If you suffer from migraine headaches, you're not alone. About 12 percent of the U.S. population gets them. Migraines are recurring attacks of moderate to severe pain.
Could that pounding headache, blurry vision and nausea be a migraine or could they be signs of something more serious?
Tune in to SMG Radio to hear Dr. Leonid Topper discuss how to accurately diagnose migraines and how to successfully treat and live with them.
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Do You Suffer from Painful Migraines?
Featured Speaker:
Learn more about Leonid Topper, MD, MRCPCH
Leonid Topper, MD
Dr. Leonid Topper is a pediatric neurologist with 16 years of experience. An Assistant Professor in the Neurology Department at Columbia University in New York City, Dr. Topper conducts a teaching clinic there several times a month. He is committed to respecting the family's preferences when deciding treatment options for the patient, whenever possible.Learn more about Leonid Topper, MD, MRCPCH
Transcription:
Do You Suffer from Painful Migraines?
Melanie Cole (Host): If you suffer from painful migraine headaches you're not alone; about twelve percent of the US population gets migraines or recurring attacks of moderate to severe pain. My guest today is Dr. Leonid Topper. He's a pediatric neurologist at Summit Medical Group. Welcome to the show, Dr. Topper. Migraines, pounding headaches--people get headaches here and there, how do you know if something is really considered a migraine?
Dr. Leonid Topper (Guest): Well, many people indeed do get occasion headache and legitimate causes for headache which can occur to any person is a situation of sinusitis or fever or head trauma. However, recurring headaches, especially severe, would not occur to any person. They usually occur to people with certain genetic predisposition. Migraine is a disorder of brain excitability. So, brain cells respond differently to different stimuli and, in the beginning of migraine attack, go to temporary shutdown so patients may experience fatigue, yawning, malaise, salt craving, and some other subtle and almost unnoticeable symptoms. Later, brain cells perk up and start firing stronger so people can see streaks in the visual fields, fields of lines, flashes of light, and then it all culminates with severe pounding headache often with nausea or vomiting, and sometimes with sensitivity to light and noise. This particular patterns affects only 12-20% of general population, and that's very distinct from any other types of headaches.
Melanie: Since migraine is one of the third most prevalent illnesses in the world, Dr. Topper, is this limited to adults? Do children get migraines? And, then, how do you know that your child is getting one? What do you do for them when they get one?
Dr. Topper: In fact, migraines most typically starts in childhood in the typical age of second decade of life, between ten and twenty. However, in my practice as pediatric neurologist, I see many much younger children, even from the age of three or even younger, because parents are more concerned and shocked when a very young child starts developing headaches and they come to medical attention earlier. Even babies can have migraines, such as when a toddler or infant develops episodes of pallor and not feeling right, especially during car rides, maybe sometimes spitting up, recurring maybe once or twice a month. It takes several years for parents to connect the dots until this very child will become verbal enough to complain of headache during one of these episodes. Then, parents understand in retrospect that this is early stages of migraines. This is not common but migraine can start even in infancy.
Melanie: If somebody is suffering a migraine, whether it's child or an adult, when people have a headache they typically just go to the Tylenol or the Motorin and take that, but does that work for migraines?
Dr. Topper: In mild to moderate case, it works well. In more severe cases, it is recommended to see a physician to be diagnosed and to be prescribed, depending on the age, more potent but also safe medications such as triptans. Triptans are not pain killers but they have a mechanism which interrupts the migraine cycle in the brain and allows the migraine to stop.
Melanie: Are there other things that you like people to try like putting a cool compress or lying down in a dark room? Give us some home remedies people can try for their migraines as well.
Dr. Topper: We usually recommend to have a small snack with calories, such as rice crackers or something like that, because quite often in children migraine happens from skipping a meal several hours prior. Usually a full glass of water or a bottle of Gatorade would be another good starting point. Resting in a dark room and possibly applying a cold object like a salad spoon or cold compress to forehead for entire five minutes can help a lot in many cases. But, at the same time, parents need to see if the migraine headache is severe pain. So, for this reason, if the child needs over the counter medicine, such as Tylenol or if they are prescribed triptans like Imitrex, that should be given also as early possible if this headache behaves like becoming severe.
Melanie: How long, typically, do migraines go on? How long does this headache last?
Dr. Topper: In adults, it can go for many hours up to several days, unfortunately. In children, migraines are usually much shorter and can go anywhere between twenty minutes to several hours. Some children have even shorter-lived headaches, which is very typical for migraines that it follows the rule, "When it comes, it's bad. When it goes away, it goes away completely." Migraine attack is usually very intense but when it resolves there is no headache whatsoever. In fact, this is the only headache type commonly encountered in real life which follows this pattern, so when we hear this pattern by history, it's quite reassuring that this is not the brain tumor or not the case of increased pressure in the head.
Melanie: If somebody does suffer migraines as a child, does that continue for the rest of their life? Can migraines go away, Dr. Topper?
Dr. Topper: Yes, migraines can behave very differently across the lifespan and, in some people, they may have severe but very infrequent attack. In some people in adolescence and college years, it can increase in frequency substantially. It is typical that in the fourth or fifth decade of life, migraines start subsiding but not always this is the case.
Melanie: What about triggers? What do you tell your patients about triggers or something that might stimulate that migraine attack? Are there certain triggers people can look out for?
Dr. Topper: Absolutely. In adults, triggers are multiple and may involve diet such as alcohol and certain foods, such as certain types of cheese, peanut butter, chocolate, exposure to certain smells and perfumes, flickering light at the work site and so on. Sleep deprivation is a huge common denominator for migraine triggering at any age. However, in school-aged children, usually there are two most common stressors and triggers. There are children whose migraines are very sensitive to the school year itself, whatever is involved in that session, sleeping less than during summer time, stressed more, being more on the schedule, having more physical activity due to seasonal sports. We call it “school year tantrum”, which blend of many other triggers related to the typical school year which is intense nowadays. There are children who are sensitive to hot and humid weather in the summer. There are, unfortunately, children who are sensitive to both. So, when the school year is over and triggering of migraine might go away, the summer comes and it continues. So, these are the most common triggers in children.
Melanie: What do you doctors do for someone with migraines that fail to respond to some of the treatments and lifestyle changes and modifications you've discussed?
Dr. Topper: In some hard to treat cases, we are always looking for some bottlenecks or obstacles in migraine cure. Common obstacles are anxiety or depression untreated and we also look for sources of stress. For example, in many children with migraine when the treatment doesn't go well, we discover school problems and undiagnosed problems such as attention problems, learning disabilities, bullying, or just other anxiety which is non-specific. In other children and adults, we find sleep apnea or medication overuse. These are common reasons when the treatment doesn't go well. But, when we eliminate this situation, the vast majority of migraine sufferers can be helped with preventive medicine, which is usually either a supplement or prescription medicine which can be given on a daily basis. In a matter of several weeks, it starts decreasing headache frequency.
Melanie: That's really great advice. Wrap it up for us with your best advice about migraines and why patients should come to Summit Medical Group for their care.
Dr. Topper: Migraines are very painful and disruptive for the lifestyle. Children in childhood and pre-college age really need to get this under control and learn how to manage this before they head to college or workforce because college age and young adults who start working are rapidly exposed to many more stressors and triggers such as sleep deprivation and so forth. If migraine is not controlled by it then, they have way less time and opportunity to get it under control.
Melanie Cole: Thank you so much for being with us today, Dr. Topper. You're listening to SMG Radio and for more information, you can go to www.summitmedicalgroup.com. That's www.summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.
Do You Suffer from Painful Migraines?
Melanie Cole (Host): If you suffer from painful migraine headaches you're not alone; about twelve percent of the US population gets migraines or recurring attacks of moderate to severe pain. My guest today is Dr. Leonid Topper. He's a pediatric neurologist at Summit Medical Group. Welcome to the show, Dr. Topper. Migraines, pounding headaches--people get headaches here and there, how do you know if something is really considered a migraine?
Dr. Leonid Topper (Guest): Well, many people indeed do get occasion headache and legitimate causes for headache which can occur to any person is a situation of sinusitis or fever or head trauma. However, recurring headaches, especially severe, would not occur to any person. They usually occur to people with certain genetic predisposition. Migraine is a disorder of brain excitability. So, brain cells respond differently to different stimuli and, in the beginning of migraine attack, go to temporary shutdown so patients may experience fatigue, yawning, malaise, salt craving, and some other subtle and almost unnoticeable symptoms. Later, brain cells perk up and start firing stronger so people can see streaks in the visual fields, fields of lines, flashes of light, and then it all culminates with severe pounding headache often with nausea or vomiting, and sometimes with sensitivity to light and noise. This particular patterns affects only 12-20% of general population, and that's very distinct from any other types of headaches.
Melanie: Since migraine is one of the third most prevalent illnesses in the world, Dr. Topper, is this limited to adults? Do children get migraines? And, then, how do you know that your child is getting one? What do you do for them when they get one?
Dr. Topper: In fact, migraines most typically starts in childhood in the typical age of second decade of life, between ten and twenty. However, in my practice as pediatric neurologist, I see many much younger children, even from the age of three or even younger, because parents are more concerned and shocked when a very young child starts developing headaches and they come to medical attention earlier. Even babies can have migraines, such as when a toddler or infant develops episodes of pallor and not feeling right, especially during car rides, maybe sometimes spitting up, recurring maybe once or twice a month. It takes several years for parents to connect the dots until this very child will become verbal enough to complain of headache during one of these episodes. Then, parents understand in retrospect that this is early stages of migraines. This is not common but migraine can start even in infancy.
Melanie: If somebody is suffering a migraine, whether it's child or an adult, when people have a headache they typically just go to the Tylenol or the Motorin and take that, but does that work for migraines?
Dr. Topper: In mild to moderate case, it works well. In more severe cases, it is recommended to see a physician to be diagnosed and to be prescribed, depending on the age, more potent but also safe medications such as triptans. Triptans are not pain killers but they have a mechanism which interrupts the migraine cycle in the brain and allows the migraine to stop.
Melanie: Are there other things that you like people to try like putting a cool compress or lying down in a dark room? Give us some home remedies people can try for their migraines as well.
Dr. Topper: We usually recommend to have a small snack with calories, such as rice crackers or something like that, because quite often in children migraine happens from skipping a meal several hours prior. Usually a full glass of water or a bottle of Gatorade would be another good starting point. Resting in a dark room and possibly applying a cold object like a salad spoon or cold compress to forehead for entire five minutes can help a lot in many cases. But, at the same time, parents need to see if the migraine headache is severe pain. So, for this reason, if the child needs over the counter medicine, such as Tylenol or if they are prescribed triptans like Imitrex, that should be given also as early possible if this headache behaves like becoming severe.
Melanie: How long, typically, do migraines go on? How long does this headache last?
Dr. Topper: In adults, it can go for many hours up to several days, unfortunately. In children, migraines are usually much shorter and can go anywhere between twenty minutes to several hours. Some children have even shorter-lived headaches, which is very typical for migraines that it follows the rule, "When it comes, it's bad. When it goes away, it goes away completely." Migraine attack is usually very intense but when it resolves there is no headache whatsoever. In fact, this is the only headache type commonly encountered in real life which follows this pattern, so when we hear this pattern by history, it's quite reassuring that this is not the brain tumor or not the case of increased pressure in the head.
Melanie: If somebody does suffer migraines as a child, does that continue for the rest of their life? Can migraines go away, Dr. Topper?
Dr. Topper: Yes, migraines can behave very differently across the lifespan and, in some people, they may have severe but very infrequent attack. In some people in adolescence and college years, it can increase in frequency substantially. It is typical that in the fourth or fifth decade of life, migraines start subsiding but not always this is the case.
Melanie: What about triggers? What do you tell your patients about triggers or something that might stimulate that migraine attack? Are there certain triggers people can look out for?
Dr. Topper: Absolutely. In adults, triggers are multiple and may involve diet such as alcohol and certain foods, such as certain types of cheese, peanut butter, chocolate, exposure to certain smells and perfumes, flickering light at the work site and so on. Sleep deprivation is a huge common denominator for migraine triggering at any age. However, in school-aged children, usually there are two most common stressors and triggers. There are children whose migraines are very sensitive to the school year itself, whatever is involved in that session, sleeping less than during summer time, stressed more, being more on the schedule, having more physical activity due to seasonal sports. We call it “school year tantrum”, which blend of many other triggers related to the typical school year which is intense nowadays. There are children who are sensitive to hot and humid weather in the summer. There are, unfortunately, children who are sensitive to both. So, when the school year is over and triggering of migraine might go away, the summer comes and it continues. So, these are the most common triggers in children.
Melanie: What do you doctors do for someone with migraines that fail to respond to some of the treatments and lifestyle changes and modifications you've discussed?
Dr. Topper: In some hard to treat cases, we are always looking for some bottlenecks or obstacles in migraine cure. Common obstacles are anxiety or depression untreated and we also look for sources of stress. For example, in many children with migraine when the treatment doesn't go well, we discover school problems and undiagnosed problems such as attention problems, learning disabilities, bullying, or just other anxiety which is non-specific. In other children and adults, we find sleep apnea or medication overuse. These are common reasons when the treatment doesn't go well. But, when we eliminate this situation, the vast majority of migraine sufferers can be helped with preventive medicine, which is usually either a supplement or prescription medicine which can be given on a daily basis. In a matter of several weeks, it starts decreasing headache frequency.
Melanie: That's really great advice. Wrap it up for us with your best advice about migraines and why patients should come to Summit Medical Group for their care.
Dr. Topper: Migraines are very painful and disruptive for the lifestyle. Children in childhood and pre-college age really need to get this under control and learn how to manage this before they head to college or workforce because college age and young adults who start working are rapidly exposed to many more stressors and triggers such as sleep deprivation and so forth. If migraine is not controlled by it then, they have way less time and opportunity to get it under control.
Melanie Cole: Thank you so much for being with us today, Dr. Topper. You're listening to SMG Radio and for more information, you can go to www.summitmedicalgroup.com. That's www.summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.