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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.
Caffeine And Vestibular Migraine
Interestingly, this same study also tested the effect of caffeine intake on Vestibular Migraine and unexplained dizziness. It found a 14% reduction in vestibular symptoms for those who completely quit caffeine, but 46% of patients found a reduction in dizziness with nortriptyline therapy.
This shows that eliminating caffeine can be a helpful addition, but medication provides the greatest reduction in symptoms of headache and dizziness.
Falling in between caffeine cessation and nortriptyline in terms of efficacy was treatment with topiramate , which resulted in a 25% reduction of dizziness.
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What Is An Ocular Migraine
An ocular migraine is an eye problem characterized by short episodes of vision loss or visual disturbances.
For example, you may see flashing lights in one eye accompanied by a headache.
Your doctor may also refer to this type of migraine as ophthalmic or monocular migraines.
These episodes may be scary. But in most cases, they are harmless and short-lived. However, ocular migraines can be a sign of a more serious condition.
Some people experience retinal migraines every few months, but the frequency varies from person to person.
Retinal migraine is a unique condition that should not be confused with headache-type migraine or migraine with aura, which often affect both eyes.1
Tips For Managing And Preventing Visual Migraines
If your visual migraine occurs frequently, here are some tips to help you prevent or manage the condition.
- Acupressure. This is an evidence-based practice of applying pressure with hands to specific points on the body to relieve pain and other symptoms. It can be an effective alternative therapy for migraine headaches.
- Lavender oil. Lavender oil can be inhaled or applied diluted to the temples to ease your migraine pain.
- Peppermint oil. According to a 2010 study, the menthol in peppermint oil can minimize migraines.6 The research showed that applying menthol to the forehead and temples relieved migraine-related pain, nausea, and light sensitivity.
- Yoga. Yoga uses breathing, meditation, and body postures to promote health and well-being, relieving the frequency, duration, and intensity of migraines.
- Massage therapy. Massage reduces stress and enhances coping skills. It also lowers heart rate, anxiety, and cortisol levels.
- Herbal supplements. Butterbur and feverfew are common herbal remedies that may aid with migraine pain and frequency reduction.
- Avoid Triggers. Ocular migraine triggers such as caffeinated foods, alcohol, dehydration, smoking, or stress
- Unwind at the end of the day. Basic things like listening to soothing music or taking a warm bath after a long day can help your body relax and prevent migraines.
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Other Specialists Who Diagnose And Treat Migraine
Migraine can be a hard condition to correctly diagnose and treat. You may need to see other medical specialists to rule out conditions that cause migraine or migraine-like symptoms. These doctors include:2-4
- Neurologists: Doctors who diagnose and treat disorders of the nervous system. These include migraine, stroke, concussion, epilepsy, Parkinsons disease, Alzheimers, and multiple sclerosis.
- Ophthalmologists: Specialists who treat eye disease. Many people with migraine have vision changes, loss of vision, and sensitivity to light. This means some people go to an eye doctor first. An ophthalmologist can help decide if symptoms are caused by an eye disorder or migraine.
- Obstetrician/gynecologists: An OB/GYN treats issues of the female reproductive system, such as pregnancy and childbirth. Women whose migraines are tied to their menstrual cycle may first talk to their OB/GYN before seeing a headache specialist.
Can Migraines Be Prevented
Preventive migraine treatments can be helpful for patients with frequent, severe headaches. The main goal for preventive strategies is to reduce the overall frequency and severity of the headaches. Avoiding known triggers may be helpful. Many people find that regular exercise makes them feel better, although strong evidence is lacking to recommend this as a highly effective migraine treatment. Other strategies may include improving sleep habits or learning to cope more effectively with stress, for example by learning relaxation techniques such as biofeedback or meditation.
Numerous medications also can be used as a preventive treatment for migraine. It is often helpful to start with a low dose of medication and increase it slowly in order to find the best balance between benefits and side effects. Some commonly used medications include amitriptyline, propranolol, and topiramate. Valproic acid and lisinopril are less commonly used. For some patients with chronic migraine, botulinum injections can help reduce headaches. Some vitamins, minerals and herbal preparations are also used to help prevent migraines.
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When To See A Doctor
If you have any type of headaches consistently, its important to speak with your primary care physician so they can help create a treatment plan or refer you to a specialist.
“If your headaches are increasing in frequency or severity, or are interfering with your usual activities, see a doctor,” says Dr. Andiman.
Seek immediate medical attention if youre experiencing the worst headache youve ever had, lose vision or consciousness, have uncontrollable vomiting, or if your headache lasts more than 72 hours with less than 4 hours pain-free.
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.
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Cooperative Care During Pregnancy
Pregnancy hormones can worsen migraines at a time when patients must avoid certain medications. At OHSU, our pregnancy providers refer patients with migraines to the OHSU Headache Center.
We can provide care that wont expose your baby to harmful medications. Often, an occipital nerve block provides relief.
Vestibular Migraine Not As Rare As Once Thought
Vestibular Migraine was once considered rare, but it is increasingly becoming a more widely recognized diagnosis. This type of Migraine is characterized by vertigo and dizziness. It is a common cause of headache with dizziness, but VM can occur with or without head pain.
Only about half of all patients with VM experience pain with their attacks. It can be confusing to get a diagnosis of Migraine if you have no pain, but an accurate diagnosis is key to finding the right treatment and relief.
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It’s Easy To Get The Care You Need
See a Premier Physician Network provider near you.
If frequent, painful migraine headaches keep interrupting your pursuit of a happy, productive life, you may be open to any and all options for possible relief even surgery.
“Before considering surgery, Id recommend exhausting other treatments that have fewer side effects.”
Two surgical techniques used to treat migraines are receiving mixed reviews from doctors. Plastic surgeons who perform the procedures have reported favorable results for a majority of their patients. Headache specialists feel more research is needed.
One procedure, called nerve decompression, removes tissue that puts pressure on one or more peripheral sensory nerves in your head thought to be trigger points for migraines. The other, called neurectomy, cuts a nerve in your head identified as contributing to migraines. The nerves lie on the surface of your skull and arent part of your brain.
The procedures evolved as patients who received eyebrow and forehead lifts were reporting back to their plastic surgeons a decline in migraine headaches following the cosmetic surgery.
Before proceeding with surgery, plastic surgeons generally require that a neurologist confirm the diagnosis of migraine. An important diagnostic challenge is to identify which nerve or nerves are trigger points for the migraines. They could be in the temple, the front of the head, or the back of the head.
When To Call 911
If a headache comes on suddenly and is severe, call 911 right away.
Another red flag is if you develop a headache with problems like slurred speech, loss of vision, or weakness.
Get help right away if you have:
- Balance problems
- Diarrhea or vomiting that doesn’t go away
- Symptoms in your ears, nose, throat, or eyes
- Vision loss
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When To See A Doctor For Headaches
Almost everyone experiences headaches now and then. However, some headaches are very severe or last for an extended period. Because mild headaches are frequent, many people dont seek treatment until their condition deteriorates.
There is no need to wait! The sooner you get a complete diagnosis and treatment, the better.
If youve rarely had headaches in the past but start to experience them regularly for two weeks or more, seeing a doctor is a good idea. You should also see a doctor if headaches of any severity or duration last for two months or more even if they are not much worse than you are used to.
Finally, get prompt medical attention if you start to experience headaches that are so painful they are debilitating or have symptoms that make it difficult for you to function at work or home. For example, headaches accompanied by eyesight problems should be investigated right away.
Tricyclic Antidepressants For Vestibular Migraine
It seems these medications work well for patients who may also have sleep disturbances or who also experience an anxiety component to their attacks. It also appears that medication is even more effective when supported by other areas of treatment, like keeping a sleep schedule and avoiding potential food triggers.
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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.
Caring For The Entire Spectrum Of Headaches
The Headache Center provides headache treatment plans for migraines, cluster headaches, facial pain, sinus headaches, tension headaches and related conditions. We treat both primary headaches and secondary headaches . The center employs a multidisciplinary team that includes physicians, nurse practitioners, psychological care providers and rehabilitation professionals who offer medical therapy as well as interventional options.
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What Are The Advantages Of Seeing A Headache Specialist
It can be difficult to find the right doctor for migraines since funding for migraine research is lacking, there is little incentive for physicians to commit themselves to finding a cure for migraines. As a result, migraine specialists are few and far between. Still, there are many advantages to seeking a skilled migraine specialist:
- Migraine specialists are privy to the latest developments in migraine research and potential treatments.
- Headache specialists have a deeper understanding of migraine headache disorder than primary care doctors do.
- Because a headache specialist treats patients with different kinds of chronic headaches, he is more familiar with various headache symptoms, and thus more likely to diagnose your headache type correctly and suggest proper medication.
- Migraine headache specialists tend to understand the specific personal needs of their patients than physicians who are not specialists in the field of migraine headache disorder.
- A headache specialist is more likely to extend after-hours care for severe migraine attacks.
What Type Of Doctor Do You See For Ocular Migraines
If you have ocular migraines, you can see an ophthalmologist oran optometrist.
Optometrists are eye care specialists who offer primary vision care services, including:
- Vision testing
- Correction of visual problems
- Treatment and management of visual issues and eye diseases
On the other hand, ophthalmologists are medical practitioners who specialize in eye and vision care. They differ from optometrists in their degrees of schooling as well as what they can diagnose and cure.
An ophthalmologist is a healthcare professional who has finished college and has at least eight years of further medical studies. He or she is licensed to practice medicine and surgery. Ophthalmologists hold a Doctor of Medicine degree.
Optometrists are healthcare professionals who complete four additional years of school after finishing undergraduate studies. They hold a Doctor of Optometry degree.
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How An Occipital Nerve Block Is Performed
You’ll have an intravenous line put in your arm. Your doctor will set up several monitors, including heart, pulse, and pulse. Your healthcare team will monitor your vital signs. Your doctor will give you IV medicine to reduce your anxiety and give you some pain relief.
Your doctor will clean your skin where the injection will be given. A local anesthetic will be injected so that you won’t feel any pain during the procedure. The medicine for the occipital block will be inserted near your occipital nerve through a small needle near the base of your skull.
Your headache may get worse briefly when the medicine is injected. This is a sign that the medicine is going to the right place. The procedure usually lasts around 15 minutes.
Doctors For Children With Migraine
Children are not little adults, so treating migraine in children means different kinds of specialists. Most children with migraine and other headache disorders see their pediatrician first. A pediatrician is a doctor who is trained to treat illness in children. If a child has migraines that are hard to treat, you may need to see a specialist.5
A pediatric neurologist specializes in treating children with migraine and other nervous system issues. A pediatric headache specialist or pediatric neurologist may work on a team in a headache center. This team may also include psychologists, physical therapists, and dietitians who all treat migraine in children.
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Whats The Outlook For People With Migraine
Although migraine is a chronic condition, there can be periods of remission.
There are also a variety of treatments to help prevent migraine attacks and mitigate symptoms when they start to occur. Knowing the triggers of migraine can also help to minimize and prevent migraine attacks and help you manage your condition.
Seeing a neurologist regularly may help you maintain the best treatment for your migraine and to address any issues that might come up.
What Symptoms Must You Have To Be Diagnosed With A Migraine
Migraine with aura . This is a headache, plus:
- Visual symptoms or vision loss.
- Sensory symptoms .
Migraine without aura . A common migraine is a headache and:
- The attacks included pain on one side of your head.
- Youve had at least five attacks, each lasting between four and 72 hours.
Plus, youve experienced at least one of the following:
- Nausea and/or vomiting.
- Lights bother you and/or you avoid light.
- Sounds bother you and/or you avoid sounds.
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