Migraine Headaches

Migraines are typically felt as a unilateral throbbing pain of moderate to severe severity that lasts 4-72 hours. They are usually accompanied by nausea, sensitivity to light and sounds. In some cases the headache is preceded by a visual aura, which can appear as flickering objects at the periphery of the visual field. Some may experience a prodrome as an emotional feeling, craving for a food, or a physical sensation prior to the migraine.

Women are 3 times more likely than men to have migraines and migraines can be associated with hormonal fluctuations such as occurs during menstrual periods or starting stopping birth control. Studies have shown that genetics plays the largest factor, as most people with migraines have a relative that also gets them. Migraines occur when the Trigeminal nerve, which innervates the blood vessels and lining of the brain, becomes irritated causing a release of chemicals resulting in the pain and throbbing sensation.

The trigeminal nerve also innervates the TMJ, jaw muscles, teeth, sinuses and joins with the nerves in the upper neck. For this reason jaw and neck problems are often trigger for the migraines.


Diagram – Migraine Headaches

Although the headache is similar, migraines with aura appear to be brought on by different mechanisms than migraines without aura. Migraines without aura can be brought on by excessive stimulation of the trigeminal nerve as occurs in tension-type headaches, myofascial pain, TMJ disorders, and dental pathology. Reducing the excessive stimulation of the trigeminal nerve can significantly reduce or eliminate migraines without aura. 

That along with identifying and avoiding other migraine triggers (see below) can often significantly reduce or eliminate your migraines. Migraines are often treated with prophylactic medications (taken every day to reduce frequency of migraine). If migraines occur more than once a week they should be treated with a medication taken every day, otherwise they can be treated with abortive medications. 

These medications can have several severe adverse side effects therefore proper diagnosis should start with your family physician or neurologist.  Bruxism (teeth clenching) and TMJ disorders can be potent triggers for migraines as the trigeminal nerve also innervates the jaw and jaw muscles.  Therefore, in some cases migraine frequency can be significantly decreased with treatment of Bruxism and TMJ disorders.  In our office, Botox into the jaw muscles and trigeminal nerve have also been shown to be effective treatment for jaw pain and migraines.

Below are a list of migraine triggers; make note of any triggers that you can identify are related to your migraines and discuss these with Dr. Pehling.

The Migraine Trigger Checklist

_____ Aged cheeses

_____ Alcohol (red wine, beer, whiskey, champagne)

_____ Caffeine (excess intake or withdrawal)

_____ Chocolate

_____ Citrus fruits

_____ Cured meats

_____ Dehydration

_____ Depression

_____ Diet (skipping meals or fasting)

_____ Dried fish

_____ Dried fruits

_____ Exercise (excessive)

_____ Eyestrain or other visual triggers

_____ Fatigue (extreme)

_____ Food additives (nitrites, nitrates, MSG)

_____ Lights (bright or flickering; sunlight)

_____ Lunchmeats

_____ Menstrual periods

_____ Medications

_____ MSG

_____ Noise (excessive)

_____ NutraSweet®

_____ Nuts

_____ Odors

_____ Onions

_____ Salty foods

_____ Sleep (too much, too little, other changes)

_____ Skipped meals

_____ Stress

_____ Television or movie viewing

_____ Weather (changing conditions)

_____ Wine (red)

_____ Others