Ear Center: Migraine Disorders

Incidence

Migraine headaches are surprisingly common and affect 18% of women and 8% of men.

Although traditionally called "sick" headaches, there is a wide variety of "migraines". Traditionally, there have been
four main classifications for migraine conditions:

  1. Classic Migraine
  2. Migraine with aura
  3. Migraine without aura
  4. Atypical Migraine variant.

As our understanding of migraine disease has increased, many new migraine classifications have been recognized.

Current ICD-9 Diagnosis Codes for Migraine Disease (as of October, 2008):

Our Code ICD9 Description ICD9 CODE
772 MIGRAINE-WITH AURA, - INTRACTABLE 346.00
970 MIGRAINE-WITH AURA, + INTRACTABLE 346.01
15 MIGRAINE-WITH AURA, - INTRACTABLE, + STATUS 346.02
16 MIGRAINE-WITH AURA, + INTRACTAB;E, + STATUS 346.03
773 MIGRAINE-WITHOUT AURA, - INTRACTRACTABLE346.10
1163 MIGRAINE-WITHOUT AURA, + INTRACTABLE 346.11
17 MIGRAINE-WITHOUT AURA, - INTRACTABLE,+ STATUS 346.12
18 MIGRAINE-WITHOUT AURA, + INTRACTABLE, +STATUS 346.13
9017 MIGRAINE-VARIANT, - INTRACTABLE 346.20
1168 MIGRAINE-VARIANT, + INTRACTABLE 346.21
19 MIGRAINE-VARIANT, - INTRACTABLE, + STATUS 346.22
20 MIGRAINE-VARIANT, + INTRACTABLE, + STATUS 346.23
21 MIGRAINE-HEMIPLEGIC, - INTRACTABLE, - STATUS 346.30
22 MIGRAINE-HEMIPLEGIC, + INTRACTABLE, - STATUS 346.31
23 MIGRAINE-HEMIPLEGIC, - INTRACTABLE, + STATUS 346.32
24 MIGRAINE-HEMIPLEGIC, + INTRACTABLE, + STATUS 346.33
25 MIGRAINE-MENSTRUAL, - INTRACTABLE, - STATUS 346.40
26 MIGRAINE-MENSTRUAL, +INTRACTABLE, - STATUS 346.41
27 MIGRAINE-MENSTRUAL, - INTRACTABLE, + STATUS 346.42
28 MIGRAINE-MENSTRUAL, + INTRACTABLE, + STATUS 346.43
29 MIGRAINE-PERSISTENT AURA, - INFARCTION, - INTRACTABLE, - STATUS 346.50
30 MIGRAINE-PERSISTENT AURA, - INFARCTION, + INTRACTABLE, - ST ATUS 346.51
31 MIGRAINE-PERSISTENT AURA, - INFARCTION, + INTRACTABLE, + STATUS 346.52
32 MIGRAINE-PERSISTENT AURA, - INFARCTION, + INTRACTABLE, + ST ATUS 346.53
33 MIGRAINE-PERSISTENT AURA, + INFARCTION, - INTRACTABLE, - STATUS 346.60
34 MIGRAINE-PERSISTENT AURA, + INFARCTION, + INTRACTABLE, - STATUS 346.61
35 MIGRAINE-PERSISTENT AURA, + INFARCTION, - INTRACTABLE, + STATUS 346.62
36 MIGRAINE-PERSISTENT AURA, + INFARCTION, +INTRACTABLE, + STATUS 346.63
37 MIGRAINE-CHRONIC, - AURA, - INTRACTABLE, - STATUS 346.70
38 MIGRAINE-CHRONIC, - AURA, + INTRACTABLE, - STATUS 346.71
39 MIGRAINE-CHRONIC, - AURA, - INTRACTABLE, + STATUS 346.72
40 MIGRAINE-CHRONIC, - AURA, + INTRACTABLE, + STATUS 346.73
1169 MIGRAINE-OTHER, OPHTHALMIC, NOT INTRACTABLE 346.80
1171 MIGRAINE-OTHER, OPHTHALMIC, INTRACTABLE 346.81
41 MIGRAINE-OTHER, - INTRACTABLE, + STATUS 346.82
42 MIGRAINE-OTHER, + INTRACTABLE, + STATUS 346.83
1264 MIGRAINE-UNSPECIFIED, - INTRACTABLE 346.90
1277 MIGRAINE-UNSPECIFIED, + INTRACTABLE 346.91
43 MIGRAINE-UNSPECIFIED, - INTRACTABLE, + STATUS 346.92
44 MIGRAINE-UNSPECIFIED, + INTRACTABLE, + STATUS 346.93

Characteristics

Migraines have distinguishing characteristics:

  1. Headaches of moderate to severe intensity with a pulsating quality which is frequently made worse by movement.
  2. Headaches which often involve one side of the head.
  3. Headaches which recur with a frequency varying from several per week to a few in a lifetime.
  4. Headaches often associated with nausea or vomiting as well as increased sensitivity to light (photophobia) and sound (phonophobia).
  5. Headaches having a tendency to run in families.
  6. Headaches which may be accompanied by symptoms such as visual disturbance, numbness, weakness, or
    difficulty thinking clearly.

Pain

The pain of a migraine is associated with dilation of the blood vessels on the surface of the brain and in the scalp. There may be inflammation of surrounding tissue and irritability of the surrounding nerves. Migraines are believed to be caused by a chemical imbalance in the brain. The chemical, serotonin, carries messages between nerve cells and affects three things: (1) pain perceptions, (2) sleep patterns, and (3) moods.

Triggers

Migraine headaches are triggered by either physical or emotional stressors. The triggers may build upon one another, thus causing a headache at certain times but not at others. Common physical stressors acting as triggers include disruptive sleep or eating routines, hormonal changes, certain foods, alcohol, caffeine, medications, nicotine, bright lights, or changes in weather. It is important to learn triggers and to avoid them when possible. We know that there is not one type of personality that is more likely to suffer from migraines.

Control

Although migraines cannot be cured, they can be controlled. Fortunately for those who experience migraines, doctors are learning much more about the headaches and are in a much better position to help. The goals of treatment are to:

  1. reduce the frequency of headaches, and
  2. to rapidly stop the headaches when they do occur.

Treatment

Treatment may involve dietary changes, stress reduction, exercise, and medication. Good sleep habits are essential for headache control. Excellent headache management should occur in approximately 90% of cases.

Vitamins, Minerals, Aspirin, Herbs, and Filters

The following vitamins, minerals, and herbs have been shown to have specific action on headaches:

  1. Magnesium aspartate or oxide: 400-500 mg tabs at night before sleep. Do not combine with calcium, zinc, or iron supplements. Do not take with dairy products or a multivitamin. May cause transient diarrhea.
  2. Riboflavin (Vitamin B2): 200 mg twice a day with meals. May turn urine bright yellow.
  3. MigreLief: contains magnesium, riboflavin, and feverfew - www.migrelief.com or 800-728-9948. Take MigreLief twice per day.
  4. Aspirin: One baby (81 mg) or adult (325 mg) aspirin per day, any brand, with a meal.
  5. Co-Enzyme Q-10: 100-300 mg per day in a single or divided dose. The cost can be expected to be approximately $30/month.
  6. Butterbur: (Petastites hybridus root) 50 mg - 3 times/day for 1 month, then twice per day. Side effects seem to be minimal although some patients develop GI problems including burping. May be obtained as "Petadolex® Butterbur Gelcaps" (approximately $50-70/month) at www.petadolex.com or www.betterhealthinternational.com.
  7. Migravent capsules contain butterbur extract 50 mg, riboflavin 200 mg, magnesium 110 mg, and feverfew extract 25 mg. We recommend 2-3 capsules per day in a divided dose. www.migravent.com or 1-866-443-2322.
  8. Melatonin: Start with 3 mg but may increase gradually to 9-12 mg 1-4 hours before bedtime to initiate & maintain sleep.
  9. Valerian: 400-900 mg to promote sleep.
  10. FL-41 Filter: It has been shown that this filter on glasses will reduce migraine headaches triggered by sunlight or glare. Contact your eye doctor or Mr. Josef Silverman, Digby Eye Associates, 336-230-1450.

When choosing a vitamin, "expensive" does not mean "better". Look for a vitamin that contains 100% RDA of the majority of elements. Megavitamins are not necessary and may not be recommended in some cases. Remember, you are getting some vitamins in your food. While the body can tolerate higher than RDA doses of some vitamins, others can be toxic at high levels. A generic vitamin is as good as a brand name. Be careful of the fat soluble vitamins - A, D, E, and K. Too high an intake of the fat soluble vitamins can lead to toxicity (hypervitaminosis conditions).

Many other medications are available to treat migraine disease. These include anti-hypertensives (Beta Blockers, calcium channel blockers, etc.), anti-convulsants, and 5-HT1 receptor activators (selective serotonin agonists). Before considering these medications, it is important to have a thorough neurologic examination and diagnostics testing by a physician who specializes in the diagnosis and treatment of migraine disorders.

Reference: from the Headache Wellness Center, 1414 Yanceyville Street, Greensboro, NC 27405. Phone 336-574-8000, Fax 336-574-8008. www.headachewellnesscenter.com.

Last updated: 01/18/2014