Feb 4, 2014

Interview Transcript

Hannah: If you have migraines like I do, we're going to try to figure out what's going on and what you can do about it coming up next on The Scope.

Man: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Hannah: Headaches may be one of the most common ailments, but what do you do when they are so severe that they're debilitating? Today I'm here with Dr. Tom Miller, Chief Medical Officer of the University of Utah Hospitals & Clinics and, thankfully, he's also an internist, so hopefully he can answer some of my questions.

Migraine vs. Tension Headache

Dr. Tom Miller: That's a great topic, Hannah, and the bottom line is there are essentially two kinds of headaches. There's more than that, of course, but most people know headaches as either migraine headaches or tension headaches. We tend to think of tension headaches as being the less severe of the two. They can occur with muscle spasm in the neck or too much reading, perhaps, at work, a number of issues, stress. Though migraine headache is the one that's more concerning and that tends to be moderate to severe.

Hannah: So, I often experience not just the headache but I'll feel really nauseous and sometimes I even throw up. It's weird because I feel like I need to go lie down and shut off all the lights. Would that be a migraine or a tension headache?

Dr. Tom Miller: That certainly sounds like a migraine. There are a few clues to a migraine that people should be aware of. Migraine headaches are fairly common, more common in women than in men, and they tend to last anywhere from four hours to three days. Most of them will last four to six hours. Generally, a migraine is on one side of the head or the other. It has this pulsing, throbbing quality and, yes, migraines are pretty commonly associated with worse pain with loud noises, worse pain in the sunshine and bright light, and you can have nausea and if it's severe, you can have vomiting.

Types of Migraines

Hannah: Are there different types of migraines or is there one big classification of headaches that are migraines?

Dr. Tom Miller: Good question. There are two types of migraine. The more common is called "common migraine" and that accounts for about 80 percent of migraines. Basically, the headache will start with that throbbing sensation; it's usually on that one side of the skull. It can become circumferential, on both sides of the head, over time associated with loud noise and light.
The other kind, the "classic migraine", usually starts with a premonition that you're going to have the headache. That premonition is typically called an aura. The aura generally is a flashing, flickering sensation of light in both eyes in the visual field. It can take on various forms and strange shapes. This generally lasts anywhere from five minutes to 20 minutes. Then, after it resolves, is when the migraine starts.

How to Treat a Migraine

Hannah: So, sometimes we can have a warning sign that a migraine is going to come one. Is there we can do, or I can do, to prevent it once it's started?

Dr. Tom Miller: Both "common migraine" and "classic migraine" can be treated in various ways. The good news is, over the last decade, there has been a new class of medications used to treat migraines, abort them, and get them to stop.
Many people with migraines can take over the counter analgesics, such as Ibuprofen, Aspirin, or Naproxen, and that is good enough for many people. But, for others, this class of medication, which is a prescription medication, is something that they may want to try and they would see a physician, an internist, a family practitioner, or, perhaps, even a headache specialist if the headaches were bad enough.
Most primary care physicians are versed at taking care of migraine headaches. One thing that we don't want to see happen is patients with migraines be treated with opiate or narcotic medications. So, there are definitely great ways to treat migraine headaches effectively without the use of narcotic medications.

Are Migraines Dangerous?

Hannah: Is there anything I should be concerned about? Could my migraines be a sign of something more serious?

Dr. Tom Miller: Rarely that's the case. Sometimes migraines can be a harbinger of something worse, like a stroke. Sometimes, they're not actually migraines especially if the migraine is associated with difficulties in speech, numbness in the arm, weakness in one of the arms, or weakness in the facial muscles. That's a very serious concern and you should seek immediate attention for that. It may not actually be a migraine, it might be something else.

Hannah: Wow.

Dr. Tom Miller: Also, very sudden headaches that are extremely severe need to be evaluate immediately.

What Triggers Migraines?

Hannah: Dr. Miller, I hate to even ask this because I'm a huge chocolate lover, but could chocolate be bringing on my migraines?

Dr. Tom Miller: It's possible. We have people sometimes keep diaries of what might trigger their migraines. Half the time, even with the diaries, we can't really tell what trigger them. But, in some people, if they make a one-to-one correlation then, yes, it's possible. There was a study done some time ago that showed that people who are fasting tend to get migraines more frequently than those who don't fast.

Hannah: Of course.

Dr. Tom Miller: So, perhaps, fasting is related in a way. But, in general, we're not clear on that. Migraines happen for many different reasons in people that are not easily identified.

Man: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.

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