HealthFirst-Migraine dangers

UNDATED -- (01/30/09)-- As if migraines aren't bad enough on their own, the painful headaches may also be a sign of a much more serious problem.

HealthFirst reporter Leslie Toldo has more on the dangerous connection between your heart and your head.

This could affect as many as half of the people who suffer with migraines.

They strike out of nowhere. "Imagine having a level five or six of pain that doesn't go away," migraine sufferer Maria McIntyre said.

"I'm not functional at all. I can't read," said migraine sufferer Richard Higgins

Migraines show no mercy. For bioengineer Richard Higgins, they became a stumbling block to his career.  "My first symptoms are auras, which are a small blind spot in my vision."

Auras afflict about a third of migraine sufferers. Most don't know the visual symptoms could be pointing to a potentially life-threatening heart defect called patent foramen ovale, or PFO.

"We believe that 50 percent of patients who have migraine with aura have PFO," interventional cardiologist Dr. Ziyad Hijazi said.

The hole in the heart leaves a person at high risk for stroke.  "If your migraine is the migraine with aura and you get it at least a few times a month, the first test that you should have is an echocardiogram to see if you have a PFO or not."

In addition to stroke, migraine with aura has been linked to an increased risk of heart attack and depression. Dr. Stil Kountakis says sinus headaches and migraines often get confused.

"Migraine headaches. I have a lot of headache patients that come to my office, 'I have the sinus. I have got the sinus.' Most of the time what they describe is a vascular type of headache."

Although Maria McIntyre's migraines haven't amounted to anything more serious, she's fought hard to get an accurate diagnosis. "You know, going back to your doctors and saying there is something else."

We have some contact information about clinical trials looking at whether the closure of PFOs prevents migraines and reduces stroke risk.

MORE THAN A MIGRAINE?  

IS IT A MIGRAINE? Migraines are severe headaches sometimes accompanied by visual symptoms called auras. They affect the daily lives of about 29.5 million Americans. Paul Winner, D.O., F.A.A.N., director of the Premiere Research Institute and Palm Beach Headache Center in West Palm Beach, Fla., and immediate past president of the American Headache Society, says if a tension headache feels like a rainstorm, a migraine feels like a hurricane. "People cannot function normally when they have a migraine," Dr. Winner told Ivanhoe. Migraines are sometimes misdiagnosed because patients confuse them with other conditions. Often, those conditions are sinus headache or tension-type headache.  

The Epilepsy Therapy Project says some types of migraine are often misdiagnosed as epilepsy. Basilar migraine, also called Bickerstaff's syndrome, is characterized by aura that sometimes leads to temporary blindness. The migraine that follows is often accompanied by vomiting. Confusional migraine is also often mistaken for epilepsy. These types of migraines are preceded by auras and marked by confusion. During this type of migraine, a patient appears inattentive and distracted and has difficulty speaking and controlling body movements. Confusional migraine can point to encephalitis, drug ingestion or acute psychosis. 

WHY YOU NEED TO KNOW: Although migraines are clearly painful and inconvenient, they can sometimes be pointing to something more dangerous, especially migraines accompanied by auras. The large-scale Women's Health Study, which followed 27,798 women over age 45, found women who had at least weekly migraines were three-times more likely to have a stroke. Another study published in Neurology in 2005 found migraine sufferers are more at risk for cardiovascular disease than those who don't experience the headaches. Migraines have also been linked to depression. A 2007 study found women with chronic headache were four-times more likely than those with episodic headache to have major depression. 

WHEN AND WHERE TO SEEK HELP: Merle Diamond, M.D., associate director of the Diamond Headache Clinic in Chicago says many cases of chronic migraine are undiagnosed. "I think it's still a hurdle for patients to think headache is important enough to seek out medical care," Dr. Diamond told Ivanhoe. She also says for many migraine sufferers, over-the-counter medications simply won't work. "A good rule of thumb is if you have to use your over-the-counter more than two times a week or you don't get to pain-free quickly, you'll do much better having a diagnosis and a (prescription) migraine treatment." The Mayo Clinic recommends seeking medical attention if your migraine pattern changes or your headaches suddenly feel different. They also recommend seeking emergency care if you experience an abrupt, severe headache like a thunderclap; a headache accompanied by symptoms like fever, seizures or double vision; a headache after a head injury; a chronic headache that gets worse after coughing, physical exertion, straining or a sudden movement; or new headache pain if you're over 50.

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