Mind Over Matter, Except When it Comes to a Migraine
Grace Weatherby
/ Categories: WELLNESS, 2024

Mind Over Matter, Except When it Comes to a Migraine

Despite being the third most common disease in the world, migraine remains misunderstood and often mis- or undiagnosed.

Among the most common misunderstandings is that a migraine is simply an awful headache. But the truth is more complicated than that as migraine is a neurological disease with no cure. And yes, headaches are a common symptom, but the disease is actually a complex group of symptoms that occur in phases (prodrome, aura, headache, and postdrome) over a period of time that can last from 4 to 72 hours. However, not everyone will experience the same symptoms, which may include: 

► Fatigue or difficulty sleeping

► Depressed mood or changes in mood

► Visual disturbances or even loss of sight

► Severe headache

► Vomiting

► Sensitivity to light, sound, and smells

► Dizziness or vertigo

It is important to recognize that experiencing one—or even two—of these symptoms does not mean you have migraine.

In order to be properly diagnosed with a migraine, the following criteria must be met:

  1. At least five attacks fulfilling criteria B-D
  2. Headache attacks lasting 4 – 72 hours
  3. Headache has at least 2 of the following four characteristics:
    1. Unilateral location (meaning one side of the head) 
    2. Pulsating quality
    3. Moderate or severe pain intensity
    4. Aggravation by or causing avoidance of routine physical activity
  4. During headache, has at least one of the following:
    1. Nausea and/or vomiting
    2. Photophobia (light sensitivity) and Hyperacusis (sound sensitivity)
  5. Not better accounted for by another ICHD-3 diagnosis as defined by the International Classification of Headache Disorders (ICHD-3). 

Experienced migraine sufferers often learn to recognize the onset phases of a migraine attack and can prepare themselves hours, or even days, before the debilitating headache phase kicks in.

Phases of a Migraine Attack

SOURCE: AmericanMigraineFoundation.org

 

In the same way there is no cure, there is also no test for a migraine. However, that should not keep you from seeking medical advice, especially if frequent or severe migraine is interfering with daily life.

If you suspect you may have a migraine, it is important to keep a timeline of symptoms, including notes about environmental elements and personal health issues, which may trigger an attack. Here is a look at some common triggers:

  • Stress
  • Changes in weather
  • Strong smells
  • Bright light
  • Certain medications
  • Alcohol
  • Caffeine
  • Changes to your sleep
  • Skipping a meal

This information, along with your personal and family health history, will help your healthcare provider assess your condition and develop a treatment plan. In some cases, they may recommend imaging of the head to rule out other potential conditions.

Common treatment options include:

  • Acute medications to stop or alleviate migraine attacks
  • Preventive medications to reduce the frequency and severity of attacks
  • Lifestyle modifications and trigger management

NOTE: It is important to distinguish migraine from other types of headaches, as the treatment and management strategies may differ.

While most migraines can be managed at home, there are certain situations when seeking immediate medical care is crucial:

  • Sudden, severe headache (thunderclap headache) that comes on within seconds
  • Headache accompanied by fever, stiff neck, confusion, seizures, or neurological deficits
  • Headache following a head injury or trauma
  • Headache that worsens with coughing, bending, or physical activity
  • Intractable migraine lasting more than 72 hours without relief
  • New or different headache pattern, especially if over 50 years old

These symptoms may indicate a more serious underlying condition, such as a stroke, aneurysm, or meningitis, and require prompt evaluation and treatment.

 

Jennie Smyth is a PA with the neurology department of Southwestern Vermont Medical Center

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Introducing Dr. Amy Freeth

Amy E. Freeth, MD, resumed endocrinology services at SVMC in March 2020. The practice, known as SVMC Endocrinology, is a part of Southwestern Vermont Medical Center (SVMC) and Southwestern Vermont Health Care (SVHC). It replaces the Bennington Osteoporosis Center, where Dr. David Gorson had provided similar services to the community until his retirement in 2019.

How do you describe endocrinology to people who don’t know what it is? The endocrine system is made up of glands that make hormones. These hormones are chemical messengers that travel via the bloodstream to communicate with the cells and organs of the body. Hormones are important for growth, development, mood, metabolism, and reproduction. These glands include the pituitary, thyroid, parathyroid, pancreas, adrenal, testes, and ovaries.

Endocrinology is a practice of medicine that specializes in disorders of these systems. Disorders most commonly are related to underactive or overactive function of these glands and require replacement of the hormone or specific treatments such as medications, ablation, or surgery.

Since hormones function in feedback loops and are part of a larger complex functional system that exists in flow with the human body, replacement hormones or treatment of endocrine disorders can be challenging and involve changes to our lifestyles that support the optimal functioning of the body.

What diagnoses are most common among the patients you treat?  Pituitary tumors, hypothyroidism, hyperthyroidism, thyroid nodules, thyroid cancer, hyperparathyroidism, osteoporosis, diabetes, adrenal insufficiency, Cushing’s disease, primary hyperaldosteronism, pheochromocytoma, obesity, and polycystic ovarian syndrome.

What sorts of treatments do you offer? I offer comprehensive consultation and management of endocrine disorders. I also interpret testing and make treatment plans for endocrine disorders. I also provide interpretation of bone density reports and perform fine needle aspiration biopsies in collaboration with Radiology Associates of Bennington. Technology is increasingly becoming more important in the management of diabetes. Technology includes glucose meters, insulin pumps, and continuous glucose monitoring (sensors). I work with certified diabetes educators to create a team approach to diabetes management. As we develop this new department, we are looking for innovative ways to help people regain and optimize their health. I have training in nutrition counseling and health coaching to help people find their path to good health.

Why is it important for patients who need an endocrinologist see them regularly? Your endocrinologist is part of your health team and has experience and a deep understanding of what is happening within your body to help assess, guide, and co-manage your disorder. There is testing that may need to be done to make sure you are living with optimal hormonal balance. Allowing hormones to run too low or too high can have lasting adverse effects on the body leading to other disease or imbalances.

How do you help protect patients who need to come into the office from infections, like COVID-19? At this time, I am seeing patients via telemedicine and phone visits. This week we are starting to see a portion of our patients in the clinic. Patients can register on the phone and wait in their car until the room is ready. Patients will be screened for fever and should wear a mask. Staff will wear proper protective equipment and follow guidelines for handwashing and cleaning of the rooms.

Since many patients who will likely want to come to the endocrinology clinic will be members of high-risk populations (diabetes, hypertension, obesity, and the elderly), patients will have a choice of the type of visit they have.

Dr. Freeth sees patients 8 a.m. – 5 p.m. Tuesday - Thursday in Suite 307 of the Medical Office Building located at 140 Hospital Drive in Bennington. For an appointment, call 802-447-4555. The schedule will expand to additional days as needed.

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