Return to Learn, Return to Play, Return to Life: Recovery from Concussion in Childhood
When most people think of migraine, they describe an aura of wavy vision, followed by an intensive headache that lasts several hours, requiring complete bed rest in a dark room until the symptoms pass. While 28 million Americans are diagnosed with this classic type of migraine, atypical forms of migraine are even more common, and widely misdiagnosed.
Symptoms of migraine: Migraine is most often a lifelong condition that can vary within an individual over the lifespan. One can experience a few to several classic migraines with severe head pain in their teens or twenties, with the presentation of migraine changing significantly over time. Symptoms of vertigo, nausea, motion sickness, light and sound sensitivity can increase, while the number of episodes of severe headache can decrease. To further complicate the diagnosis, if headache is present at all, it can be dull and low grade, and can occur at different times than the other associated symptoms. Many patients will have a mild, low grade headache that is constant, rather than the headache that comes and goes. Additional symptoms of migraine can include dizziness, nausea, sinus pain and pressure with no sinus disease, facial or head pain at the surface, stuffy or runny nose, ringing in the ears, sharp ear pain that lasts seconds, visual disturbances, retention of fluid, anxiety, sensitivity to bright lights and sound, and fatigue/lethargy.
What is Migraine?: People with migraine typically have an inherited problem in the ion channels in the brain. It can also occur after brain injury or concussion. This disorder results in a sensitive brain. Abnormal electrical activity occurs in the brain, resulting in changes to the flow of nutrients and neurochemicals in the brain. This leads to changes in blood flow.
What Triggers Migraine?: The sensitivity of the migraine brain results in a low threshold to stimuli such as loud noise, bright lights, busy environments, stress, or strong smells. Exposure to excessive motion or intensive exercise can trigger migraine. Some people become so oversensitive that day to day life becomes a regular trigger due to the low threshold for stimulation. In addition, triggers may include weather changes, low blood sugar, dehydration, sleep pattern changes, and diet. Dietary triggers are common, but can be very complex. In many cases, symptoms of migraine occur days later, or only after a certain amount or combination of foods occurs. Common food triggers include: red wine, aged cheese, yeast in bread and yogurt, coffee, MSG, artificial sweeteners, nitrates in packaged foods and processed meats, and gluten/wheat products. Physical stress such as heat, hunger (low blood sugar), and lack of sleep are common triggers. Hormone changes associated with menstruation or menopause are also known triggers.
Treatment: Understanding your brain, getting the proper diagnosis, and learning about trigger avoidance is key to success. Elimination diets are the often the first step in gaining understanding about food triggers. Regular meals, sleep patterns and exercise are other keys to success. Medications are at times required to break the cycle of chronic, atypical migraine. Medicines that elevate the threshold above which migraine is triggered are most beneficial in the long run. Pain killers cover the symptoms, and can increase the frequency of headache in a rebound process. Medications originally used for blood pressure control, seizures, or depression are some of the most effective at controlling the sensitivity of the migraine brain. Working with a physician who specializes in atypical migraine is paramount.
Migraine and Vertigo: Up to 50% of patients with migraine experience vertigo. Many patients with vertigo and no headache have a history migraine in their past, or a strong family history is present. The prevalence of migraine in patients with Meniere’s disease is 50-85%, while the general population incidence is 13%. ENT and Neurology physicians specializing in dizziness are recognizing the connection between Meniere’s disease and migraine. It has recently been discovered that the tiny blood vessels in the inner ear are innervated by branches of the same nerve (Trigeminal Nerve) that innervates the blood vessels in the brain that are most often affected in migraine. It is becoming clear that many patients with symptoms of Meniere’s disease respond well to adding treatment for vestibular migraine.
Physical Therapy for migraine and dizziness: The best outcome is indeed the broad approach of trigger avoidance, regular sleep, and exercise. For many patients with chronic conditions, the combination of medication and vestibular rehabilitation will be most effective. When an individual has been dizzy for several months, the balance system maladapts to the symptoms. This results in excessive use of vision to stabilize balance, making busy visual environments, reading, and computer work difficult to tolerate. The vestibular system can also be suppressed by the brain, resulting in difficulty walking in the dark and limiting tolerance to rapid head motion. Julie Knoll has extensive experience working with patients with vertigo and migraine, and works with many excellent doctors for medical diagnosis of the condition. Vestibular rehabilitation and education for vestibular migraine may work for you.
References and Resources:
Migraine-More than a Headache. Michael Teixido, MD and John Carey, MD. Johns Hopkins Otololarygology-Head and Neck Surgery.
http://dizziness-and-balance.com/disorders/central/migraine/mav.html Heal your Headache.
The 1-2-3 Program by David Buchholz, MD