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The basics of migraine, chronic or not

Migraines are painful, they come on suddenly and they're more common than you think. But there are ways to manage triggers and treat the condition effectively.

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.

  Lorraine Rapp: What is a migraine and how is it different than other types of headaches?

Dr. Mark Green: Migraine is by far the most common headache that drives the visit to the office. Tension headaches are actually the most common headache but tension headaches are minor. People self-treat and they don't need medical attention. But migraines are very disabling and actually if your headache clinic, 90 percent or more of the people you see have migraines.

Rapp: What are the common symptoms of a migraine?

Dr. Green: Well firstly [a] migraine’s genetic. The cause is typically something you inherit. I think a good way of looking at it is if you have a low threshold for headache. In other words it doesn't take very much for you to get a headache. Migraines are often terrible and sometimes they’re really minor. Sometimes people with migraine have nothing more than a little yawning and a slight headache as well. Most common is a throbbing headache but it doesn't have to be throbbing it can sometimes be squeezing. It’s often on one side but sometimes it’s both sides and you are typically sensitive to light and sound. You may have nausea. For the many, many symptoms you have to be very flexible, and a person with migraine has migraine. I mean, that’s their biology.

Rapp: You say it's genetic. So what is it that runs in the family?

Dr. Green: The top of the brain, the cortex, the surface of the brain is very excitable and I think it's that excitability of their cortex of their brain which is what they inherit. People with migraine have a sensitive brain, and it's sensitive to a lot of things [such as], missing a meal, over sleeping, under sleeping, stress to various hormones, and particular drops of hormones. It's the genetic sensitivities which you inherit. 

Linda Lowen: There are many things that can trigger a migraine in a particularly sensitive person. What might those be?

Dr. Green: If you look at the triggers for migraine, they'll trigger a headache in anyone but it doesn't take much to trigger it in a migraine person. In other words, if everyone out here had a gallon of Kyunki (?), everyone's going to get a headache. But a person with migraine may have a glass of Kyunki (?) and get a headache. So it's the amount. You should be able to miss a meal without a bad headache. You should be able to get through a period without a bad headache. If you don't, that's probably migraine. The triggers don't define the diagnosis. The triggers are just relevant in someone who has migraine. 

Rapp: Can you tell us what is the treatment for migraines once the diagnosis is made?

Dr. Green: First thing is we try and define triggers, if we can. We try and behaviorally fix that. That's hardly ever enough, but that's something we would do. We sometimes use herbal treatments. Although, honestly, I don't think they're nearly as effective as most medications. If someone has headaches that are fairly frequent, six or more a month, we often use preventive drugs. In terms of what you take when you get an attack, the most common ones we use are called trip tans. Those are often effective not just in terms of the headache but in terms of all the other migraine symptoms. For those to work you have to take them right away. And so a lot of the failures of medication is that you delayed treatment. Too many people sit and say , “Well, let me see how it goes.” I can tell you how it goes, it'll go badly and so 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.

More of this interview can be heard on "Take Care," WRVO's health and wellness show Sunday at 6:30 p.m. Support for this story comes from the Health Foundation for Western and Central New York.