According to the International
Headache Society criteria, when the headache phase of a
Migraine
attack lasts more than 72 hours, whether it is treated or not, it
is termed "status migrainousus:"
- head pain may be continuous through
the attack or interrupted by headache-free periods of less than
four hours
- relief while sleeping is disregarded
- some triggers of status migrainousus
are diet, hormones, depression, and overuse of medications (rebound)
- "Patients with status
migrainousus need aggressive treatment ... The principles
of treatment for status migrainousus include the following:
- fluid and electrolyte replacement
- drug detoxification
- IV pharmacotherapy to control
pain
- treatment of associated symptoms
of nausea and vomiting
- concurrent implementation
of Migraine prophylaxis (if indicated). . .
- After acute treatment is completed,
many patients with status migrainousus require continuing
care. . ."2
MAGNUM,
The National Migraine Association, has an excellent mission
statement. One section of it reads:
"To make persons aware that
Migraine is not a benign disorder. For example, 27% of all strokes
suffered by persons under the age of 45 are caused by Migraine.
(Stroke is the third leading cause of death in this country.)
In fact, more people died from Migrainous stroke last year than
were murdered by handguns."
Another section of their site is
Migraine:
Myths Vs. Reality, where you will find:
- "MYTH:
Migraine IS NOT LIFE THREATENING, JUST ANNOYING.
REALITY: Migraine CAN BE LIFE THREATENING, INDUCING SUCH CONDITIONS
AS STROKE AND COMA.
Migraine can induce a host of serious
physical conditions: strokes, aneurysms, permanent visual loss,
severe dental problems, coma and even death.
According to the New England Journal
of Medicine, "Migraine can sometimes lead to ischemic stroke
and stroke can sometimes be aggravated by or associated with the
development of Migraine." Twenty-seven percent of all strokes
suffered by persons under the age of 45 are caused by Migraine.
Stroke is the third leading cause of death in this country. In
addition, twenty-five percent of all incidents of cerebral infarction
were associated with Migraines, according to the Mayo clinic."
- "MYTH:
ANY DOCTOR WILL RECOGNIZE AND PROPERLY TREAT Migraine.
REALITY: Migraine IS ONE OF THE MOST MISDIAGNOSED, MISTREATED
AND LEAST UNDERSTOOD DISEASES.
The fact that so many doctors don't take
Migraine seriously can be as disabling to the Migraineur as the
disability itself. The leading doctors in the areas of neurology
and head pain have themselves stated that this disease is grossly
misunderstood and misdiagnosed. In fact, 60% of women and 70%
of men with Migraine have never been diagnosed with this disease.
This medical ignorance and corresponding inaccurate writings unfortunately
perpetuate the myths and misunderstandings about Migraine and
convey this to the general public.
Dr. Saper stated that "Migraine
is a serious and underestimated health problem ... Patients with
Migraine are shunted along an assembly line of misdiagnosis, undertreatment,
or frank mismanagement. They are subjected to unnecessary procedures
and preventable consequences." And as Dr. Silberstein wrote
to M.A.G.N.U.M., "Migraine sufferers must not only cope with
their pain, but also with society's misunderstanding of the disorder.
Migraineurs are frequently dismissed as neurotic complainers who
are unable to handle stress. The truth is that they frequently
battle against great odds in order to hold down jobs and support
families ... Young Migraine sufferers sometimes miss enough school
so that they are unable to graduate with their peers."
Similarly, Dr. Sheftell stated "In
addition to misdiagnosis and under-diagnosis, Migraine sufferers
will bear the brunt of discriminatory policies by a variety of
health care agencies." Such agencies may deny reimbursement
for emergency room visits and for hospitalizations for the most
severe sufferers. It is not uncommon for doctors to think that
a Migraine sufferer is in the emergency room to receive drugs,
and dangerously turn them away."
3
Health Watch estimates a greatly
increased risk of stroke in Migraineurs:
"Migraine
and Stroke
People who suffer with Migraine headaches
may have an 80 percent higher risk of stroke than those who don't
have the painful headaches. Stroke is the third-leading killer
in the United States. Compounding the problem is that the term
"Migraine" is one of the most frequently overused medical
words. Migraine sufferers have complained that they encountered
skepticism from doctors when first suggesting they might be experiencing
Migraine headaches...
Recognizing early stroke symptoms also
is important. Some of the warning signs of stroke include sudden
loss of vision or blurred vision, particularly in one eye; sudden
difficulty speaking or understanding simple statements; sudden
numbness, weakness or paralysis of the limbs or face; unexplained
dizziness or loss of coordination. You need immediate medical
attention if those symptoms develop."4
A point on which there is general
agreement is that migrainous stroke risk is increased in the presence
of untreated Migraine and other risk factors:
"Long-term Migraine without
treatment has been shown to predispose sufferers to increased
effect on the blood vessels of the brain, especially in those
with signs of Migraine with aura (classical Migraine). Persons
who have visual or neurological symptoms accompanying their
Migraine
attacks should avoid other risk factors such as smoking, high
cholesterol diets, the use of estrogen and untreated hypertension.
These risk factors for cerebral vascular disease, if present in
a setting of Migraine, may greatly increase the risk of one having
a Migraine related stroke."5
When To
Call the Doctor:
"Don’t fall into the "it’s-only-a-headache-so-I-don’t-need-to-call-the-doctor"
trap. A headache can indicate some other serious disease that needs
attention. The American Council for Headache Education lists the
following warning signs that should prompt you to call your doctor:
- You have three or more headaches
a week.
- You need to take something every
day to relieve the pain.
- Fever or a stiff neck accompanies
your headache – a warning sign of an infection (fever) or bleeding
(stiff neck) within the brain.
- In addition to a headache, you’re
unsteady on your feet, your speech is slurred, your arms or legs
are weak or numb or they tingle (all of which suggest stroke).
- If the headache follows a head
injury and you’re confused and/or drowsy, you may have suffered
a subdural hematoma, a collection of blood that forms under the
skull and presses on the brain.
- You’re over 50 years of age.
- If your old, familiar headache
has changed in character, some new problem may be superimposed
on whatever caused the original headache.
Check it
out."6
Summary:
Though the experts don't agree on the degree to which
Migraine
increases stroke risk, they do agree that there is
increased risk. Status migrainousus, as described above, can be
especially dangerous. Please don't take chances.
When
in doubt, check it out!
Resources
& References
1
MAGNUM, the National Migraine Association: Mission Statement.
http://www.Migraines.org/about/aboumiss.htm
2 Stephen D. Silberstein,
M.D., Richard B. Lipton, M.D., Donald J. Dalessio, M.D., Wolff's
Headache and Other Head Pain. (New York, Oxford University Press,
2001) 207-211.
3
Michael John Coleman, Terri Miller Burchfield of M.A.G.N.U.M.
An Understanding of Migraine Disease & Tips for Migraine
Management.
http://www.Migraines.org/myth/mythreal.htm
4
Health Watch
is a Public Service of the Office of News and Publications &
the Library at University of Texas Southwestern Medical Center at
Dallas.
http://www3.utsouthwestern.edu/library/consumer/migrain.htm
5
The National Headache Foundation: Topic Sheets
http://www.headaches.org/topicsheets/stroke.html
6
ACHE: The American Council for Headache Education: When a Nasty
Headache Comes Back.
http://www.achenet.org/news/art3.php
