For thousands of years, a significant percentage of humanity has suffered with intense, long-lasting, and disabling headaches called migraines.  This term is derived from the initial name of “hemikrania” or “half of the head ; since the times of Hippocrates and Plato it was known that these wicked neurologic “storms” classically  involved  just one side of the brain.  They are associated with unusual preceding symptoms, marked aversion to bright lights and loud noises, nausea, vomiting, terrible pulsating head pain that lasts for hours or even days, and prolonged extreme fatigue once it has passed.  They remain a major cause of disability in this country.  Unfortunately, despite centuries of studies and experiments, this condition remains poorly understood and poorly-controlled.  Great minds such as Thomas Jefferson, Sigmund Freud, Virginia Wolfe,  and Lewis Carroll were haunted by  these recurring “super headaches” but powerless to advance our understanding or treatment.  The only truth that seems to emerge from a historical analysis of migraines is that they are one of nature‘s truly powerful events:  a hurricane in the brain, so to speak.

Migraine headaches differ from common/tension headaches not only in their severity but in their pattern.    A significant number of migraine sufferers—or migraneurs, as they are called—experience an “aura” hours before the pain begins.   The aura is a neurological phenomenon thought to be caused by reduced blood flow and/or reduced brain activity in certain brain areas—this  MAY be the initiating item, the “first domino”, in the series of events that culminates in the pounding  headache.    Auras most commonly are visual—such as seeing flashing lights that aren’t really there, or wavy, shimmery lines, or NOT seeing something that IS there, such as visualizing a person with a white or black void where their face should be!   Other auras, caused by low brain function in a different part of the brain, are olfactory—people smell things that aren’t there, like oranges or coffee.  Or an aura might start in the part of the brain that has to do with sensation, so the migraneur experiences numbness or tingling in part of their body.  These hallucinations can actually help the headache sufferer by warning them that the migraine is coming.   Early recognition and treatment is a crucial aspect of successful migraine management.

Migraines remain mysterious—no one is really sure what causes the extreme symptoms of these headaches.   For a long while it was felt that a “rebound” dilation of the blood vessels that had constricted to cause the aura, were solely responsible for the pain.  Now, though, it is felt that other important factors, such as secretion of inflammatory chemicals into brain matter, and an imbalance of “neurochemicals” in the area between nerves cells, may be the primary cause of this affliction.  This multifactorial basis helps explain why there are many different treatment strategies.  No single one works for everybody!   The therapy model that succeeds most frequently, though,  does so by reducing the excessive blood flow in dilated arteries.  In ancient Egypt, the prescribed treatment for migraines was to write names of the gods on a strip of linen and tie it tightly around the skull.  While honoring deities probably didn’t hurt, it is felt that physically blocking scalp arteries was the helpful aspect !  Similarly, drugs such as caffeine, ergotamine and the “triptans” (Imitrex is a common brand) work by stabilizing/reducing blood flow in the head.  There is even a surgeon in South Africa who claims great success in curing migraines by removing certain non-essential scalp blood vessels!

Migraine headaches have a perplexing origin and no truly reliable cure, so prevention is a primary focus of treatment.    For many sufferers, dietary items can be the trigger, thus headache specialists urge their patients to keep detailed food diaries over extended periods of time in order to reveal any possible causative agent.  It is a lucky migraneur who discovers that they can deter these cursed neurological events by simply avoiding certain foods or food additives!  Tyramine-rich foods have been found to be the most consistent provoking agents—these include cheeses, yogurt, bacon, pickles and sourdough bread—removing these from the diet can really help.  Another helpful technique to forestall these headaches is to reduce the excitability or irritability of nerve endings in the brain.  Drugs such as beta-blockers (which are more commonly used to control blood pressure or rapid heart rate) or tricyclics (previously used to treat depression) can help deter migraines when taken daily.  And  strategies to relax the nervous system overall, such as meditation, acupuncture, biofeedback or simply getting enough sleep and minimizing stress are important weapons in controlling this severe condition.

Migraines are exceptionally painful, but in general have a benign course in the short-term.   In the long term, however, there is a small but significant increased risk of strokes for those with this condition, particularly females.   And  there are two issues regarding extreme headaches that are important to be remembered by patient and doctor alike.   Firstly, not all terrible headaches are migraines, even in a known migraine sufferer!  An intense headache that has different characteristics than one’s usual migraine, particularly if it’s “worst headache you’ve ever had” should receive urgent medical attention, as it might indicate a more ominous diagnosis.  Secondly, using even necessary and successful medicine more often than 8-10 times per month can actually provoke more headaches!  Migraines remain as one of the true enigmas in medical science; common but mysterious, a major source of human pain and disability that we cannot explain or conquer.  If you are lucky enough never to have experienced this “dark side of the brain”, be thankful, and give your migraneur friend or family member an extra hug!

Dr. Passidomo:

Dutchess county born and raised!  Born 1960 in Poughkeepsie, graduated from Rhinebeck High. Started college in Pennsylvania–was training to run a medical lab– and realized I could reach further and be a doctor.  My boyfriend at the time (Paul Passidomo) was very supportive and I doubt I would have had the confidence to change my course if it weren’t for him.  I transferred to NYU, graduated with a BA in biology, minor in history, then went on to medical school at New York Medical College in Valhalla, NY.  I have two sons, now in their twenties, and am an avid hiking, music, and skiing fan.  I’ve had the privilege of practicing with Dr. Michael Grill and our wonderful staff for over 15 years.  We are all dedicated to blending the science and art of this wonderful profession