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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h o u s e c a l l s { fall 2016 } 37 Diagnosing the Condition Migraines often begin during childhood and peak between ages 25 and 55, but they can begin at any time during a person's life. The condition is often genetic, and women are three times more likely to experience migraines than men (according to the Migraine Research Foundation, 18 percent of women in the U.S. suffer from migraines, compared to six percent of men). For an initial diagnosis, seek out a neurologist who specializes in headaches. Once accurately diagnosed, the neurologist may treat the patient with medication, or refer them to a facial surgeon for one of several new treatment options. From there, primary care physicians, including an OB/GYN or pediatrician, communicate with the specialists to help with long-term management of the condition. Treating the Pain Most treatment programs begin with medication, including drugs intended to halt the pain (these include triptans, steroids, and IV infusions) as well as preventative medications that aim to ward off migraines before they start (beta-blockers, anti-seizure medications, and anti-depressants). For more long-term relief, doctors have turned to nerve blocks—a treatment option in which a local anesthetic is placed around specific branches of the trigeminal nerve and the sphenopalatine ganglion, a cluster of nerve cells in the nose, to block pain information from being sent to the brain. Although the medicine only blocks the input to the brain for a few hours, the relief often lasts much longer. "It's like turning the power off on a computer," says Dr. Hochman. "When it reboots, everything comes back closer to normal." If nerve blocks yield positive results, additional treatment options, such as Botox injections, may be used. Though designed as a way to minimize fine lines and wrinkles, Botox—which was approved by the FDA for the treatment of chronic migraines in 2010—has been found to decrease the contraction of the muscles surrounding pain-sensitive nerves, providing migraine relief lasting for several months. If nerve blocks and/or Botox are successful and it's clear that pharmacologically decompressing muscles helps, a patient may be a candidate for surgical decompression at various trigger sites, an outpatient procedure similar to a brow lift that can permanently weaken the muscles that provoke the pain. Less than a decade after facial surgery and Botox became relief options for migraines, the treatments make up more than a quarter of Dr. Hochman's facial plastic surgery procedures. "As a typical example, I had one patient who had very intense migraines that she described as feeling like an ice pick behind her eyes," he recalls. "Medication hadn't worked, so we tried nerve blocks, found success, and ultimately chose surgery. She's now a completely different person in terms of her quality of life." A decade ago, that patient might still be suffering. "We're in a place in the medical history of migraines in which research, clinical experience, technology, and pharmacology are coming together to give hope to people who have run out of options," says Dr. Hochman. "In the end, it's all about finding what works best for the individual patient." "I see improvement in small things, like occasionally being able to cook dinner, walk the dogs, or go on a vacation." —ANDREANA VALICENTI FIEM "It wouldn't be doing it justice to simply call a migraine 'a headache.'" — DR. MARCELO HOCHMAN Pinpointing Your Pain CLUSTER HEADACHES: Intense pain localized in one side of the head, often comes with a runny nose on the same side of the face. These typically recur over time, can be debilitating, and are often confused with migraines. Though there is no cure for cluster headaches, a specialist can help manage the condition with similar techniques as for migraines. TENSION HEADACHES: Identified by persistent ache and pressure at the temples and in the back of the neck. Typically treated with over-the-counter medication. SINUS HEADACHES: An infected sinus tract can cause headache pain, and is typically treated with antibiotics. More than 150 different types of headaches exist, many of which are debilitating. If your headache doesn't sound like a migraine, it could be one of the three most common types: P H O T O G R A P H S ( 2 ) B Y K A T I E F I E D L E R & I L L U S T R A T I O N C O U R T E S Y O F M I G R A I N E A R T C O L L E C T I O N Dr. Marcelo Hochman

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