House Calls

FALL 2016

House Calls Magazine is a quarterly publication that focuses on health and wellness. It includes a wide assortment of articles with topics on the latest health and wellness information, nutrition, safety, lifestyles, and more.

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36 { fall 2016 } h o u s e c a l l s Dissecting a Migraine For decades, migraines were believed to be caused by vascular issues—specifically, by a shift in blood flow to the brain. Recently, however, additional factors have been pinpointed; for example, it's thought that a shift in serotonin levels in the brain facilitates activation of the trigeminal nerve pathways (which control sensation in the face and motor functions such as biting and chewing). Regardless, many questions remain about what causes the condition. There are four potential stages of a migraine headache: the prodrome, aura, attack, and postdrome. Some time before the headache sets in, the prodrome (also known as the preheadache) period begins, bringing about symptoms like moodiness, neck stiffness, cravings, and constipation. Just before the headache, some people experience a second phase, known as aura, which can include weakness, distorted vision, hallucinations, and seeing zigzag patterns and flashing lights. "The aura is a very specific neurological event," says Dr. Hochman, adding that the electrical activity in the brain during an aura phase of a migraine is similar to that during a seizure. "There's a spreading wave of excitement across the brain's surface, followed by a depressed state," he says. The migraine itself—known as the attack phase, with its hallmark symptoms of unilateral, throbbing pain and nausea—can last anywhere from four hours to three days and is followed by a postdrome period of mental fogginess and fatigue. All in all, migraines can cause sufferers to miss out on school, work, and time with loved ones. "When patients are asked to draw what a migraine feels like, a striking theme of loss of time always comes through," says Dr. Hochman. "Family, children—it's like they're escaping through your fingers because you're incapacitated, but you can't do anything to stop it." F ortunately, recent treatment breakthroughs are helping bring relief to patients who have suffered from migraines for years. Here, Dr. Hochman explains how. THE FUTURE OF MIGRAINE TREATMENT Migraine treatment options that were fringe a decade ago are now commonplace. Here, Dr. Hochman shares what lies ahead for the field: Æ CRYOTHERAPY: Freezing the nerves responsible for migraine pain is a precise art: too cold and you kill the nerve, not enough and you irritate the nerve and exacerbate pain. But get it just right, and ahh … sweet relief. Dr. Hochman is the first doctor in South Carolina to offer this recently approved treatment method, in which under ultrasound guidance the specific culprit nerves are targeted. Æ NERVE STIMULATION: This new type of therapy is often effective for back pain and is showing promise for migraine treatment, although it is currently not FDA-approved in the United States. Æ MEDICAL THERAPY: New drugs are targeting calcitonin gene-related peptide (CGRP), a molecule thought to be integrally related to migraine pain. When Mount Pleasant resident Andreana Valicenti Fiem was diagnosed with chronic migraines in 2013, she was bed-bound four to six days a week due to the pain and symptoms. Thanks to nerve blocks, decompression surgery, and lifestyle changes recommended by Dr. Hochman, today she has only three migraines a month that keep her bed-bound, and is typically pain-free two days a week. Depiction of a migraine, drawn by a sufferer.

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