Ending the pain

HOUGHTON – Migraines can be horrifically painful and completely debilitating, but a wide range of treatments offer hope for almost anyone suffering from chronic headaches.

“If you’ve had migraines for a long time and gave up, there are lots of new options,” said family practitioner Dr. Mariana Perinot, who practices at the Aspirus Keweenaw Medical Arts Clinic in Houghton.

Perinot said doctors, nurse practitioners and staff at the clinic these days regularly recommend physical therapy, relaxation, exercise and even acupuncture, as well as modern pharmaceutical medicines that cause fewer secondary problems than previous drugs.

“Treatments used to have horrible side effects,” acknowledged clinic Nurse Practitioner Joan Suits, a certified acupuncturist.

“With migraines I like to treat with as many approaches as possible,” she said.

Perinot said scientists still aren’t sure of the exact cause of migraines, but they’re generally believed to be primarily a neurological issue, with genetics playing some role. In general, she said, “no one really seems to understand the causes, or who’s going to get a migraine when exposed to a certain trigger.”

All sorts of hormonal and environmental factors can bring on the start of a headache in different individuals, including caffeine usage or withdrawal, dehydration, overuse of medication, vision problems, jaw joint issues from grinding or clenching teeth, or even a tight neck.

“Sometimes certain foods seem to be a trigger,” Perinot said. “For me, certain odors trigger migraines.”

About 17 percent of women have been diagnosed with migraines, compared to about 6 percent of men. In women, the headaches are often correlated with hormonal changes during the menstrual cycle, or with pregnancy.

It can sometimes be hard for medical workers to determine whether or not a headache is a true migraine, but Perinot said migraines are characterized by a sharp pain behind the eyes or eyebrows, sensitivity to light or sound, nausea and the fact that the pain has become disabling. Also, sufferers sometimes see auras around other people or objects.

“The definition is often a matter of degree or severity, rather than the type of headache,” Perinot said.

Migraines normally last from a few hours to a few days.

Suits offered a more visceral description, based on her personal experience from before she got migraines under control.

“It felt like a giant ice pick through my head,” she said. “I thought I was going to die.”

Perinot warned that extremely painful headaches can be serious problems, and that “if you feel like you’re having the worst headache of your life, you should probably go to the emergency room.”

When dealing with a new patient, Perinot said she first looks at the context of a person’s headache to understand what factors might be involved. Next, she asks the patient to keep a headache diary, to record how often headaches occur, for how long, and any factors that may have played a role.

She says it’s important to have a good idea what’s going on, and if headaches are actually migraines, “before we start giving out big-time medications.”

At that point, depending on what physical factors have been discovered, and what patients are comfortable with, systematic treatment can begin.

Pharmacological treatments might include antidepressants, anti-seizure or blood pressure medication for preventative treatment, or Imitrex, which narrows blood vessels around the brain, to help handle immediate symptoms.

Magnesium supplements can also help, as can stretching, physical therapy, exercise and even botox injections for patients who are depressed or carrying a lot of tension.

Combining therapies can be especially effective.

“There’s nothing that says you can’t do acupuncture as well as lifestyle changes and medication,” Perinot said.

Sometimes, finding the proper regimen is a matter of trial and error. Clinical Supervisor Nichole McCloskey suffered from migraines for about 15 years before starting on a preventative drug she’s found effective.

“Traditional beta blockers didn’t work, but TOPAMAX worked, and I got my life back,” McCloskey said.

If none of the standard methods help a patient with migraines, Perinot said she’d then refer the patient to a neurologist, who can usually help in even the most stubborn cases.

She warned against trying to treat migraines without help, as overuse of painkillers can cause rebound headaches that just worsen the problem. If you do use over-the-counter pain killers, she said, always start with the lowest possible dose.

Better yet though, she said, seek help.

“There’s no reason to be suffering from migraines regularly when you can decrease them with medical attention,” Perinot said.