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Migraines: Symptoms, Auras, Treatment


By Kalila Fleming

WRNMMC Command Communications

Headache disorders are amongst the most common disorders of the nervous system.
The most common debilitating headaches are migraines, which are recurrent, often lifelong disorders that begin during puberty, according to the World Health Organization.
Army Lt. Col. (Dr.) Nathan Tagg, chief of the Department of Neurology and neuro-ophthalmologist at Walter Reed National Military Medical Center (WRNMMC) explained the demographics of those who suffer from migraines, as well as why migraines are misunderstood.
“Migraines are more common in women than men, affecting people of all races. One study showed the prevalence in women to be highest; [by race] in Caucasians 20.4 percent followed by African Americans 16.2 percent and Asian Americans 9.2 percent. This same trend held for men as well, but the overall prevalence was lower,” Tagg stated.
“Migraine is a complex neurobiological phenomenon that has been difficult to study,” Tagg added. Modern techniques such as functional MRI and genome wide association studies have helped advance our understanding of what causes migraine. Based on these studies, treatments specific for migraine have been and continue to be developed. There are a number of very promising medications which have been reported in the medical literature lately.”
Dr. Kevin Cannard, a staff neurologist who subspecializes in movement disorder at WRNMMC explained common symptoms that patients reveal when reporting migraines to their physicians.
“[At the onset of a migraine] a minority of people with migraines have an aura. An aura is a symptom that is typically visual, which may come on most commonly before the headache starts,” Cannard explained.
“[Patients] may get a spot that slowly enlarges in the center or offset from the center of their visual field and it may grow. That spot may be white or black, it can have sparkling edges, zig-zag edges (which is called a scotoma aura). They may have sparkles (which are called scintillations); these scintillations can appear to look like shooting stars. Patients have also described temporarily losing their vision,” he added.
Cannard also stated that [migraines] tend to be worse on one side of the head than the other, however, they can be bilateral (affecting both sides), tending to pulsate; nausea is often a common symptom, as well as a loss of appetite and vomiting when it is severe.
“One of the distinctive hallmarks that those who suffer from moderate to severe migraines is that they typically always want to retreat to a quiet, dark room. Cannard explained, “Patients almost always experience sensitivity to light, which is what we call photophobia. As well as sensitivity to noise, this is also known as phonophobia.”
Cannard emphasized these headaches are one of the leading causes of missed work and disability.
The neurologist explained unmanageable migraines are one of the most common causes for service members to receive a Medical Board for possible separation from the military.
From a military standpoint he noted that, “When a person has a visual aura [associated with migraines] they cannot be a pilot or apply to work in other fields [that require visual attentiveness], because this condition is disqualifying.”
Navy career counselor Hospital Corpsman 1st Class Darryl Davis explained that a service member who suffers from a condition that precludes them from being “worldwide deployable,” [such as migraines] is usually placed in a limited duty status until the condition improves, or he or she faces the possibility of being medically separated.”
Tagg referenced Dr. Shuu-Jiun Wang of the Neurological Institute in Taipei, Taiwan and leading expert in migraine disorders elaborated on the comorbidities that have been prevalent with migraine sufferers.
 “Migraine headaches are very common and so can co-exist with many other medical conditions, though the relationship is usually co-incidental. Some of the conditions that have been associated with migraine include depression, anxiety, and stroke,” according to Tagg’s reference.
The treatment of migraines can be divided into two categories. One is preventative treatments, which is also known as a prophylactic treatment. The preventative treatment is given to reduce the number of a person’s migraines. The other is rescue medication or aborted medication. [Rescue medication] is to be given when a person begins to have a migraine to get rid of it.
Rescue medications can be anything as simple as a non-steroidal anti-inflammatory agent like ibuprofen.
However, the whole treatment of migraines was revolutionized when a new group of serotonin based medications were developed called the triptans (serotonin receptor agonists); and how they work are they narrow blood vessels in the brain and relieve swelling, Cannard explained.
Tagg added that those patients who suffer from migraines should consult their primary care physicians because they are the ones who are on the frontlines of migraine treatment; and those patients with severe or complicated migraine, should suggest having a referral to a neurologist.
Both Tagg and Cannard added that the frontline of migraine management is the primary care team, and that the neurology service at Walter Reed Bethesda offers a referral-based comprehensive approach to the diagnosis and treatment of migraine.
For more information regarding migraines, please contact the Neurology Clinic at Walter Reed National Military Medical Center at 301-295-4770 or schedule an appointment at the clinic in the America Zone, Building 19, located on the sixth floor.