DR. KESTNER: Causes Of Migraines Remain Unclear

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Migraine headaches sufferers know that this condition can steal your life away, one day at a time.

Throughout the years that I have treated migraine patients, I have heard countless stories about sufferers having to wake up every day, wondering whether it's going to be a bad day.

Sometimes, they tell me that co-workers or family don't seem to understand the magnitude of a migraine. They are often met with a stone wall of indifference when they attempt to explain their symptoms.  Acquaintances may seem to be completely unsympathetic toward their pain or dismiss them with a "Take an aspirin and get over it," attitude.

Migraines are different from other types of head pain. Migraine sufferers experience more symptoms than just pain. When a migraine strikes, even simple, ordinary tasks seem nearly impossible.

Migraine patients often lose work time due to the condition. They may also be faced with trying to carry on at the workplace in an impaired condition, unable to think and perform like they normally would.

Migraines usually don't respond to typical headache medications. In many cases, patients have been through a gamut of various trials of over-the-counter and prescription medications that still come up short.  

For others, the only thing that brings relief is a drug cocktail that sedates them long enough to last through the migraine pain.

Many migraine patients take prescription medications daily in an effort to prevent the episodes. Sometimes, the drugs work, sometimes they don't.

In my experience, acupuncture, chiropractic and other alternative care have been very helpful for many migraine patients.  

For some, the problem has actually been resolved completely. In a minority of cases, the results are minimal or nothing. However, most patients report fewer episodes of migraines and less severe symptoms when the headaches occur. Patients generally respond positively.

It is not unusual for patients to improve so well that they are able to discontinue their medication after receiving clinical acupuncture.

As a result, primary care physicians are now recommending their migraine patients try acupuncture to reduce their need for medication.

The variations in response are likely due to the headaches having different triggering mechanisms.

For many years, the mechanism of migraine was thought to be an initial constriction of blood vessels in the brain. This was believed to cause the aura that some migraine patients experience.  

The theory went on to explain that when the blood vessels constricted, this action resulted in a decrease in oxygen getting to brain cells, causing the odd sensation that is known as an aura. Reflexively as a survival response, the brain immediately reacted by dilating the vessels which in turn caused the head pain and other symptoms.

Although this theory seemed to explain the entire migraine phenomenon very neatly and became very popular, it turns out that it was not accurate.

Recent research using brain scanners that can detect vascular blood flow in detail have disproven this theory.  

So, if this mechanism is not accurate, what does cause the disturbing and incapacitating symptoms of a migraine attack?

The answer still isn't quite clear.

Recent research has shown that prior to the migraine attack levels of the neurotransmitter serotonin drop significantly. One action of serotonin is to cause constriction of blood vessels in the brain.  

One of the drugs used widely to prevent or stop a migraine once it has begun, Sumatriptan (sold as Imitrex), acts on a molecular level to prevent serotonin from acting on blood vessels within the brain itself. This has been a tremendous help for many migraine patients, although the results are not perfect. Side effects can range from unpleasant to severe.

It has also been found that during a migraine attack, a wave of electrical discharge begins near the back of the brain and radiates toward the front. This event has been likened to a severe electrical storm passing through the brain. It is thought that in some individuals the wave of electrical energy causes the disorientation and leaves the nerve cells of the visual center exhausted and unable to function properly for some time, and thus, causes the visual impairment.

Next week: news about a simple nutritional supplement that may prevent migraine.
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