Do not use non-prescription pain medicine for more than 14 days in a month.
This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
Can Migraines Be Prevented Or Avoided
Medicine to prevent migraines may be helpful if your headaches happen more than 2 times a month. You may want to consider this medicine if your headaches make it hard for you to work and function. These medicines are taken every day, whether you have a headache or not.
Preventive medications for migraines can include prescription drugs often used to treat other ailments. Anti-seizure medicines, antidepressants, medicines to lower blood pressure, and even Botox injections are some of the preventive medications your doctor may prescribe. Calcitonin gene-related peptide inhibitors can also help prevent migraines. They do so by blocking a gene-related peptide in your sensory nerves. This peptide is known to increase during a migraine attack, so blocking it can help prevent migraines.
There are also a number of non-medical treatments designed to help minimize migraine pain and frequency. One is an electrical stimulation device, which has been approved by the FDA. It is a headband that you wear once a day for 20 minutes to stimulate the nerve linked to migraines. Another non-medical treatment is counseling aimed at helping you feel in more control of your migraines. This counseling works best when paired with medical prevention of migraines, as well.
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How To Treat Rebound Headaches
Frequent use of any acute headache medication, including OTC drugs, can cause what are known as rebound, or medication-overuse, headaches, says Rozental. By definition, a medication-overuse headache occurs on 15 or more days of the month as a consequence of regular overuse of acute or symptomatic headache medication.
The only way to stop medication-overuse headaches is to stop using the drug thats causing them. However, this process can be uncomfortable and can causing worsening of the headache, among other symptoms, according to The Migraine Trust. If you think you may have medication-overuse headache, speak to your doctor or a neurologist trained in chronic headache management.
Ocular Migraines: Common Questions And Answers
Below are some frequently asked questions about ocular migraines:
Can dehydration cause ocular migraines?
Dehydration is one of the triggers of ocular migraines. Keeping your body hydrated will help prevent or reduce the frequency of occurrence of migraines.
Can anxiety cause ocular migraines?
Just like dehydration, anxiety is also a trigger of ocular migraines. The symptoms of ocular migraines can also cause anxiety, which worsens ocular migraines.
Simple reassurance from your doctor will lower anxiety levels and decrease or eliminate ocular migraines.
Can high blood pressure cause ocular migraines?
Researchers are working to fully understand the relationship between high blood pressure and ocular migraines.
Current research points to the fact that migraine attacks are prevalent in people with high blood pressure.
Anyone suffering from high blood pressure is advised to get it under control, especially those with a known history of ocular migraines.
Are ocular migraines a symptom of a brain tumor?
A migraine that is accompanied by vision issues can be associated with certain tumors, such as the occipital lobe tumor.
Although this is a rare condition, migraines are common among patients with brain tumors.
Is an ocular migraine a sign of a stroke?
An ocular migraine is not necessarily a sign of a stroke, but can indicate increased risk.
However, research indicates that people with a history of ocular migraines are at a higher risk of stroke.
In this article
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How Prevalent Are Migraines
Migraines are about three times more common in women than men, and may affect more than 12 percent of the U.S. adult population. Migraines often run in families, and can start as early as elementary school but most often in early adulthood. They often fade away later in life, but can strike at any time. The most common cause of recurring, disabling headache pain, migraines are also the most common underlying cause of disabling chronic, daily headache pain. While migraines are the No. 1 reason that patients see a neurologist, most cases are handled by primary care physicians.
Things that can make the headaches more likely to occur include:
What Are The Symptoms Of A Migraine
Individual migraines are moderate to severe in intensity, often characterized by a throbbing or pounding feeling. Although they are frequently one-sided, they may occur anywhere on the head, neck and face or all over. At their worst, they are typically associated with sensitivity to light, noise and/or smells. Nausea is one of the most common symptoms and it worsens with activity, which often results in patient disability. In many respects, migraines are much like alcohol-related hangovers.
Migraine pain can be felt in the face, where it may be mistaken for sinus headache or in the neck, where it may be mistaken for arthritis or muscle spasm. Complicating the diagnosis of migraine is that the headaches may be accompanied by other “sinus like” symptoms, including watering eyes, nasal congestion and a sense of facial pressure. Most patients who think they have sinus headache in fact have migraines.
In up to 25 percent of patients, the migraine headache pain may be preceded by an aura, a temporary neurological syndrome that slowly progresses and then typically resolves just as the pain begins. While the most common type of migraine aura involves visual disturbances , many people experience numbness, confusion, trouble speaking, vertigo and other strokelike neurological symptoms. Some patients may experience auras without headaches.
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How Are Migraines Treated
Migraine headaches are chronic. They cant be cured, but they can be managed and possibly improved. There are two main treatment approaches that use medications: abortive and preventive.
- Abortive medications are most effective when you use them at the first sign of a migraine. Take them while the pain is mild. By possibly stopping the headache process, abortive medications help stop or decrease your migraine symptoms, including pain, nausea, light sensitivity, etc. Some abortive medications work by constricting your blood vessels, bringing them back to normal and relieving the throbbing pain.
- Preventive medications may be prescribed when your headaches are severe, occur more than four times a month and are significantly interfering with your normal activities. Preventive medications reduce the frequency and severity of the headaches. Medications are generally taken on a regular, daily basis to help prevent migraines.
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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