There are headaches, and then there are headaches. For up to 17 percent of women and 6 percent of men, migraines are the mother of all headaches. “Actually, most of the headaches that cause people to seek medical care are migraines,” says Dr. Todd Silverman, a neurologist with St. Luke’s Hospital Brain and Spine Center. Symptoms of a migraine may include severe, throbbing pain, often on one side of the head; scalp tenderness; nausea and vomiting; and sensitivity to bright light and loud noise.
“Sometimes a visual disturbance will precede or accompany the headache,” Silverman says. “Occasionally, dizziness, confusion, numbness, tingling or weakness can be part of the picture. Most people with a migraine just want to rest in a dark room. Although a migraine is usually not dangerous to health, it can be miserable and debilitating.”
Silverman notes that milder headaches, often classified as tension or sinus headaches, may actually be caused by the same neurological mechanism as a full-blown migraine. For this reason, accurate diagnosis is key and begins with a careful history and physical. Physicians then work to identify specific triggers that may set off a migraine. “This takes time, and it takes a doctor who knows headache well,” he says.
While eliminating triggers may be all that’s needed for some patients to experience relief, many require some type of medication both to prevent and treat migraines. Over-the-counter pain medicines like Excedrin may be helpful, but using them too often can cause rebound headaches. “When medication is required, a triptan is usually prescribed for the occasional severe headache,” Silverman says. He also treats many patients who have frequent, severe migraines with one of several types of medication known to help prevent them, such as a beta blockers, antidepressants or antiepileptics.
Pilar Williamsen, a chiropractic physician who works regularly with health professionals at St. John’s Ryan Headache Center, agrees that identifying triggers and physical conditions that may exacerbate headache pain is an important first step in treatment. “Headaches can have a mechanical cause that results in inflammation,” she notes. “Tight muscles or problems with the jaw can also irritate nerves.”
Williamsen’s chiropractic approach considers the biometrics in the neck and head. Acupuncture is one type of treatment she uses to gently relax nerves and decrease inflammation. “If the patient has an acute migraine, we sometimes can use acupuncture needles in the wrist or feet to help increase the body’s production of pain-relieving endorphins,” she adds.
Identifying psychological or lifestyle related stressors that may contribute to migraines is another aspect of diagnosis and treatment, explains osteopathic physician Dr. Rajiv Yadava. Using the osteopathic emphasis on the musculo-skeletal system, Yadava also pays close attention to the spine and pelvis region, particularly looking for signs of strain. He adds that allergies and hormonal shifts also can aggravate migraines.
Using treatments that may include osteopathic manipulation, acupuncture and trigger-point injections, Yadava instructs patients to take it easy for 24 hours after treatment. “I do the initial work and help the body relax as much as possible,” he says. “The body’s healing capacity and Mother Nature do the rest.” Yadava notes that when the body is healing, patients also may notice improvements in their bowels, allergies or other problem areas. “And a lot of migraines do have an emotional component,” he adds. “Relaxation reboots the body and allows it to function as it should.”