MIGRAINE TYPE HEADACHES

 Most headaches are both vascular and muscle-tension type (Mixed).  This type of headache exists when both vascular and muscular systems co-exist.  Typically these combined migraine (vascular) and muscular symptoms result in bilateral or unilateral severe headaches that can last many hours per day and many days of the week.  Migraines can be preceded by an “aura”.   An “aura” is a transient visual or motor prodrome.  The attacks are usually associated with anorexia, nausea, and vomiting.  Migraines have a familial history and are more common in females.

 Migraine headaches are usually brought about by a variety of stressful situations.  Another triggering factor is change in hormonal levels as in menstruating females or changes in blood sugar as in hypoglycemia.  Certain foods such as alcohol, chocolate, nuts, or aged cheese can precipitate an attack.  Physical stimulus such as a stuffy room or bright lights can also be a trigger.  The typical migraine personality is compulsive, ambitious, and emphasis on perfection.

Medication used for migraine headaches include nonsteroidal anti-inflammatory drugs, Ergotamine, Methysergide, Lithium, Beta-Blockers, muscle relaxants, and Ca channel blockers.  For headaches that do not respond to medication and have a high frequency and duration effect, Botulinum Toxin (Botox) works best.

Botox injections for Migraines are FDA approved and have been shown to reduce the frequency, maximal severity, and duration of the headaches.  Most investigators believe that Botox decreases the muscle tone by inhibiting the release of acetylcholine as well as other neutrally active substances and thereby, usually prevents the headache from occurring.  The Botox treatment is usually repeated 3 -4 times per year.  Most PPO insurances cover treatment of Migraine headaches with Botulinum Toxin.