Headaches: The Quest for the Proper Diagnosis
By Heather Maloney
Beth Israel Deaconess Medical Center Staff
24-year-old Marlene remembers getting her first migraine at age 4. At first, she didn't get them very often, but by the time she turned 12, she was experiencing them more regularly.
Her parents took her to a doctor who diagnosed sinus trouble, and prescribed Claritin and a series of other allergy medications. None of them helped.
"At this point, everyone's attitude was that I just needed to deal with it," Marlene says.
By the time she left Somerville for college in Vermont, Marlene was having migraines 12-14 times a month, each one leaving her debilitated for 24-36 hours. That's when she decided to take matters into her own hands.
"I started seeking out doctors on my own," she says. This lead her to a local neurologist near her school in Vermont, who finally diagnosed her as having migraines. He started her on preventative medications, but they didn't provide any kind of substantial relief.
The pain of her migraines brought Marlene to the emergency room four separate times. There she finally found some relief: doctors gave her injections of Imitrex, which successfully aborted the migraine in process. While she was excited at the thought of having found her "miracle drug", Marlene still she had to convince her neurologist to give her a prescription for Imitrex so she could inject herself when a migraine struck.
Dr. Carolyn Bernstein, an attending neurologist and headache specialist at the Arnold Pain Management Center at Beth Israel Deaconess Medical Center in Boston, says that only 25 percent of people with migraine actually get the correct diagnosis. Part of the problem is that many people, including some doctors, don't recognize that migraine is a neurological disease, and headache is only one of its symptoms.
"People with migraine actually have hyper-sensitive cells in their brains," says Dr. Bernstein. "What they're experiencing is not just a tension headache, it's a real illness that's affecting all different parts of their nervous system."
According to the National Headache Foundation, migraines afflict about 30 million people in the United States alone. As many as 6% of all men and up to 18% of all women (about 12% of the population as a whole) experience a migraine headache at some time.
Compounding the problem: there is a wide range of symptoms, what triggers attacks, and treatments that work.
"The symptoms are varied from one person to the next," Dr. Bernstein says. "Some get visual aura, others get changes in vision or hearing, while others experience GI problems, or even excessive crying and hunger pangs."
Migraines are not caused by stress (though stress may be a trigger). Some migraines run in families; if you have a parent or sibling who gets migraines, there is an increased chance you will develop them as well.
New prescription medications have been shown to be very effective in aborting migraines, but only a small percentage of migraineurs (people who suffer from migraines) use them. Many complementary and alternative treatments (like biofeedback and meditation) have also been shown to help, but most migraineurs don't know about these options either.
If you think you suffer from migraines, Dr. Bernstein says you should know that help is available. The first step is talking to your primary care doctor.
"A lot of PCPs know a lot about migraines; you need to find someone who has expertise with migraines and the different treatment options (both drug and non-drug)," she says. "If your headaches don't respond to treatment, you should consult with a specialist, ideally a neurologist who specializes in treating headaches."
Today, Marlene is a patient of Dr. Bernstein's. She says she feels better, but she still gets migraines about four times a month. She's found some relief with preventative medications, and she has started doing yoga, which she says has helped her a lot. And Dr. Bernstein is optimistic that she will continue to get better.
"For a long time, there was a real stigma around migraines," Dr. Bernstein says. "Doctors are now becoming increasingly well-educated about making this diagnosis, and patients are becoming more educated as well. But it can be a very tricky diagnosis to make."
Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
Posted October 2009
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