Pain Relief: The L.A. Pain Clinic Guideby Sota Omoigui

MIGRAINE HEADACHE

The symptoms are intense throbbing pain often on one side of the head, which may spread to the entire head, neck and shoulders. Sometimes bright spots, flashing lights or zigzag patterns may be seen prior to the headache. The headache is often present on awakening and may be accompanied by nausea, vomiting, dizziness and tingling in the lips. Bright lights and noises become unbearable. The headache is due to swelling of the blood vessels that go to the scalp and brain. Before swelling, the blood vessels first tighten up, decreasing the amount of blood going to the brain. This produces the visual disturbances and in severe attacks may cause paralysis, and loss of ability to speak. During attacks, some people become pale, with bloodshot eyes and runny nose.
Migraine headaches occur most often when unwinding from stress such as during weekends or holidays. In some women, migraine headaches coincide with their menstrual cycle. Get enough rest and minimize stress. Avoid irregular eating habits (which may decrease your blood sugar), certain medications e.g. birth control pills, nitrates. About 20% of migraine sufferers have a sensitivity to certain beverages and foods. Beverages which can trigger an attack include red wine, beer, whiskeys, scotch, tanin containing beverages e.g. apple juice and caffeinated drinks such as coffee, tea and colas, chocolate or cocoa. Foods which can trigger an attack include dairy products such as milk, buttermilk, cream, sour cream, yogurt, hard/aged cheeses, cheddar, brie, processed cheeses, fats and lard. Meats/poultry triggers include processed meats containing sodium nitrite (e.g. hot dogs, bologna), aged, cured smoked, marinated meats, organ meats (e.g. chicken livers). Fish triggers include smoked or dried fish, pickled herring. Vegetable triggers include broad beans, most peas, onions, pickles, olives, sauerkraut. Grains/breads that may precipitate an attack include yeast breads, white breads and sourdough. Soup triggers include any soup containing the additives MSG or yeast and soups from bouillon cubes. Fruit triggers include citrus fruits, other fruits e.g. bananas, figs, raisons, papaya, kiwi, plums, pineapples, avocados. Deserts triggers include chocolates, ice cream, cookies/cakes made with yeast, potato chip products, nuts. Additives such as MSG and other flavor enhancers, artificial sweeteners, seasonings and spices may sometimes be dietary triggers. Start a headache diary for everything you eat or drink and all the medications you take. By checking the diary later you may be able to find out which foods or medicines are bringing on the attacks. If you have menstrual migraine, you may obtain relief by wearing a low dosage (one-fifth of the birth control dosage) estrogen patch on your buttocks. This is worn for three to nine days or during the time you normally get the migraine attack. The estrogen patch evens out the hormonal level, which usually drops just before your cycle starts. If you have more than two migraine attacks a month, you may need to take migraine prevention medications. Anti-seizure medications such as Topamax or Trileptal, antidepressants such as Elavil or Lexapro, beta-blockers such as Propranolol (Inderal), calcium-channel blockers such as Amlodipine (Norvasc), and the anti-inflammatory/muscle relaxant Zanaflex (Tizanidine) help to prevent migraine attacks when taken regularly. It is important to check if you have high blood pressure and treat it as high blood pressure may contribute to headaches. Inderal and Norvasc can both treat high blood pressure as well as prevent migraine. Also check or re-check your eyesight as eye strain may contribute to headaches. Riboflavin (Vitamin B2) has been shown to prevent migraines when taken regularly. Take 200 mg twice daily. This may also be combined with Valerian root to get restful nights sleep (1000 mg at bedtime). Another herbal medication that may help prevent and treat migraine headache is feverfew. Take one to three capsules daily. It takes a few weeks to notice the effects. Feverfew is available at your local health food store. The label should state that it contains 0.2% parthenolide – the active ingredient.
Apply a cold cloth or ice pack to your head, or splash your face with cold water. Take herbal supplements such as Quercetin, Rutin, Curcumin, Red Wine tablets, Cinnamon and Ground Clove Extracts. These contain polyphenols which are the best anti-inflammatory agents that nature has provided to us. Take over the counter pain relievers such as Excedrin. Relax if possible. Lie down in a quiet, dark room for several hours. Listen to soft music, sleep or meditate. Your doctor may prescribe migraine triptan medications such as Sumatriptan (Imitrex), Zomig, Frova or Axert tablets. Sumatriptan is available as an injection and your doctor can teach you how to give yourself the injection. Sumavel is an injection of Sumatriptan that uses compressed air and does not have a needle. It is easier to use than the regular Imitrex patient injection kits. Imitrex and Zomig are also available as a nasal spray. Carry your medications with you at all times. Migraine medications used to abort an attack are more effective if taken at the onset. Older migraine medications such as Ergotamine or Midrin are not as effective and may be associated with more side effects such as nausea, vomiting, chest pain, increasing headache or cold extremities. Ergotamine tablets can be taken by mouth or sublingually which means you place the tablet under your tongue. D.H.E. (Dihydroergotamine) is a derivative of ergotamine with fewer side effects and is given by injection or nasal spray to treat migraine. The nasal spray formulation is called Migranal and is made by Novartis. You may call the company hotline at 888 697-3543 to obtain a free video on how to use D.H.E. spray. Migranal may be expensive and if you cannot afford the price, a compounding pharmacist can make up generic D.H.E. nasal spray for you at a fraction of the price. Other medications used to treat migraine attacks include capsaicin (0.075% ointment applied in the affected side of your nostrils), Lidocaine nose drops and medications such as Phenergan or Reglan to treat nausea and vomiting. Strong but gentle anti-inflammatory medications include Tolmetin sodium or Diclofenac. Either medication is 10 times stronger than Motrin and very effective. Strong short acting pain medications such as Vicodin ES or Norco 10 may be given. With severe pain, your doctor may prescribe strong short acting pain medications such as Demerol tablets. Long acting strong pain medications such as Oxycontin are not advisable as they may lead to rebound headaches when taken every day or for too long.. Drugs that help control a migraine crisis include an intravenous (IV) infusion of the anti-seizure drug Depacon combined with IV infusion of magnesium sulfate.

Call your Doctor: If your headache is associated with crossed eyes, paralysis or inability to speak or if it persists for more than 24 hours.