Migraines

1. Migraines Adam Smith

2. Migraine Defined Migraine: Disorder where frequent extreme headaches can occur from a few times in a lifetime to almost every day. Average occurrence is 1-3 times per month Associated with nausea blurred vision Extreme headache:usually isolated to one side of the head Sensitivity to light and sound

3. Phases Prodromal Phase – Anytime from a few hours to a few days before the headache. Does not occur in all cases. Aura Phase – Comes just before the headache. Does not occur in all people Headache Phase – Excruciating pain(Maybe) Postdromal Phase – After the pain phase. Sufferers can still feel ill and fatigued but some feel well rested and even euphoric.

4. Triggers Commonly, factors known as triggers can cause a headache and may include Food – specific to a person Weather – high humidity with extreme temperatures. Chinook winds in Canada. Stress

5. Prodrome Occurs in about half of people who have migraines Symptoms are specific and usually consistent to an individual. They may include Altered mood Irritability Depression Euphoria Fatigue

6. More Prodromal Symptoms Yawning Food Cravings Stiff Muscles Constipation Diarrhea Increased Urination Can be considered the 'warning phase'

7. Aura Phase The Aura Phase occurs just before the headache phase. Includes many types of sensations and hallucinations. Occurs in less than 1/3 of migraine sufferers.

8. Visual Aura Most common of Aural events Include: Flashes of white light Photopsia – Flashes of colored light Fortification Spectra – lines that look like the battlements of a castle Tunnel vision Blurred or cloudy vision

9. Somatosensory Aura Pins and needle feeling begins in a hand or arm and then spreads to the face Vertigo Aphasia - Inability to understand language Touch Sensitivity

10. Other hallucinations Auditory Olfactory

11. The Pain Phase The pain phase usually begins about 1 hour from the end of the aura phase, if one is present. Pain can be unilateral or bilateral and will usually change Unilateral pain will usually switch sides from migraine to migraine Slow increase in pain and then a slow decrease Lasts 4-72 hours in adults and 1-48 hours in children

12. The Pain Phase continued Most people do not eat and experience nausea but only 1\3 experience vomiting During the pain phase most people are hypersensitive to light, smell, and sound and will occupy a dark quiet place for the duration of this phase. Signs of illness such as cold clammy extremities, sweating, diarrhea, nasal discharge and congestion, sore muscles, blurred vision, fever, and lightheadedness have been seen.

13. Postdrome phase During this phase the victim of the migraine may feel many of the symptoms of the pain phase to a lesser degree as they recover. In some cases, people have reported that they feel euphoric and energized afterward.

14. Treatments Avoid Triggers – people report success but it hasn't been proven. Treat Symptoms – Home remedies or medication Preventative Drugs – many different variations

15. Phsyiology Two different theories...

16. Vasodilation Vasodilation – the increase of the diameter of the blood vessels. The dilation of the superficial cranial arteries is believed to cause migraine. The increased dilation of the blood vessels in the brain cause pressure on the brain and the throbbing pain is a result of that pressure. As the dilation spreads across the brain, the pain also spreads.

17. Vasodilation studies Sargent et al. 1972 Treated 62 migraine patients using biofeedback for warming the hands. 74% showed improvement Theory: Warming the hands relaxes the parts of the sympathetic nervous system that controls the blood flow to the hands. This increases blood flow. This relaxation of the SNS is then assumed to spread to other parts of the body, including the head, increasing blood flow and thus alleviating the migraine

18. Another Study Blanchard, Theobald, Silver, Williamson, and Brown. 1978 Three groups: 1. Skin temp. BFT and relaxation 2. Relaxation only 3. No treatment Both of the treatment groups saw improvement. There was no correlation between expectancy and effectiveness of treatment.

19. Cooling vs Warming Blanchard et al., 1997 4 groups: 1. Stabilize Temperature 2. Hand Warming 3. Hand Cooling 4. Suppress Alpha in EEG All but group 1 showed improvement and groups 2 and 3 lessened medication.

20. Another Test Gauthier et al. 1983 Suggested that BFT for vasoconstriction would alleviate migraines better than BFT for vasodilation Results showed that both vasodilation and constriction showed same improvements, while the control showed no change. Gauthier theorized that both groups allowed for greater regulation of vasomotor activity, which decreased the variability of vessel dilation Low variability correlates with less migraines

21. Neuronal model Cortical Spreading Depression – Functioning in the cortex is depressed which leads to the release of inflammatory mediators. These inflammatory mediators irritate the trigeminal nerve.

22. New Theory Schwerzmann M, Wiher S, Nedeltchev K, Mattle HP, Wahl A, Seiler C, Meier B, Windecker S. 2004 Migraines may also be caused by a lack of oxygen due to a patent foramen ovale. Needs more research

23. Conclusion Haiku Inconclusive tests. Migraines are hard to study. Interlinked theories.

24. References Holzhammer J, Wober C (2006). "[Alimentary trigger factors that provoke migraine and tension-type headache]". Schmerz 20 (2): 151-9 Low Tyramine Headache Diet (116 Kb PDF) pp. 2. National Headache Foundation (October 2004). Retrieved on 2006-10-12. Prince PB, Rapoport AM, Sheftell FD, Tepper SJ, Bigal ME (2004). "The effect of weather on headache". Headache 44 (6): 596-602. Cooke LJ, Rose MS, Becker WJ (2000). "Chinook winds and migraine headache". Neurology 54 (2): 302-7 Schwerzmann M, Wiher S, Nedeltchev K, Mattle HP, Wahl A, Seiler C, Meier B, Windecker S (2004). "Percutaneous closure of patent foramen ovale reduces the frequency of migraine attacks". Neurology 62 (8): 1399-401 Young, William B. and Silberstein, Stephen D., Migraine and Other Headaches. St. Paul, Minn: AAN Press, 2004. Evans, Randolph W., MD, and Matthew, Ninan T., MD. Handbook of Headache, Second Edition. Philadelphia: Lippincott Williams & Wilkins. 2005. Silberstein, Stephen D.; Lipton, Richard B.; Goadsby, Peter J. Headache in Clinical Practice Second Edition. Andover: Thomson Publishing Services. 2002.