The term “migraine headache” is often incorrectly used as a catch-all phrase to describe a severe and sometimes debilitating headache. Eighteen percent of adult women and six percent of adult men suffer from migraine headaches, and over 3 MILLION cases of migraine headaches are diagnosed each year.  While many different types of chronic headaches are debilitating, migraine headaches most often involve a combination of 4 stages, including the prodrom (onset), aura, attack, and post-attack or postdrom phases.

Phases/Stages of a Migraine

Prodrom Stage

During the first PRODROM stage of a migraine, patients may feel tired, excited, irritable, or even crave particular foods.  These issues may or may not be recognized as migraine-related when they happen.  When they are recognized, these symptoms may be the best time to take an abortive medication in those patients who have success with this regimen.

Aura Stage

In the next AURA stage of migraine headache, the sensory aspects of the migraine begin to take shape.  Patient auras may be very different from one another, but a visual aura is quite common and can be represented by spots or flashes of light, or a blind spot in the normal field of vision.  Some patients report trouble speaking or thinking, and often it can be difficult to concentrate.

Attack Phase

During the ATTACK phase, the headache pain most often presents. This pain is often throbbing in nature, and often involves one side of the head.  The pain can begin in the front or the back of the head, and often radiates to other parts of the head from its origin.  Other symptoms can be associated with the attack phase, and nausea and vomiting often accompany the pain.  Migraine sufferers can be hypersensitive to light and sound, and can even lose the ability to use parts of their body (called hemiplegic migraines).

Postdromal Phase

The last phase of a migraine is the POSTDROMAL phase.  Patients report exhaustion, confusion, and often have a “soreness” of their head similar to that of having a pulled muscle.

While these 4 phases are typical of migraine patients, not all migraine patients experience all of these phases.  Some patients only have 2 of these four, while others may have more.  Migraines can be acute, sporadic, chronic, or even constant, and one kind of migraine can evolve into another over time.  Migraine headaches may be of variable intensity with a variety of symptoms, and in fact pain may not be one of them. Some patients experience “visual migraines” alone where pain in the head never occurs, but their vision is impaired for a period of time. Other patients experience episodic dizziness without actual pain. Because of the variability of the migraine experience, definitive diagnosis and specific treatment regimens have often been difficult to obtain.

Migraine Factors/Causes

The science of migraines is vast and controversial.  There are camps who feel that the migraine is a central brain disease, and theories of blood vessel dilation to chemical imbalance have been popularized over time. Progressively, however, we are realizing that migraine headaches are often “peripherally mediated.”  This means that it is becoming apparent that the onset of migraines is often from a trigger of a peripheral nerve rather than a central brain issue.  These peripheral triggers send distress signals to the brain itself, and can then cause the cascade of events that manifest into a migraine headache.  The science does not stop there.  Research suggests that there are actually migraine genes that are coded in the DNA of many migraine sufferers that predisposes them to having migraine disease.  Some of these patients may not actually have migraines until some seemingly small event triggers the migraines to surface.   Other such patients can have onset of their migraines from an early age for no apparent reason at all.

Research has found that the peripheral nerve irritation in several areas of the head and neck may be the causal factor which triggers the deeper migraine pain. In some cases, constrictive bands of tissue may be compressing the nerves, and in other cases bone or muscle may be pushing on the nerves, creating the pain. Often, a blood vessel adjacent to the nerve creates this pressure, and can be responsible for the “pulsating pain” that some migraine headache patients suffer from.

In some people, these anatomic issues remain non-problematic.  In patients susceptible to migraines, however, these constrictions and compressions are often the cause of the deeper pain syndromes that they experience.  Release of the effected nerves from these constrictions and pressures can provide improvement or even resolution from migraine symptoms in those patients who suffer from the migraines that these issues create.  This is the principle behind migraine surgery, often called “nerve decompression surgery.”  Read more about the surgical procedures that can relieve your migraine pain here.  For a more thorough discussion of your particular situation, please contact us here or call our facility at 805-969-9004 and our patient coordinators can set up a phone or personal consultation with Dr. Lowenstein.

FAQs: Migraine Headaches

  • What causes migraine headaches?

    While the exact cause of migraine headaches is incompletely understood, it is likely that there are several causal factors that can work alone or together to cause the severe headaches and accompanying symptoms that we term as a migraine headache. Because “migraine headache” is somewhat of a catch-all phrase for many different types of headaches, patients with migraines may in fact have varying causalities from occipital neuralgia to organic brain disease and in some cases even aneurysms or tumors. It is for this reason that patients with severe migraines should see an experienced physician and neurologist in order to be properly evaluated.
  • How are peripheral nerves related to migraines?

    Physicians have discovered that in many cases of severe headache, nerve compression at one of 14 known sensory nerves can be the root cause of discomfort. Compression and restriction of these nerves seems to provide a feedback to the pain centers of the brain to trigger the symptoms of migraines including pain, visual disturbances, dizziness, and other associated symptoms. These compressed nerves can become chronically inflamed or diseased over time which can create a chronic and recurring condition of recurrent or persistent headaches. By addressing these compressed nerves by releasing them from their restrictions or even cutting them in regions where they remain healthy, plastic surgeons have found that we can modulate and in many instances eradicate the painful feedback loop and improve or prevent severe headache pain.
  • Who should I see for my migraine headaches?

    Evaluation of your headache should begin with your primary care provider. Not all headaches are considered migraines, but diagnosis of a migraine can be a non-specific term encompassing many different headache types. Your primary care physician may treat you, or they may refer you to a neurologist, particularly if the first line of treatment is unsuccessful. Your workup may include a CT or MRI of the head to rule out tumor, aneurysm, or other pathology. Your neurologist may also involve a pain specialist in order to help control your symptoms if necessary.
  • Who should get an evaluation for migraine surgery?

    Patients that end up in our office have usually been seen by a primary care physician and neurologist, and may have been treated by pain physicians, chiropractors, other providers. Patients have often tried multiple different medications and may have had nerve stimulators or even previous surgery in the attempt to control their headaches.
  • I have had previous unsuccessful surgery. Do you do revision/re-operative surgery?

    Our experience has shown that while migraine surgery is not always successful, patients who have had migraine surgery elsewhere might have not had as extensive a release as we routinely perform. Patients who have had previous surgery for migraine headaches or occipital neuralgia may very well find improved relief following a second release at our Headache Center. Specific workup including an evaluation of previous treatments and surgeries is accompanied by specific diagnostic maneuvers to evaluate whether these patients are candidates for revision headache surgery.

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