Surviving Migraines with Christina Peterson, M.D.

Last Editorial Review: 10/23/2003

WebMD Live Events Transcript

Join Dr Christina Peterson, author of The Women's Migraine Survival Guide, for a discussion about the causes of migraine pain and treatments for real relief.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Good afternoon all! Our guest this afternoon is Dr Christina Peterson...

Dr. Peterson: Good afternoon.

Moderator: Christina Peterson, MD, is a neurologist in private practice and the medical director of the Oregon Headache Clinic in Oregon City, Oregon. She is a member of the National Headache Foundation, the American Association for the Study of the Headache, and the International Headache Society. How are you today?

Dr. Peterson: I am fine. Would love to answer any questions about headache .

Moderator: Well, let's begin with a definition of migraine. How does a migraine differ from a headache?

Dr. Peterson: A migraine is a specific pattern of headache pain. Migraine is a specific type of headache pain. It is often, but not always, one-sided. It is often a pounding type of pain, but can be a pressure-pain It is often accompanied by associated characteristics like nausea, avoidance of bright light, avoidance of sound, dizziness, or mood change. It is not necessarily preceded by an aura. About 20% of migraine headaches start with odd neurological symptoms which come before the pain starts, like vision changes, sparkling lights, or even numbness in a hand or in the face. This lasts a few minutes to an hour before the headache.

Moderator: What are the major kinds of migraine?

Dr. Peterson: Migraine with aura and migraine without aura are the two most common types. The majority of migraine sufferers have migraine without aura.

HankW_WebMD: Does your diet affect the severity of your migraines?

Dr. Peterson: It can, if you have a lot of dietary migraine triggers.  About 25% of migraine sufferers have food triggers for their headaches I usually recommend that you keep a headache diary to identify your triggers.

wabe_grb_WebMD: What are the latest advances in migraine treatment?

Dr. Peterson: The latest advances in migraine treatment are a better understanding of why preventative medications work, which helps us identify more meds that might prevent migraines. We are also closer to an understanding of the chemical changes in the brain during a migraine, which is very complex. This will lead to the development of better medications for acute migraine relief. Migraine research is also looking at the genetics of migraine. We may be able to predict who will get migraine in the future.

Moderator: Are migraines heredity?

Dr. Peterson: If careful interviews of the family of migraine sufferers are done, interviewing three generations, there is a family history in about 90%, so yes, it is often hereditary. But family members may not know that their headaches are migraine. They may think that they have sinus or tension headaches, or just refer to their headaches as "sick headaches."

estelle31_WebMD: Has psychiatry been able to help with migraine treatment over the years?

Dr. Peterson: Most migraine is physiological and not psychological, but there are two ways in which psychiatry and psychology can be helpful. One is in stress reduction, which affects many. Stress is the number one migraine trigger. The other is that there are some migraine sufferers who also have anxiety and/or depression, and psychiatric treatment of these conditions can reduce the frequency and severity of headaches. There is an increased frequency of depression and anxiety in migraine sufferers than in the general population. However, personality testing in migraineurs is normal between headaches, although it can be abnormal during the headache. Many migraineurs become depressed during the migraine but are fine the rest of the time.

estelle31_WebMD: Is there a way to tell the difference between the physical and mental? Must they be treated separately?

Dr. Peterson: There is in migraine, as with most other diseases, a huge overlap between the two. The mind-body connection is a very powerful thing, and often treating with both medications and therapy is very effective. I have seen severe migraine headaches that were resistant to medication  go completely away with hypnotherapy, for example, although this is not the rule.

amleko_WebMD: Do migraines cause strokes?

Dr. Peterson: Usually not. There is a very slight increase in the risk of stroke in migraineurs in general versus the general population. There are some specific, unusual subtypes of migraine that do carry an increased risk of stroke. The concept of "migraine stroke" is controversial. Many researchers feel that migraine stroke has been grossly overestimated. People with migraine get older, have risk factors for stroke or a family history of stroke. Some of them will have strokes when older, but not necessarily because of the migraines. So new diagnostic criteria are being developed so that we can be more specific about this and determine which strokes really are due to migraine so that we can quote accurate statistics as to the risk of migrainous stroke.

wabe_grb_WebMD: Are there any herbal remedies for migraines?

Dr. Peterson: There are a few. Feverfew has been shown to be useful for migraine prevention in about 40% of cases, but may take two months to become effective. High dose riboflavin (vitamin B-2) has also shown some effectiveness, but this needs to be taken for about three months before you can tell if it will work. Magnesium can also be helpful for some migraine patients. Problem is -- we can't predict which ones, but magnesium is fairly safe to try--so are the others. I often use riboflavin in pregnant women who cannot take medications. Peppermint and lavender oils used to massage the skin can also help. Other aromatherapy oils are being studied.

amleko_WebMD: How common is migraine aura without the headache?

Dr. Peterson: This does happen occasionally. We do not know why. I have a friend who gets aura without headache only while pregnant. I have several patients who get both aura with headache and without, and often women who have had migraine with aura will notice fewer headaches as they age, but will see an increase in visual aura in older age. This is not an indicator of stroke risk, although it can mimic a TIA (transient ischemic attack), which IS a sign of cerebrovascular disease, and can lead to stroke, so it is important to let your doctor know you have a history of migraine if this occurs.

estelle31_WebMD: Is there a way to know the difference between a migraine and a bad muscle tension or stress headaches or are they all the same?

Dr. Peterson: Well -- that depends. If you are a migraine sufferer and also get tension headaches, there is a point at which it can be difficult to tell. Tension headaches can go on into a migraine if you are prone to migraine, and sometimes it is tough to tell if that is about to happen. And sometimes the migraine pain causes a secondary tension headache. You can tell this by feeling the neck muscles to see if there is a pattern of muscle spasm. When this occurs, I treat both types of headache.

Moderator: Well, our time is about up...

Moderator: Do you have any parting comments?

Dr. Peterson: Thank you for your questions. I hope you all find good doctors and gain good control of your migraines.

estelle31_WebMD: Thank you for being here and answering our questions.

Dr. Peterson: You are very welcome--would be happy to do so again some time

Moderator: Thank you. Our guest this afternoon was Dr. Christina Peterson, a neurologist in private practice and the medical director of the Oregon Headache Clinic in Oregon City, Oregon. Thank you also to our members who asked some great questions! Peterson is also author of The Women's Migraine Survival Guide. Is that title available everywhere?

Dr. Peterson: Yes, it is published by HarperCollins. It is available at bookstores and online through the usual channels.

Moderator: Great! Thank you for your time this afternoon!

Dr. Peterson: You are welcome.

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