DEAR DR. GOTT: Many, MANY years ago, probably the 4th year in my career as a flight attendant, I was on a cross-country overnight flight. All was quiet and most of my passengers were asleep except one. I watched as he tried to find a comfortable position, fidgeted around and finally ended up bent over with his head in his hands. I finally asked what I could do to make him feel better. “Nothing”, he said. When asked if he felt like he was going to pass out, he just nodded. I got an ammonia inhalant, popped it, and waved it under his nose, then put it in his hand. I returned to the buffet area. A few minutes later, he was standing by me with a bewildered look on his face. “How did you know what to do”, he asked. When explaining I just thought he looked dizzy, he indicated he’d had migraine headaches forever and this was the first time something had completely stopped one…just like THAT! We were both amazed and I’ve always wanted to check it out. I’ve waited much too long to ask you about it. Maybe it has something to do with enlarging blood vessels. So, what happened?
DEAR READER: To begin with, let me discuss migraines in general before I respond to your question. Almost 30 million Americans suffer from migraines which can cause nausea, vomiting, extreme sensitivity to light, odors, or sound because of the intense, throbbing pain experienced. An attack can last from several minutes to a few days. The frequency varies from person to person. The condition may begin in childhood, during adolescence, or into early adulthood and may or may not progress through four stages.
The first stage known as prodrome or forewarning has one or more “signs” one or two days prior to the migraine and may include a food craving, diarrhea, depression, hyperactivity, and more. The second stage is aura. Not all sufferers experience this but if it occurs, it may be in the form of a prickling sensation in an arm or leg, problems with speech, visual loss, or seeing light flashes, bright spots and a variety of shapes. A less common occurrence of an aura is weakness of one limb. The third stage is the attack and can cause blurred vision and lightheadedness that can be followed by fainting, nausea, vomiting, and throbbing pain on one side of the head (although some may experience bilateral pain). The final phase known as postdrome, occurs following an attack when an individual may feel relieved and even excited and at the same time, physically exhausted.
What is known is that migraines may be caused by a serotonin imbalance, a neurotransmitter in the brain that constricts blood vessels with changes in the brainstem and how it interacts with the trigeminal nerve. Serotonin levels drop during an attack.
This action may cause the trigeminal system to release neuropeptides which travel to the outer covering of the brain, resulting in head pain.
Some of the more common triggers include stress, bright light, foods to include chocolate, excessive caffeine, MSG, red wine, brewer’s yeast, nuts, aged cheeses, a modification of sleep patterns, and specific medications to include nitroglycerine and oral contraceptives.
Diagnosis often begins with a history and examination presented to a physician. When necessary, he or she can order a CT or MRI. If an underlying condition such as meningitis is suspected, a lumbar puncture might be ordered.
There are two types of treatment for migraine sufferers, preventive and pain-relieving. Preventive medicine is aimed at reducing the frequency and severity of attacks. It is intended for those who have two more migraines per month, pain-relieving medicines aren’t working, or if prolonged numbness, weakness or aura is experienced. These preventives include beta-blockers, certain anti-depressants, Botox, cyproheptadine (an antihistamine), and some anti-seizure drugs. For women, reducing estrogen by avoiding estrogen-containing medications may be beneficial. For most sufferers, pain-relieving meds taken at the first sign of a migraine is enough. These drugs include over-the-counter pain relievers, triptans, ergots, anti-nausea medications, narcotics and dexamethasone (a corticosteroid).
Chiropractic, acupuncture and herbal remedies may further help some individuals maintain control. It is unclear exactly how or why oxygen therapy works to alleviated symptoms for some sufferers; however, as you questioned, blood vessels do dilate during an attack. Since oxygen constricts blood vessels, it may allow the brain to return to normal functioning, reducing or eradicating the attack. When your passenger got a jolt of an ammonia inhalant, his breathing increase, getting more oxygen to his brain. Unfortunately, as I see it, problems occur when a migraine sufferer doesn’t have oxygen immediately available. So, unless he or she carries ampules of smelling salts or an oxygen tank around at all times, this isn’t always a viable option. Fortunately, you provided an alternative method without realizing it.
Non-drug prevention might be accomplished with regular exercise such as walking or swimming and the avoidance of foods and scents that might trigger an attack.
Readers who would like related information can order my Health Report “Headaches” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.
