Ignoring Headaches and Migraines Can Spell Danger

Patient Expert

**. . . more people died from Migrainous Stroke last year than were murdered by handguns.**1

Unfortunately, those who suffer with Migraine disease or other headache disorders are all too used to not being taken seriously. A doctor recently said to one of our forum members that, "Migraine isn't really a health issue as much as a quality of life issue." Were it within my power, I'd revoke his license to practice medicine -- after I slapped him silly, of course. Is it any wonder that Migraineurs often don't realize the possibly serious ramifications of Migraine attacks when their doctors make such uneducated comments?

Abi S. was young woman who was a participant in a forum and chat room I moderated was in the throes of a multi-day Migraine attack. Her medications hadn't helped, and she had not sought emergency care because her parents had accused her of faking Migraines to get attention. A few days later, I received an email from her mother telling me that on the seventh day of her Migraine, the young woman began having seizures, and was in a coma. Tests indicate that she has had a stroke. She came out of the coma, recovered, and was discharged from the hospital. A few weeks later, she had another Migraine, suffered another Migrainous stroke, and died. She was just days from her 22nd birthday.

Migraine and the degree to which it increases risk of stroke is a topic on which expert opinions vary. There is, however, agreement that Migraine does increase the risk, and that status migrainous increases the risk even further.

According to the International Headache Society criteria, when a debilitating Migraine attack lasts more than 72 hours, whether it is treated or not, it is termed "status migrainousus:"

  • head pain may be continuous through the attack or interrupted by headache-free periods of less than four hours

  • relief while sleeping is disregarded

  • short-lasting relief from medications is also disregarded

  • "Patients with status migrainousus need aggressive treatment ... The principles of treatment for status migrainousus include the following:

    • fluid and electrolyte replacement
    • drug detoxification if medication overuse is present
    • IV pharmacotherapy to abort the Migraine
    • treatment of associated symptoms of nausea and vomiting
    • concurrent implementation of Migraine prophylaxis (if indicated). . .
    • After acute treatment is completed, many patients with status migrainousus require continuing care. . ."2

MAGNUM, The National Migraine Association, has an excellent mission statement. One section of it reads:

"To make persons aware that Migraine is not a benign disorder. For example, 27% of all strokes suffered by persons under the age of 45 are caused by Migraine. (Stroke is the third leading cause of death in this country.) In fact, more people died from Migrainous stroke last year than were murdered by handguns."

Another section of the MAGNUM site is Migraine: Myths Vs. Reality, where you will find:

  • MYTH: Migraine is not life-threatening, just annoying. REALITY: Migraine can be life-threatening, inducing conditions such as stroke and coma. Migraine can induce a host of serious physical conditions: strokes, aneurysms, permanent visual loss, severe dental problems, coma and even death. According to the New England Journal of Medicine, "Migraine can sometimes lead to ischemic stroke and stroke can sometimes be aggravated by or associated with the development of Migraine." Twenty-seven percent of all strokes suffered by persons under the age of 45 are caused by Migraine. Stroke is the third leading cause of death in this country. In addition, twenty-five percent of all incidents of cerebral infarction were associated with Migraines, according to the Mayo clinic."
  • MYTH: Any doctor will recognize and properly treat Migraine. REALITY: Migraine is one of the most misdiagnosed, mistreated, and least understood diseases. The fact that so many doctors don't take Migraine seriously can be as disabling to the Migraineur as the disability itself. The leading doctors in the areas of neurology and head pain have themselves stated that this disease is grossly misunderstood and misdiagnosed. In fact, 60% of women and 70% of men with Migraine have never been diagnosed with this disease. This medical ignorance and corresponding inaccurate writings unfortunately perpetuate the myths and misunderstandings about Migraine and convey this to the general public. Dr. Saper stated that "Migraine is a serious and underestimated health problem ... Patients with Migraine are shunted along an assembly line of misdiagnosis, undertreatment, or frank mismanagement. They are subjected to unnecessary procedures and preventable consequences." And as Dr. Silberstein wrote to M.A.G.N.U.M., "M_igraine sufferers must not only cope with their pain, but also with society's misunderstanding of the disorder. Migraineurs are frequently dismissed as neurotic complainers who are unable to handle stress. The truth is that they frequently battle against great odds in order to hold down jobs and support families ... Young Migraine sufferers sometimes miss enough school so that they are unable to graduate with their peers_." Similarly, Dr. Sheftell stated "In addition to misdiagnosis and under-diagnosis, Migraine sufferers will bear the brunt of discriminatory policies by a variety of health care agencies." Such agencies may deny reimbursement for emergency room visits and for hospitalizations for the most severe sufferers. It is not uncommon for doctors to think that a Migraine sufferer is in the emergency room to receive drugs, and dangerously turn them away." 3

Health Watch estimates a greatly increased risk of stroke in Migraineurs:

Migraine and Stroke People who suffer with Migraine headaches may have an 80 percent higher risk of stroke than those who don't have the painful headaches. Stroke is the third-leading killer in the United States. Compounding the problem is that the term "Migraine" is one of the most frequently overused medical words. Migraine sufferers have complained that they encountered skepticism from doctors when first suggesting they might be experiencing Migraine headaches... Recognizing early stroke symptoms also is important. Some of the warning signs of stroke include sudden loss of vision or blurred vision, particularly in one eye; sudden difficulty speaking or understanding simple statements; sudden numbness, weakness or paralysis of the limbs or face; unexplained dizziness or loss of coordination. You need immediate medical attention if those symptoms develop."4

A point on which there is general agreement is that migrainous stroke risk is increased in the presence of untreated Migraine and other risk factors:

"Long-term Migraine without treatment has been shown to predispose sufferers to increased effect on the blood vessels of the brain, especially in those with signs of Migraine with aura (classical Migraine). Persons who have visual or neurological symptoms accompanying their Migraine attacks should avoid other risk factors such as smoking, high cholesterol diets, the use of estrogen and untreated hypertension. These risk factors for cerebral vascular disease, if present in a setting of Migraine, may greatly increase the risk of one having a Migraine related stroke."5

When To Call the Doctor: Don't fall into the "it's-only-a-headache-so-I-don't-need-to-call-the-doctor" trap. A headache can indicate some other serious disease that needs attention. The American Council for Headache Education lists the following warning signs that should prompt you to call your doctor:

  • You have three or more headaches a week.
  • You need to take something every day to relieve the pain.
  • Fever or a stiff neck accompanies your headache - a warning sign of an infection (fever) or bleeding (stiff neck) within the brain.
  • In addition to a headache, you're unsteady on your feet, your speech is slurred, your arms or legs are weak or numb or they tingle (all of which suggest stroke).
  • If the headache follows a head injury and you're confused and/or drowsy, you may have suffered a subdural hematoma, a collection of blood that forms under the skull and presses on the brain.
  • You're over 50 years of age.
  • If your old, familiar headache has changed in character, some new problem may be superimposed on whatever caused the original headache.

Check it out."

Summary: Though the experts don't agree on the degree to which Migraine increases stroke risk, they do agree that there is increased risk. Status migrainousus, as described above, can be especially dangerous. Please don't take chances.

Remember: When in doubt, check it out!


References:

1 MAGNUM, the National Migraine Association: Mission Statement. http://www.Migraines.org/about/aboumiss.htm

2 Stephen D. Silberstein, M.D., Richard B. Lipton, M.D., Donald J. Dalessio, M.D., "Wolff's Headache and Other Head Pain." (New York, Oxford University Press, 2001) 207-211.

3 Michael John Coleman, Terri Miller Burchfield of M.A.G.N.U.M. "An Understanding of Migraine Disease & Tips for Migraine Management." http://www.Migraines.org/myth/mythreal.htm

4 Health Watch is a Public Service of the Office of News and Publications & the Library at University of Texas Southwestern Medical Center at Dallas.

5 The National Headache Foundation: Topic Sheets - Stroke.

6 ACHE: The American Council for Headache Education: When a Nasty Headache Comes Back.