Posted tagged ‘migraines’

Stanford headache specialist demystifies migraine auras

July 12, 2017

I have close friends who get debilitating migraines so I knew a bit about auras, which are sensory disturbances that often precede migraine headaches. But experiencing one myself was still quite frightening.

It snuck up on me: I was happily reading a novel in bed when a spot on the page became blurry, even when I closed one eye. It quickly expanded in size, turning into a flickering, zig-zag pattern. After checking online and guessing that I probably had a migraine aura, I tried to go to sleep — and that’s when it really got weird. Suddenly I saw the geometric pattern in color moving across my field of vision, even when I had my eyes closed.

Luckily, my aura lasted less than 30 minutes, so I was eventually able to go to sleep. I was also very happy to avoid the unbearable headache pain common in migraines. But my experience inspired me to learn more about auras.

According to Stanford neurologist Nada Hindiyeh, MD, about 30 percent of people that suffer from migraines get an aura before their headache pain. However, migraine auras can also occur without a headache. This used to be called an ocular migraine, but it is now classified by the International Headache Society as a “typical aura without headache,” she said.

“Aura is a term used to describe focal neurological disturbances that precede a migraine headache and typically develop over a 5 to 60 minute period and last less than an hour. The most common neurological symptoms include visual changes,” said Hindiyeh, who works at the Stanford Headache Clinic. “During a visual aura, people may describe a blind spot in part of their field of vision, sparkles or stars, colored spots, zig-zag lines, flashes of light or tunnel vision.”

A migraine aura is thought to be initiated by a phenomena in the brain known as cortical spreading depression — a self-propagating wave of electrical silence in which cortical neurons stop firing and go quiet. This starts a chain of reactions in the brain that causes the various symptoms of a migraine attack, Hindiyeh explained.

A long list of factors can trigger migraines, she said, including stress, changes in sleep patterns, hormonal changes in women, skipping meals, and eating certain foods and beverages such as high processed foods and excessive caffeine.

“Migraine symptoms can change throughout a person’s lifetime. Attacks of migraine aura without a headache are more common as migraine sufferers get older,” Hindiyeh said. “However, if you are older than the age of 40 and develop a migraine with aura for the first time, you should be evaluated by a neurologist. If needed, you may then be referred to a headache specialist.”

And it turns out I’m not the only one who finds auras frightening. “Having an aura can be quite a scary experience,” Hindiyeh said. “Talk to your doctor about what steps to take when you do have one, such as pulling over if you’re driving, taking deep breathes, lying in a dark room or taking specific medication. That way you have an action plan in place and are prepared when an aura comes on.”

Hindiyeh said she has focused her research and practice on migraines because she believes it to be an underdiagnosed and undertreated disease. “Migraine affects 36 million people nationwide and is the seventh leading cause of disability worldwide. These statistics are staggering. I felt that this was a field in neurology where I could hopefully provide care for many patients, and raise awareness about this disabling disease.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

New imaging study investigates role of dopamine in migraine attacks

April 7, 2017

Many people suffer from migraines —throbbing, painful headaches that last up to 72 hours and are often accompanied by nausea, vomiting and sensitivity to light and sound.

Although not fully understood, an imbalance in a brain neurotransmitter is thought to contribute to migraines. The neurotransmitter, dopamine, is a chemical in your brain that affects your movements, emotions, motivations and sensory perceptions, including the ability to modulate pain.

Now, researchers at the University of Michigan have shown that dopamine levels in the brain fall during a migraine attack relative to their baseline level between attacks, as reported in a recent news release.

The research team performed two PET scans on different days to study eight migraine sufferers during a spontaneous migraine and in between attacks, comparing their brain activity and dopamine levels with and without a headache. On average, these patients were 27 years old and experienced migraines about six times per month. The scientists also imaged eight healthy adults, comparing migraine sufferers to controls.

They found that dopamine levels in the brain fluctuated, temporarily reducing during migraine attacks. They also found that the study participants were more sensitive to non-painful stimuli, such as warmth applied to the forehead, during a migraine.

“With this study, we better understand how dopamine is related to the suffering during a migraine attack,” said Alex DaSilva, DDS, DMedSc, assistant professor of dentistry and of the Center for Human Growth and Development at the University of Michigan, in the video above. “Lower dopamine levels mean you are more sensitive to pain and stimulation. Second, lower dopamine levels also inhibit your behavior. You want a dark room. You want to avoid social interactions.”

In their paper, the researchers call for additional studies to confirm the results and evaluate how they can be used to develop more effective migraine therapies.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.


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