Pfizer Pharmaceutical has recently released a new web site called CampaignAgainstMigraine.com to help educate migraine patients about different medications and treatment options that might be available to them.   Obviously, Pfizer is a large drug manufacturing company – their migraine medications include Relprax (a triptan class medicine) – but this site is valuable in that it describes the types of migraines commonly seen, migraine triggers, questions for one’s doctor and even a migraine diary.

The migraine diary form can be especially helpful for Social Security disability claimants.  Disability judges will award benefits in migraine cases but they want to see on-going treatment records as well as evidence regarding the frequency of your migraine headaches.

Social Security defines disability in terms of your capacity to perform the duties of a simple, entry level job.  Click here to learn more about how Social Security defines the term “disability.”  If you are likely to miss 3 or 4 days per month, or if you are likely to need unplanned breaks from work once or twice a week, most vocational witnesses who appear at hearings will testify that you would not be reliable enough for competitive work.

If you are able to keep a regular migraine diary over a period of months or years, that diary can serve as valuable evidence in your case

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How do you describe to a Social Security judge what it is like to experience migraine headaches?   Describing headaches is a difficult task at best, but you can assume it will be more difficult when you add in the stress of testifying in a Social Security courtroom before a judge.

One of the keys to successful testimony is to remember how Social Security looks at “disability” in a migraine case – your inability to perform a simple, entry-level job because of symptoms associated with your migraines, medication side effects and symptoms from any other medical condition you may have.

Another way to think about what you want your testimony to accomplish – how do I show the judge that I would not be a reliable worker?  that I would miss too many days of work and that I would have too many unplanned absences during the days I was there.

Here are some tips about how to prepare your testimony:

• discuss duration and frequency of your headaches – even though your migraines may not follow a set pattern, for purposes of your disability hearing, decide how you will answer the judge’s questions about the frequency and duration of your headaches.  Do not say “I get bad headaches all the time and they can last all day.”  Instead, say something like this:  “I get severe migraine headaches at least once every 10 days.  When I feel a migraine coming on, I immediately take XYZ medicine and sometimes that will reduce the severity of the headache and it will only last five or six hours.  If I don’t catch it in time, my headache will last at least eight to ten hours.  During cold weather, the frequency of my headaches increases and I have them every 7 days.  If I am under stress, they could happen every 3 or 4 days.  Under the best of circumstances, my migraines will last five or six hours, at worst they can last eight to 24 hours.”
• discuss severity of your headaches – do not say “when I get a migraine, it feels like a toothache.”  Instead, say something like this:  “when I get a migraine, the pain in my head is at a 9 or 10 on a ten point scale.  The pain is so bad that I cannot tolerate light or noise and I immediately go to bed, pull the shades down and avoid any light nor noise.”
• discuss your efforts to control your headaches and your frustration at not being able to do so.  Say something like this: “I have done everything my doctor has told me to do.  I took XYZ medication but I found that it did not control my pain and I got nauseous.  My doctor then put me on ABC medication and I take it when I feel a migraine coming on – it can shorten the duration of my headaches but it does not reduce the intensity.  My doctor suggested biofeedback and I tried it.  My doctor suggested XYZ therapy and I tried it.  These headaches have completely altered my life.  I avoid leaving my house because of my fear about what I would do if a migraine hit.  I have not been able to travel to see my (grand)children and I avoid all social situations – even movies and grocery shopping.

Remember, Social Security judges want specifics – not generalities.  The more you can focus on time, distance, and other units of measurement the better.  This allows judges to put those limitations into a question about your capacity that will be posed to a vocational witness.  The more realistic and severe limitations you can set out the better your chances.

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The United States Food & Drug Administration is likely to approve several promising new migraine treatments in 2011.   The treatment perhaps closest to market is the Zelrix patch, manufactured by NuPathe Pharmaceuticals.   According to NuPathe’s web site,

Zelrix utilizes SmartRelief, our proprietary transdermal delivery technology. SmartRelief consists of a controlled delivery technology that uses a mild electrical current to actively deliver medication through the skin in a process called iontophoresis.

As you can see, the Zelrix patch looks like a large bandage with batteries and electrodes embedded therein.  The batteries generate a mild electrical current to push the medicine into the skin.   Patients who participated in one of the clinical trials enjoyed the benefit of an effective medication but did not experience the nausea and queasiness associated with traditional oral medications.

Another pharmaceutical company, Map Pharmaceuticals of Mountain View, California, is developing a mist inhaler designed to infuse the drug dihydroergotamine (DHE) into the bloodstream.  DHE is considered one of the more effective drug treatments for migraines, but it must be administered intravenously.  If Map Pharmaceutical’s formulation (called Levadex) is approved, more migraine sufferers will have access to DHE without many of the unpleasant side effects associated with current treatment.  Map has also developed a new style inhaler device called the Tempo inhaler designed to deliver medicine more effectively than current inhaler technology.

New technologies like the Zelrix patch and the Tempo inhaler offer promise to migraine sufferers who cannot tolerate oral medications (pills) or who do not respond to currently prescribed medications.   Most migraine headache Social Security disability cases involve assertions that the claimant’s severe headaches cause numerous unscheduled breaks from work and significant problems with attention and concentration.

Until new and effective treatments become widely available migraine patients will continue to qualify for disability benefits based on debilitating migraine headaches.

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What if the medicine you were taking to remedy a chronic condition or disease was actually causing your illness to worsen, or even causing another condition to develop?  That is exactly the idea behind some recent studies that have shown that some medications used to treat headaches, especially migraines, may be actually contributing to the problem.  Many people who take triptans for migraines end up developing headaches that can be attributed to these drugs.  In fact, according to ABC News, approximately four million people may suffer from medication-overuse headaches, as well as “rebound” headaches that occur when a medication wears off.

In a study of 160,000 patients, Dr. Lipton, from the Montefiore Headache Center at the Albert Einstein College of Medicine, found that approximately two percent of individuals who take migraine medication at least three times a month may become dependent on the drugs.  This dependency causes them to develop more migraines, and as such, they may have to change medications or treatment options.  But, these medications provide such great relief in the interim that it is difficult to give them up.  What can an individual do when he/she is suffering from such debilitating headaches without relying on medication?  ABC News offers some suggestions about how to manage migraines without drugs.  These guidelines may also help people to function better, as they will not have to suffer through medication side effects in addition to the migraine pain.

First, try to keep a routine schedule, which means the same bedtime, mealtime, and wake up time every single day of the week, including weekends.  This means avoiding sleeping in on weekends or rainy days, and avoiding big changes to this schedule whenever possible.  Next, try to keep a journal detailing what foods provoke a migraine and then avoid those particular items.  Don’t want to go through trial and error of finding what foods cause headaches?  Then, get a food list from the American Council on Headache Education and try to limit your consumption of these items.  It is also suggested that you exercise moderately and often.  In this same vein, you should avoid smoking and manage or avoid stressful situations.  Finally, try to get evaluated for any neck or jaw pain, as there could be an underlying cause of your headaches that is easily fixed with a neck pillow or a mouth guard.  If a headache has already developed, you can apply ice to the head and temples, and heat at the neck to stave off further pain.  Although all of these suggestions may not work for every migraine, they may help to curb some of the pain and may also result in fewer instances of medication overuse.

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Although the specific cause of migraines is unknown, many people can identify certain environmental factors that trigger them. For some people it is unusual or spicy foods and for others it is stressful situations. Or perhaps these disabling headaches occur based on weather changes. Well, migraines may be very unpredictable, but the weather may be less so. And now, thanks to a new tool from AccuWeather, weather and subsequent migraines may be easier to predict.

According to AccuWeather’s blog, variable highs and lows in atmospheric pressure, oppressive heat, extreme humidity, and precipitation can cause the brain’s blood vessels to contract and expand. Migraines and their severe symptoms of nausea, pain, and difficulty functioning often occur because of the changes in the size of blood vessels. In fact, the blog notes that a certain study found that temperature changes with humidity, changes in barometric pressure, and varied weather patterns are the largest contributors to a migraine attack. The particular study was conducted in 2004 in Connecticut where researchers examined migraine sufferers’ diaries and compared them with local weather reports for a period of time. They found that approximately half of the participants reported an onslaught of migraine headaches during weather changes. Moreover, about sixty percent of the individuals felt that they were sensitive to abrupt weather disruptions.

Another study, conducted in Canada, found that individuals also reported more migraines when winds changed in their local region. What’s more is that the individuals in both studies indicated that while weather was an important factor in migraine occurrence, it was only heightened when other conditions, such as stress or lack of sleep, were present. Fortunately, AccuWeather has developed a forecasting tool that allows people to assess what the likelihood of having a migraine due to weather may be. The tool targets a local region and you can see how the weather may impact a migraine suffer on any given day. It rates the likelihood of an attack from a beneficial weather forecast to an extreme risk of developing a migraine.

Perhaps, with tools such as this one, people who live with these difficult headaches can better prepare for their day. If the weather is such that a migraine may occur, a person can try to limit other factors and also ensure that they have their medication. It is just this kind of preemptive treatment that can really allow individuals to better their quality of life without worrying that a disabling headache is just around the corner.

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What if the root of your migraine pain was not really in your head after all? What if it was tied to a completely different organ located on your face? You may immediately think it has something to do with your eyes since blurred vision, seeing auras, and light sensitivity are all symptoms of a severe migraine. You would be wrong. According to Houston doctor Kevin Smith, your migraine may be specifically tied to your nose! The Houston Chronicle interviewed Dr. Smith about his novel theory and his new book, The Migraine Imposter.

Dr. Smith, who is an ear, nose, and throat doctor, believes that many migraine sufferers are actually suffering from a deviated septum. This occurs when the cartilage separating the right and left airways becomes damaged or otherwise displaced. Dr. Smith thinks that this damaged septum can come in contact with sensitive tissue in the nose, thereby triggering headaches, such as migraines. He encourages individuals to visit a neurologist and get a MRI to reveal if any tumors or other abnormalities are present. If none are discovered, he believes that patients should then get a CT scan of their sinuses to look for signs of a deviated septum. If this is found Dr. Smith proposes a relatively easy and quick procedure that will not only repair the septum, but also possibly the migraine headaches. The twenty minute procedure called a septoplasty has resulted in ninety percent of Dr. Smith’s patients reporting relief from debilitating headaches.

Deviated septums, according to Dr. Smith, usually occur after some type of trauma to the nose. Additionally, he notes that many athletes who complain of severe headaches, but are constantly subjected to damaging trauma may in fact have a deviated septum. Even childhood accidents can lead to a damaged septum. Dr. Smith believes that if more people were tested for a deviated septum, not only would they feel relief from migraine pain, but would also save thousands of dollars on health care every year. Furthermore, individuals with migraines are recognized to have a disability if they are unable to continue working. He believes that more people will be able to continue working if they have their septums fixed and find migraine relief. Migraines are difficult to manage and can cause debilitating pain that have no identifiable cause. Hopefully, Dr. Smith’s hunch is correct and the way to relief is through your nose!

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One of the hallmarks of a severe migraine headache is a person’s sensitivity to light.  Often, when someone is suffering from one of these debilitating headaches, he/she seeks refuge in a darkened room, limiting as much light as possible, as well as avoiding any distractions.  Migraine sufferers can spend hours in the room, waiting for the pain to dissipate and adjusting to their environment again.  It can be so bad that some people must leave work to avoid the light and ride the migraine out.  Most individuals who have migraines note that light makes the headaches worse, and sometimes, it is that very light exposure that causes a migraine to occur.  But, why exactly is there a connection between light and the onset of a migraine? Two Scottish researchers set out to find out why and if this relationship really exists.

The research team divided study participants into two groups: one group had never suffered from migraines, while the other group consisted of individuals who experienced chronic migraines.  The participants were asked to focus on a small white light, while light noise played in the background.  This light noise was akin to the television static that comes on when the cable is out or programming is discontinued.  The researchers noted that when the background noise was not on, the healthy participants, as well as the migraine sufferers could each find the white light with little to no problems.  In this instance, those living with migraines did not complain of any difficulty or pain.  When the background was turned on, however, those migraine sufferers had a very difficult time finding the white light when compared with the healthy participants.  It is important to note that those who were prone to migraines were not suffering from any at the time of the study.

The researchers concluded that people who suffer from migraines recognize visual cues better when there are no distractions around, such as the background noise in the study.  What was surprising to the researchers is that this was true even when they were not suffering from migraines.  They concluded that migraine sufferers are likely at a disadvantage when they are attempting to focus on a particular object or details in a cluttered environment.  Unfortunately, our environment is chock full of objects, noise, lights, etc. that may prevent these individuals from being able to focus.  This may explain why being in a dark room devoid of distractions allows an individual with a migraine to focus better and relax their eyes, contributing to some pain relief.

This also may the reason people with migraines find it so difficult to maintain employment and will often file for Social Security Disability. The work environment often involves noise, light, other people’s perfumes, etc., so it’s no wonder migraine sufferers have such a tough time on the job.

If you suffer from migraines, you may benefit from decreasing the amount of distractions present in your environment – be it at work or at home.  Additionally, when a migraine hits, it is prudent to escape to a quiet, darkened room to ease the adjustment to all that is present around you. If your migraines are so bad that even these measures do not help you, it may be time to file for Social Security Disability.

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Most people will go to any length imaginable in order to make the pain associated with a migraine headache go away.  They are often relegated to taking an assortment of prescription medications to ease the pain and possibly prevent a migraine attack from occurring.  Despite the relative success of these drugs, many migraine sufferers find they cannot take them because of the severe side effects associated with them.  Unfortunately, most individuals must take something in order to combat the migraine because its effects often result in being absent from work, school, and other activities – which is why people with migraines often end up applying for social security disability.  Two new studies published in the journal Headache, however, give some hope to those migraine sufferers who simply cannot take or do not respond well to the traditional drug therapies.  Each of these studies concluded that taking naproxen (or Aleve) and acetaminophen (or Tylenol) reduced migraine pain and recurrence, as well as other migraine symptoms, such as nausea.

In the first study, researchers from Taiwan examined the results of previous studies using naproxen at a dosage level of 500 to 825 milligrams for approximately 2,168 migraine patients.  The researchers found that naproxen reduced the migraine intensity, pain, and symptoms within two hours of taking it, according to Reuters.  This resulted in a “desirable outcome” as defined by the International Headache Society.  Despite this favorable outcome, the researchers also found that naproxen did not always offer the same clinical benefits as triptans, the traditional migraine drugs.  Moreover, the researchers also found that aspirin provided better relief than naproxen in regulating migraine pain.  In fact, according to Reuters, the research team concluded that a 1,000 milligram dose of aspirin was the best treatment option for migraines when compared to naproxen or acetaminophen.  However, many people cannot take triptans or aspirin because of their harsh side effects.  Because of this, Aleve and Tylenol may provide the best alternative to migraine pain management.

In the second study, the manufacturers of Tylenol conducted an examination 378 migraine sufferers who were randomly given Tylenol or a placebo.  Over ninety days, the researchers found that those taking the Tylenol reported reduced pain within an hour of taking the pill, and after two hours, fifty-two percent report little to no pain.  Conversely, those in the placebo group continued to report pain after two hours at a rate of sixty-eight percent.  They also found that Tylenol reduced other migraine associated problems such as nausea and light sensitivity, whereas the placebo did not.

This is great news for migraine sufferers who have reached their wits’ end about how to effectively counter the effects of a migraine.  Taking Tylenol or Aleve are low cost, effective alternatives to the traditional migraine drugs on the market.  Further, it may be easier for people to purchase and take them without having to wait for a prescription or worry about injecting a medication while at work or school.  Because these medications are not approved by the FDA as a migraine treatment, it is best to speak with your doctor about taking them as part of your migraine therapy.  Hopefully, you will get the green light to take something already in your medicine cabinet and get the relief you have been looking for.

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Numerous studies have shown that the majority of migraine sufferers are women.  Specifically, of the thirty million migraine patients, three out of four are women.  It is difficult, however, to determine whether a woman is suffering from migraines or from another health condition where migraines result as an offshoot.  Although there is no definable cause for migraine occurrence, it appears that woman’s hormones often play a role in influencing a migraine attack, triggering debilitating pain, nausea, and light sensitivity.  Furthermore, although no one can definitively predict when a migraine is going to attack, most medical professionals agree that estrogen plays a significant role in the frequency, intensity, and fluctuation of migraines.  This may be why women experience more severe migraine symptoms around the time of their period and why birth control is sometimes used as a way to control migraine attacks.  This link between estrogen and migraines may also provide an understanding as to why women who suffer from migraines also exhibit a lower risk of breast cancer.

According to USA Weekend, studies published between 2008 and 2009 show that women who suffer from migraines have a twenty-six to thirty-three percent lower risk of developing breast cancer.  After these studies, researchers began to wonder whether it was the actual migraines or the non-steroidal anti-inflammatory drugs that reduced the risk of breast cancer.  The USA Weekend article notes that both aspirin and these types of drugs have been shown to reduce the overall risk of breast cancer and are often taken to combat migraines.  The researchers found that migraine sufferers were eleven percent less likely to develop breast cancer and seventeen percent less likely to develop hormone sensitive breast cancer, even if they were not  taking any of the aforementioned drugs.

The research team believes that the estrogen’s role in breast cancer and migraine attacks is the reason for these associations.  They cite the evidence that more women experience severe headaches around the time of menstruation and that pregnant women have fewer migraines once the estrogen stabilizes in the middle of pregnancy.  How estrogen actually influences these conditions is still largely unknown and more research will be needed in this area.  It does provide some hope, however, that those who suffer with migraines may be able to better manage them depending on their estrogen levels.  It is also significant that having such a debilitating condition can actually decrease the chances of developing another serious disease like cancer.

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When you go to the dentist, does he or she suggest that some of your dental problems may be attributed to teeth grinding? For me, this has been the case over the years, but I have conveniently managed to ignore my dentist when it comes to this issue; I simply cannot stand the idea of wearing one of those mouth guards. However, if you are stubborn like me but suffer from migraine headaches, you may want to re-think your stubbornness. I recently read an article by Dr. Lee Sheldon regarding the link between teeth grinding and the development of migraines, and this article makes a compelling argument that says teeth grinding can lead to migraines.

The article talks about how migraines occur when blood vessels in the head become engorged and press down on the trigeminal nerve, which is responsible for pain behind the eyes and on the side of the head. This compression of the nerve produces the intense pain often associated with a migraine. This nerve, however, also has another function in which it controls the temporalis muscle and other muscles in the lower jaw. The temporalis muscle is located between your eye and ear, and when you clench your teeth, you can feel it bulge. Dr. Sheldon notes that when this particular muscle is strained, the trigeminal nerve begins firing. He goes on to point out that most people grind or clench their teeth in five second intervals during the night and it usually goes unnoticed. That is, until a migraine occurs. Dr. Sheldon cautions that the continuous grinding makes the nerve fire over and over, which in turn engorges the blood vessels, and finally, a migraine develops. Additionally, approximately forty-eight percent of migraines begin to occur between four and nine in the morning, just after a night full of teeth grinding.

Dr. Sheldon admits that most people do not think that they grind their teeth, and therefore, have no idea why migraines begin to develop. He advises people to take a good look at their teeth and if they are flat or the edges are jagged, it can usually be attributed to grinding. So, what can you do? As I mentioned earlier, most dentists and neurologists recommend wearing a dental appliance that can reduce the clenching and grinding, thereby reducing the excessive muscle and nerve tension leading to migraines. These appliances have been shown to reduce the severity and frequency of migraines. As much as it may pain you to have to get fitted for one of these mouth guards (I know I wouldn’t want to do it) the migraine pain probably far outweighs your painful pride!

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