 Types and Causes
Frequently Asked Questions
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Migraine: Types
and Causes (by Joel R. Saper, MD)
What causes migraine headaches?
For most people migraine is a hereditary
medical condition. Some people get migraine headaches after head trauma or a brain
injury. Several different brain chemicals (neuro-transmitters) are involved in triggering
and perpetuating the migraine attack. Inflammatory changes develop around blood
vessels and there are alterations in blood flow to the brain. The usual electrical
activity of the brain may change. This complex sequence of events causes the pain
and the other symptoms associated with migraine.
Since the same neurochemical transmitters
which are involved in migraine are necessary for other body functions such as sleep
and mood, it may not be unusual for people with migraine to experience depression,
anxiety, panic attacks and sleep disturbances. These associations are important
in developing an effective program for preventive migraine treatment.
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Could genetics or heredity factors play a part in my headaches?
Yes, over 80% of patients with recurring
headaches have a family member who also suffers from headaches. And just as in other
illnesses which were once thought to be "psychological," migraine headaches are
caused by biochemical abnormalities in the brain. Hereditary factors play a role
in that physiological vulnerability.
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What is the relationship between fluctuations in my blood sugar and hypoglycemia
and occurrence of a headache?
As one's blood sugar drops too rapidly,
it can trigger a headache of a migraine type. In addition, a person with an abnormal
blood sugar metabolism can trigger a headache by missing even a single meal. So
it is better to eat regularly, at the same time in the day, and regulate medications around meal times as well. Headaches that occur after sleeping longer than usual
or headaches that occur during the night or upon awakening may reflect hypoglycemia,
although many other explanations are possible.
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Does stress cause headaches?
Stress does not cause headache,
but stress can be an important trigger for many headache sufferers. Headache sufferers
do not have a specific personality type or experience more stressful life events
than other people.
Stress is inevitable. It is neither
possible nor desirable to eliminate all stress. The false belief that one should
lead a stress-free life and always feel good can become a major source of stress.
However, needless worry and frustration about things you can't change can deplete
your physical and mental energies. Prolonged and constant worry can make you sick.
Exercise, relaxation techniques,
and coping strategies can reduce the negative effects of stress.
Caution: Physical or psychological
symptoms that affect a person's ability to work, play, or find pleasure in life
or hope for the future are unlikely to be merely due to stress. Stress management
techniques alone are unlikely to provide adequate relief. Such symptoms may require
professional help. This should be discussed with your physician.
- How to Stop Worrying.
Ask yourself, "What is the worst possible thing that can happen?" "What are the
chances that this will occur?" "What can I do to reduce the risk of this happening?"
"What is the problem?" "What is the CAUSE of the problem?" "Do I have all the facts
I need to make a decision?" "What are the possible solutions to the problem?" "What
is the best solution?"
If you have to make a decision about
an important matter, it is useful to write down the problem and the possible solutions.
List the possible solutions as #1, #2, etc. Don't worry about the order at this
time. It is best to compare only 2 choices at a time: compare #1 with #2 and place
a check mark next to the better solution and then compare #1 and #3. Continue until
you have compared the last item with the next-to-the-last item. An example is shown
below:
Problem: Not enough money
to send your 17-year-old child to a prestigious private college next year
Cause: Poor performance of
investments and low interest rate on CDs
Possible solutions:
#1 Rob a bank.
#2 Postpone college by one year to allow savings to grow and child to earn money.
#3 Attend state university for 1-2 years and then transfer.
#4 Forget college altogether.
If it is an important decision,
sleep on it. If the decision still seems to be a good one, act. If the decision
no longer appears to be a good decision, see if combining the best solutions is
possible, or get advice from an expert. Don't ruminate or obsess. Strive to make
good decisions with the information you have at hand, and don't blame yourself for
not selecting the absolute best solution. It is important to remember that even
the most brilliant people select the best solution only 40% of the time.
Disraeli said: "Life is too short
to be little." Don't waste valuable energy worrying about things that are unimportant
or are unlikely to ever happen. And don't saw sawdust or cry over spilt milk. Don't
resent what can't be changed.
- Dealing with Difficult People.
Have you read the "80-20 rule"? According to this rule, 80% of your problems are
caused by 20% of your customers (or clients, coworkers, or employees). The vast
majority of people are kind, considerate, and fair (seriously). However, if you
don't have strategies for dealing with the relatively small number of difficult
people, it is easy to lose perspective. You may dread the workplace, classroom,
or other settings where you have to deal with difficult people.
The first step to deal with difficult
individuals is to resist your instinctive response. Your natural response may be
to strike back, give in, or break off. If you strike back, you may be able to defeat
the difficult person this time, but this "win-lose" outcome may not be in your best
long-term interest. If you give in and settle for a "lose-win" outcome, the difficult
person will expect you to cave in in the future. This will put you at a disadvantage.
The false belief that people will like you more if you do what they want increases
the likelihood that people will manipulate you and respect you less. If you "break
off," you may lose a potentially valuable client, customer, or employee. Instead
of reacting and losing sight of your interests, take a step back and analyze the
situation.
The second step is to know your
"hot buttons." If the other person's tactic has made you angry or frustrated, don't
respond immediately. Pause and say nothing for 20-30 seconds. If you still feel
angry, take a short break and leave the room if you can. When your anger has dissipated
somewhat, say, "Help me understand why you feel so strongly about this." This makes
the difficult person shift from an offensive posture to a slightly defensive posture.
This also slows down the process. Never make important decisions when you are angry
or frustrated.
The first step: listen to understand
the other person's point of view. Agree whenever you can without conceding. Identify
your common interests. Behave as if you believe the other person is reasonable and
interested in genuine problem-solving. Ask your "opponent" to offer a solution that
would allow both of you to achieve your interests. If his "solution" is too one-sided,
ask "why" and "why not" to help him find a better solution. These techniques are
described in William Ury's book, Getting Past No.
In Coping with Difficult People,
Dr. Robert Bramson describes simple techniques that can help you cope with specific
difficult behaviors. For example, Dr. Bramson describes the Sniper. This difficult
person uses not-too-subtle digs, nonplayful teasing, and innuendo to defeat you.
He has a very strong sense of how others ought to think and act. Dr. Bramson suggests
the following strategy: "Your comment was somewhat humorous, but I got the feeling
that there was a dig there. Is that how you intended it?" If he then says, "What's
the matter. Can't you take a joke?", you should reply, "Yes, I can take a joke,
but I felt that you intended a dig, and I feel you are making another dig about
my ability to make a joke. Is that how you meant it?" The Sniper won't change his
behavior, but he will soon find another victim. It works.
- Dealing with Time Pressure.
Do you constantly feel like you don't have enough time to do the things you need
to do or want to do? If so, you may want to take a look at your organizational skills
and time management skills. If you spend too much time on unimportant tasks, you
will not have enough time to spend on important tasks. The main reason for this
is a failure to set priorities. A multi-grid "TO DO" list can help:
|
|
IMPORTANT |
SOMEWHAT IMPORTANT |
NOT IMPORTANT |
|
URGENT
|
Call about biopsy results |
Arrange transportation to airport |
Fix flat tire |
|
LESS URGENT
|
Order new prescription blanks |
Make reservations for dinner |
|
|
NOT URGENT |
Review recent medical literature |
Redo office forms |
Gossip with coworkers |
Use a day planner to schedule your time.
Organize your files and desk so that you can find important information quickly.
Set aside some time early in the day to accomplish "important but not urgent" tasks.
If you don't do this, minor emergencies and interruptions during the day will keep
you from doing tasks that are important for career advancement and personal development.
Jeffrey J. Mayer's book, If you haven't got the time to do it right, when will you
find the time to do it over?, provides invaluable advice on getting organized
and managing your time.
- Coping with Chronic Pain. A significant minority of headache sufferers experience almost constant pain that does not respond
to currently available medications. Patients who suffer chronic pain deserve care
and compassion. However, chronic pain does not grant you permission to be obnoxious,
abusive, or demanding. Such behavior may result in isolation and loss of support
from family, friends, and caregivers.
Unlike the patient in acute pain from
a kidney stone or intermittent migraine or cluster headache, the individual suffering
from chronic pain may appear normal to family, friends, coworkers, and supervisors.
Chronic pain is a personal and private suffering. Even physicians cannot determine
whether chronic pain is mild or severe. This isn't "fair," but this is the way it
is.
This aspect of chronic pain can lead
to discouragement and demoralization. Emotional suffering may exceed the physical
suffering of chronic pain. Constant pain drains one's energy and spirits. Physicians
trained in "find it and fix it" may blame the victim when their best efforts fail
to find a cause and a cure for the chronic pain.
Dr. Richard Sternbach, in his book Mastering
Pain, describes a positive twelve-step program for coping with chronic pain:
- accept the fact of having chronic pain
- set specific goals for work, recreation
or hobbies, and social activities toward which you will work
- let yourself get angry at your pain if
it seems to be getting the best of you;
- take your analgesics on a strict time
schedule and then taper them down
- get in the best physical shape possible,
then keep fit
- learn how to relax, and practice relaxation
regularly
- keep yourself busy
- pace your activities
- have your family and friends support
only your healthy behavior, not your invalidism
- be open and reasonable with your doctor
- practice effective empathy with others
having pain problems
- remain hopeful.
This book offers practical and valuable advice
for the patient suffering from chronic pain.
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My mother "outgrew" her headaches in older age. Will I?
The lifetime course of chronic recurring
head pain is variable. Many people will outgrow their symptoms, while others will
experience their first headache later in life. If the person from whom it is likely
that headaches have been inherited outgrew the headaches, that represents a good
but not absolute indication that the offspring will outgrow the headaches as well.
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Are there specific tests which can
prove that you have migraines?
No. There are no specific tests which will show if one has a migraine. However,
there are a number of tests which will help to rule out certain illnesses and provide
information related to circulation, brain wave, and brain anatomy. Tests are performed
to eliminate causes of headache other than those which are "built into" your physiology
(such as migraine and other primary headaches).
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My tests are normal. What, then, causes
my headache?
Most of the tests involved in the assessment of headache are done to identify other
illnesses which could be causing the head pain. Tests such as CT scan, MRI, EEG,
and blood studies are usually normal or near normal in patients with migraine. No
tests currently available for routine use can detect the changes that occur in migraine.
This should be interpreted as good news, not bad, and should not frustrate headache
sufferers.
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