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Proposal Requirement 4 Example: Migraines

Writer: Aditi Bang

Instagram: @aditib06

Email: aditi.b604@gmail.com


Current Solutions and Their Insufficiencies

Right now, there are no official drugs that can cure migraines. Over 39 million Americans and 1 billion people endure their migraines and try to find a way to alleviate the pain. Migraine medications treat symptoms using one of the two methods: prevent a migraine attack or relieve symptoms. Many migraineurs depend on pain relievers such as over-the-counter drugs like acetaminophen, anti-inflammatories such as ibuprofen, and prescription narcotics. This type of treatment supplies relief, but it does not aim at the physiological processes that occur during a migraine attack.

Acute medications fall in these groups: analgesics/ NSAIDs, ergotamines, and triptans. Analgesics and NSAIDs are affordable and easily available as over-the-counter medications such as acetaminophen. Naproxen sodium, aspirin, etc. Patients should not use NSAIDs if they have hyperacidity symptoms such as ulcers, nasal polyps, asthma, or kidney disease (“Commonly Used Acute Migraine Treatments | AMF”). Regular use of these drugs can create medication overuse leading to worse headaches. Ergotamines may work on more than just activated pathways in migraine (“Commonly Used Acute Migraine Treatments | AMF”). Nausea, spinning sensations, and weakness can be side effects of this medication. Triptans are prescription based and more migraine-specific. Common side effects are tingling, sleepiness, and chest tightness. If a patient uses acute medication more than nine days a month, prevention therapy is likely needed.

Sometimes, a migraine sufferer has to try preventative therapy; there are some blood pressure drugs, antidepressants, and anti-seizure drugs that have the potential for prevention (“Migraine Medications: Types, Side Effects, Uses & Safety”). Preventative therapy is for patients who experience terrific disability from repetitive migraines. However, preventative measures may not present any positive effects instantly and benefits might be seen after six months.

Although there are countless medications for the prevention of migraines, there are only some effective ones and recommended by the American Headache Society and the American Academy of Neurology (AAN): sodium valproate, Topamax, Metoprolol, Propranolol, and Timolol(“Migraine Medications: Types, Side Effects, Uses & Safety”). Consuming sodium valproate has so many common side effects such as weight gain, hair thinning, tremors, irregular periods, headaches, and swollen gums that happen in more than 1 in 100 people (NHS website). Some serious side effects include suicidal thoughts, yellowing of skin or eyes hinting liver problems, and abnormal bruises indicating blood disorders. When Topomax is taken with sodium valproate, the ammonia levels in the blood can rise which slows alertness and induces nausea. Another complication from using Topomax with sodium valproate is a huge drop in body temperature to less than 95 degrees Fahrenheit which can trigger confusion or coma. Rare but possible reactions from using Topomax can be severe skin reactions, kidney stones, and mood problems. The peeling skin all over the body can lead to a deathly situation, toxic epidermal necrolysis, which can cause death. There can be great issues with concentration and attention and can also affect mood and sleepiness.

At the start of a migraine, the blood vessels constrict which makes the brain think that it needs more blood than it does (“Topamax (Topiramate): Uses, Dosage, Side Effects, Interactions, Warning”). In response, the blood vessels dilate so that blood flows to the brain. Beta-blockers relieve that pain by signaling the blood vessels to relax so the blood flows normally. They are recommended to those who endure one migraine a week or six a month so preventative drugs can reduce the amount. The three common ones are propranolol, metoprolol, and timolol. It can take around three months to measure the effectiveness, and many side effects, such as depression, insomnia, weight gain, and fatigue, can happen too. Chest tightness and heart failure are potential complications; people with existing kidney problems, thyroid issues, diabetes, or abnormal heartbeats might not be able to handle these beta-blockers. Newer migraine drugs such as triptan target serotonin receptors and cause the tightening of blood vessels (“Migraine Medications: Types, Side Effects, Uses & Safety”). The serotonin lessens inflammation and narrows blood vessels, alleviating the pain (“New Ways to Manage Migraines”). They work well for approximately 80% of migraineurs; however, some are not allowed to use triptan because of underlying health conditions such as heart disease. Triptans can change blood flow to the head, but also the heart. Other side effects include nausea, chest tightness, rapid heart rate, and burning sensations all over the skin (“Oral Triptan Therapy”). Antihistamines are also used to relieve migraine symptoms by counteracting the effect of histamine, a chemical that dilates blood vessels.

Certain procedures can be done to control migraine attacks. Surgical decompression of the peripheral sensory nerves around the skull can be beneficial to the frequency, strength, and length of the migraine (University of Wisconsin Hospitals and Clinics Authority). The surgeon does not perform the surgery on the brain or remove skull bones. Surgeons pinpoint the locations thought to be trigger points for migraines and remove tissue that places pressure on one or more peripheral sensory nerves (“Surgery for Migraine Relief: Fad or Fact?”). A neurectomy cuts a nerve in the head that is contributing to the migraine. Complications can arise from surgery such as wound healing difficulties, nerve injuries, and severe bleeding which can put the patient at a life-threatening position. Many neurologists and headache specialists are not willing to address these procedures in the standard migraine treatment. More study is required, and the FDA has not approved the operations for migraine relief either (“Surgery for Migraine Relief: Fad or Fact?”).

Despite the countless list of medications, treatments, and operations, there is no definitive way to cure a migraine. Specialists and scientists are still studying the root causes and treatment options for migraines. Migraines are a puzzling medical problem affecting the lives of one billion people worldwide.


Analysis

The author describes all treatment options for migraines and greatly emphasizes how there is no exact way to handle a migraine. She explains all types of medications in tremendous detail with their complications. The author could have improved on expanding more on how the surgeries work by explaining the steps. In conclusion, she did a great job of conveying all the available options to tackle a migraine and could have worked on explaining more about the procedures.


Bibliography

“Commonly Used Acute Migraine Treatments | AMF.” American Migraine Foundation, 17 June 2020, americanmigrainefoundation.org/resource-library/acute-migraine-treatments.

“Migraine Medications: Types, Side Effects, Uses & Safety.” RxList, www.rxlist.com/migraine_medications/drug-class.htm.

“New Ways to Manage Migraines.” Harvard Health, www.health.harvard.edu/pain/new-ways-to-manage-migraines. Accessed 3 Aug. 2020.

NHS website. “Sodium Valproate.” Nhs.Uk, 26 May 2020, www.nhs.uk/medicines/sodium-valproate.

“Oral Triptan Therapy.” American Migraine Foundation, 5 Nov. 2018, americanmigrainefoundation.org/resource-library/oral-triptan-therapy.

“Surgery for Migraine Relief: Fad or Fact?” Premier Health, www.premierhealth.com/your-health/articles/women-wisdom-wellness-/surgery-for-migraine-relief-fad-or-fact-. Accessed 3 Aug. 2020.

“Topamax (Topiramate): Uses, Dosage, Side Effects, Interactions, Warning.” RxList, 19 June 2020, www.rxlist.com/topamax-drug.htm.

University of Wisconsin Hospitals and Clinics Authority. “Surgery for Migraine Headaches.” UW Health, www.uwhealth.org/reconstructive-surgery/surgery-for-migraine-headaches/36613. Accessed 3 Aug. 2020.


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