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Finding triggers of chronic migraine and treating the condition


Only four percent of people experience chronic migraines. But all migraine sufferers can have life-long recurrences, often beginning at puberty and affecting those between 35 and 45 years old.

This week on “Take Care,” Dr. Mark Green talks about what causes migraines and how to manage them. Green is the director of the Center for Headache and Pain Medicine and professor of neurology and anesthesiology at the Mount Sinai School of Medicine. 

“A migraine is, by far, the most common headache that drives a visit to the office,” Green says. “Tension headaches are actually the most common headaches, but tension headaches are minor that people self-treat and don’t need medical attention. Migraines are very disabling.”

Migraines are genetic and, according to Green, if a parent suffers from them, a child has a 50 percent chance of developing it and is at 80 percent if both parents have them.

Symptoms include throbbing or squeezing head pain and sensitivity to light and sounds. Vomiting and nausea are also possible.

“Twenty percent of people with migraines get an aura which is something that is often visual like lights or lines or numbness or tingling.”

Someone with a migraine can develop tingling and numbness and have difficulty speaking or forming words, which can appear like symptoms of a stroke.

“People with migraines have a sensitive brain,” Green says. “It’s sensitive to a lot of things.”

However, if you typically suffer from migraines and experience stroke-like symptoms at the same time, Green says it is more likely to be a migraine than a stroke.

“When people get hand and face tingling and numbness, it’s almost always migraines even though it’s very scary,” Green says.

A person who suffers from migraines may be more sensitive to certain triggers. They can be affected by just two glasses of wine when everyone else has a headache after drinking a whole bottle.

“The triggers don’t define the diagnosis; the triggers are just relevant in someone who has migraines,” Green says.

Green says once a diagnosis is made, doctors try to find that patient’s triggers.

“If it turns out that a lot of your attacks are triggered by missing a meal, missing caffeine or oversleeping and things like that, we try and behaviorally fix that,” Green says.” That’s hardly ever enough but that’s something we would do.”

Doctors also use preventive drugs for patients who suffer from frequent headaches, six or more a month. According to Green, the drugs are often helpful, but can take some time to work.

“Even when you’re on those [preventive drugs] you need to take something when you get an attack,” Green says.

The most common drugs doctors use for patients undergoing bouts of migraines are Triptans.

Triptans are often effective in targeting migraines and their symptoms such as vomiting. However, Green says, it is important to take them right away in order for them to work.

“A lot of the failures of medication is that you delay treatment,” Green says. “The longer you wait, the less likely it is to work. We use those drugs but we say, treat aggressively and treat early and manage your triggers.”