Thursday, 24 May 2018

Is It a Migraine? Many Patients Don’t Realize What Causes Their Suffering

Migraine pain

The first of a replacement class of medicine to stop migraines was approved last week.

The medication, called Aimovig, reduces the frequency of migraines among those severely afflicted, but the drug rarely prevents these episodes altogether.

One expert called it “progress but not a panacea.

” Migraine is that the most disabling nervous disorder within the world among people under age 50, beating epilepsy, strokes, and chronic back pain.

Yet many that have migraines don’t know it or maybe mention their symptoms to a doctor.

How does one know if you've got migraines?


Migraines aren't just headaches. it's diagnosed in patients as long as they need had a minimum of 5 attacks, each lasting four to 72 hours. Each attack has got to include a minimum of two of the subsequent symptoms: throbbing headache with pain that's moderate to severe, which worsens with activity and is merely on just one side of the top.

Also, an individual suffering a migraine attack is nauseated or abhors sound or noise.

What about auras? Are they a part of a migraine?


Sometimes, but not always. About 20 percent of migraine patients get an aura before the headache. Auras involve distortions of vision.

People see jagged lights or have blind spots in their field of vision.

But auras can take other forms as well: a prickling pins-and-needles feeling on parts of the body, speech disturbances, distortions of sounds.

Some get auras without a headache or only a slight headache.

Auras actually involve different areas of the brain than migraines, and it's not clear why they're linked to migraine headaches.

How common are migraines?

They can start in childhood, although they typically begin in adolescence or young adulthood.

They strike nearly one in five women worldwide, one in 16 men and one in 11 children.

One out of 4 households has a minimum of one member with migraines.

The condition seems to spring from a mixture of genetic and environmental factors.

There is nothing an individual can do to scale back the chances of developing migraines.

Why do more women than men get migraines? Is it due to hormones?

Possibly, but nobody knows needless to say. Estrogen — the hormone that's abundant in women before menopause and present in much lower amounts in men — is one think about migraines, although not the sole one.

Migraine attacks seem to be more frequent and severe when estrogen levels change during puberty, menses, the primary trimester of pregnancy, and therefore the years before menopause.

Why do patients and doctors so often not realize a person’s
headaches are migraines?

They often think the headaches are caused by tension, stress, or dehydration, or that they're “sinus headaches” — a category that doesn’t exist.

“Sinus headaches are an invention of Madison Avenue,” said Dr. Stewart Tepper, professor of neurology at Dartmouth College.

“If you attend Europe, they don’t know what you're talking about.”

The runny nose and tearing eyes that accompany a headache are often migraine symptoms, he said.

In one study, 88 percent of patients with self-reported headache s or a physician diagnosis of sinus headache actually was having migraines.

Misdiagnoses abound. In another study, medical care providers who diagnosed a patient’s headaches as something aside from migraines were usually wrong.

Even patients with chronic migraines, defined as a minimum of 15 headache days a month, are often not correctly diagnosed.

One a large study found that only 4.5 percent of individuals with chronic migraine had spoken to their doctors about their symptoms, get an accurate diagnosis, and received appropriate care.

What works and doesn’t in treating migraines?

Over-the-counter pain relievers like aspirin and ibuprofen usually don’t work.

Sinus drugs also tend to be useless. And no treatment always prevents migraines.

Patients usually find a drug, combination of medicine, or device that helps shorten the severity and duration of migraines.

The options include a category of medicine, triptans, that help about 60 percent of patients.

They are generic and are available with prices starting from about $11 for nine pills to $70 for 2 injections to $428 for a supply of six nasal sprays.

Devices include Cefaly, which attaches sort of a rhinoceros horn to the forehead and transmits electric pulses to a nerve beneath the skin. It costs $550.

GammaCore maybe a nerve stimulator that costs $575. It’s held at the neck and transmits electric signals to a nerve there.

Another device that helps some patients is Spring TMS. It is held at the rear of the top.

Patients press a button and it sends a fast magnetic pulse into the brain.

It rents for $150 a month for the primary three months, $220 a month afterward.

The newly approved drug, Aimovig, by Amgen and Novartis, is that the first drug specifically designed to stop migraines.

it's injected once a month with a tool almost like the one wont to inject insulin.

Its asking price is $6,900 a year.

Botox can also reduce the frequency of migraines, but it's even costlier and approved just for chronic migraines, defined as a minimum of 15 days of headache per month a minimum of 4 hours per day.

The drug costs about $6,000 a year.

Although private doctors can administer it, most don’t for administrative reasons, Dr. Tepper said. So most patients need to attend medical centers for injections every 12 weeks.

With the prices of storage and costs for hospital, nurse, doctor, and room, it can cost $15,000 or more per annum, he said.

Other generic drugs which will reduce migraine frequency include antidepressants, epilepsy drugs, and a kind of heart drug — beta-blockers — that slow the guts rate and reduce vital signs.

Side effects are often significant. With topiramate, or Topamax, an epilepsy drug, they will include cognitive and mood changes, weight loss, allergic glaucoma, loss of sweating, kidney stones, and tingling of hands and feet.

What do patients say about migraines?

The pain is often terrible. Dr. Amaal Starling, a migraine specialist at the Mayo Clinic in Phoenix comes from a family of girls who get migraines — and she or he gets them herself.

Hers began with an aura that manifested as blind spots that lasted 10 to fifteen minutes.

Then a pounding headache began.

“Lights were so bright I couldn’t keep my eyes open,” she said.

“Even quiet voices seemed like loud echoing voices and made my headache worse.”

When she was in college, she began having migraines every other day and sought help at the clinic.

A doctor told her the headaches were caused by stress.

He advised her to require more easy courses and drink more water.

Finally, in the school of medicine, she took a pharmacology course and learned about triptans.

“I visited a doctor and said, ‘I think I even have a migraine, I would like to undertake triptans.

’ and that I told my relations to undertake triptans. Now we all take them.”

Lisa Johnson, 57, a billboard land manager in Quincy, Mass., said her throbbing headaches began when she was an adolescent.

Even a traditional speaking voice worsened the pain. So did bright light.
Each headache lasted four or five days.

She’d get a reprieve for each day approximately, then the subsequent headache would start.

She tried over-the-counter pain and sinus medicines, also as acupuncture, to no avail.

In her mid-30s, a headache specialist diagnosed her with migraines. But the available treatments didn’t help.

About four years ago, she entered an Amgen’s clinical test for its recently approved drug.

She had a really unusual response: her migraines stopped completely.

“I don’t even remember the pain I used to be in,” she said.“When you don’t have it, you'll live your life.”

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