Archive for the ‘Migraines’ Category

What is a migraine?

Posted on: February 28th, 2017 by Dr. Rich Hirschinger No Comments

migraine, dr. rich hirschinger, beverly hills headache

This is a typical location for a migraine.

A migraine is a primary headache, which means there is no other cause of the headache such as a tumor or a stroke. The following is based on the criteria developed by the International Headache Society. If you memorize “5472 PUMA PPNV” then you know how to diagnose a migraine. Let me break down the acronym.

5472 – a history of 5 headaches lasting between 4 and 72 hours.

PUMA – at least two of these four features must be met.

Pulsating
One-sided
Moderate to severe
Aggravated by exertion or the avoidance thereof

Some people think a migraine must be one-sided but that is not the case.

PPNV – if the above criteria are met then the headache must also meet one of the following two criteria:

Photophobia (light) and phonophobia (sound) sensitivity. It must have both to meet the criteria.
Nausea and/or vomiting

To clarify, nausea alone meets the criteria. If you don’t have nausea then you must have light and sound sensitivity or vomiting to meet the criteria.

A study in 2003 asked migraineurs these three questions.

Has a headache limited your activities for a day or more in the last three months?
Are you nauseated or sick to your stomach when you have a headache?
Does light bother you when you have a headache?

Patients who answer positively to two out of these three symptom questions have a 93% chance of a migraine diagnosis and, if all three are answered positively, there is a 98% chance of a migraine diagnosis.

Aura

Some migraineurs experience an aura. An aura can be visual such as seeing flashing lights, sensory such as tingling, or motor such as slurred speech. Here is a very unique video of a CBS reporter in Los Angeles having a motor aura, which preceded a migraine, on live TV.

There are many different options when treating migraines, which I treat at my Beverly Hills office. There are abortive medications to stop an existing migraine, and there are preventative medications, which are drugs taken daily to reduce or prevent the migraines from occurring. One thing I do know is that migraines are not typically related to how your teeth meet so I would never recommend a dentist grinding your teeth to help with your migraine headaches. I would be happy to answer any questions you might about your migraine or other type of headache.

Putting Enough Force on Anything Is Not Good

Posted on: September 30th, 2014 by Dr. Rich Hirschinger No Comments

The rage the past few days has been that the new iPhone 6 Plus bends if you put enough force on it, or if you sit on it when it is in your pocket. Here is the YouTube video that brought it to the attention of millions of people:

What does that have to do with facial pain? Everything. Most people who own an iPhone are not going to deliberately try to bend their phone just like most people will not try to deliberately overwork their facial muscles. My point is that everything has a tipping point, which is a point at which something will break, or in the case of facial muscles, a point that will cause pain.

Dr. Rich Hirschinger Beverly Hills Facial Pain Migraines Headaches

The superficial masseter is the strongest muscle in our body in pounds per square inch.

The superficial masseter, which is a very strong muscle, and is one of four closing muscles, is a muscle that does a lot of work during the day due to chewing, talking, and swallowing, and, it is working extra if you clench your teeth during the day, bite your nails, chew gum, etc. At night, it really goes to work since most people clench and/or grind their teeth at night. We really do not know why people clench and/or grind their teeth. There are a lot of theories but there is no definitive answer, and there is no medication that we can give to a patient to get them to stop the habit. There are medications that can increase clenching and/or grinding such as SSRI’s, which stands for selective serotonin reuptake inhibitors. These are anti-depressant medications, and the common brand names are Prozac, Celexa, Zoloft,Paxil, and Lexapro.

If you start to feel pain in your jaw or in your temples, you are likely overworking your closing muscles, and they need a break. Stretching is something that I have almost every patient in my Beverly Hills facial pain and migraine headahce practice do, and my favorite way to have them stretch is to use a wine cork. It must be measured to the appropriate length so don’t just try sticking a cork in your mouth and expect to get better.

I do not recommend that you try to bend your new, or old, iPhone to see if you can bend it because there will be a point at which it will bend. For the same reason, I do not recommend that you clench your teeth during the day and chew gum for three to four hours a day for months on end since you will likely end up with facial pain and/or headaches. If you do have facial pain, please feel free to give me a call at 888.981.8981. In the meantime, I guarantee you that you can bend a paper clip if you try but if you use it for its intended purpose, it will be useful as a paper clip for many years. Treat your mobile phone, and your facial muscles the same way.

Headache is Not a Diagnosis

Posted on: October 13th, 2013 by Dr. Rich Hirschinger 2 Comments

Headaches Explained by Dr. Rich Hirschinger Beverly Hills

I learned very early in the first few days of my two year orofacial pain residency at UCLA that “headache is not a diagnosis.” Every time I make a diagnosis of a type of headache it is based on the criteria of the International Headache Society. This post will help you understand what type of headache you might have and will focus primarily on migraines.

It is very important to understand the difference between a primary headache, and a secondary headache. A primary headache is a headache that is not attributed to another disorder. A secondary headache is a headache that is attributed to another disorder such as a tumor, a stroke, a brain bleed, etc. In other words, there is nothing else causing a primary headache whereas a secondary headache is caused by something else.

I use several acronyms to remember the various types of headaches, some of which I learned from others and a few that I created myself. One of the acronyms I learned from others is SNOOPS. These are the “red flag” signs of headaches that require immediate attention.

S stands for systemic, which include symptoms such as a fever, and weight loss.
N stands for neurological, which includes symptoms such as confusion, altered level of consciousness, or numbness.
O stands for onset such as a very sudden, abrupt, split second onset of the headache.
O stands for older. If you are older than approximately 50 years of age, and the headache is a new onset or progressive, that is a red flag.
P stands for previous history of headaches. If you have a previous history of a headache but this headache is new or different, if there is a change in attack frequency, severity or clinical features then that is a red flag.
S stands for secondary risk factors. If you have a systemic condition such as HIV, or systemic cancer along with the headache that is a red flag.

If you have any of these red flags, immediate attention in an emergency room is the best course of action.

Primary Headaches

There are four categories of primary headaches, which are:

Migraine
Tension-type headaches
Cluster headache and other trigeminal autonomic cephalalgias
Other primary headaches

Migraine

Over 60% of migraines are unilateral

There are many types of migraine headaches but the main type of migraine headache is easy to diagnose based on the International Headache Society criteria. The acronym I created to remember the criteria is 5472 PUMA PPNV ACE. Let me explain how to interpret the acronym so that it makes sense.

Many people think that since they have a headache it is a migraine. This could not be further from the truth. Just like headache is a not a diagnosis, if you have a headache, it does not necessarily mean you have migraines. If you meet the following criteria, then you have a migraine.

Migraine Criteria 5472 PUMA PPNV ACE

5472 – If you have had 5 headaches in your life lasting between 4 and 72 hours that was untreated or did not respond to treatment, then move to the next set of criteria to see if you have a migraine headache.

PUMA – If you have two of the four PUMA criteria during the headache, then move to the next criteria to see if you have a migraine headache.

P stands for pulsating, throbbing type of headache.
U stands for unilateral. Over 60% of migraines are unilateral, which means a one sided headache.
M stands for moderate to severe.
A stands for aggravation with exertion meaning the headache gets worse if you walk, run, work out or exert yourself.

PPNV – If you have one of the following criteria during the headache, including the above criteria, then you have met the diagnosis of a migraine.

Photophobia and phonophobia. Photophobia means that the headache causes you to be sensitive to light, and phonophobia means that the headache causes you to be sensitive to sound.
Nausea and/or vomiting.

ACE – If the criteria for migraine has been met then ask if there is an aura, and how frequent the migraine headaches occur.

A stands for aura. Aura’s can be positive or negative, and they can be visual or sensory, and the symptoms are completely reversible.
C stands for chronic. If you get 15 or more migraines a month, it is a chronic migraine.
E stands for episodic. If you get less than 15 migraines a month, it is an episodic migraine.

Aura – An aura gradually develops over a period of about 5-20 minutes and lasts for less than an hour.The aura can be fully reversible visual symptoms like lines, spots, or beautiful colors, which are all positive auras meaning you see something extra, or holes in the visual field called scotomas, or gray spots, which are all negative auras meaning you see something less than you usually see. The aura can also be fully reversible sensory symptoms such as like pins and needles, or numbness, which is a positive aura, or slurred speech, which is a negative aura.

Based on the above criteria, you should be able to know if you truly suffer from migraines. In the next post, I will discuss how to treat migraines, which is based on both abortive treatments, meaning how to treat the migraine after it starts, and preventative treatments, meaning how to help prevent migraines from occurring.

Quick Migraine Symptom Diagnosis

Having stated all of the above, research shows a very simple way to determine if you have a migraine by answering the following questions.

Has the headache limited your activities for a day or more in the last three months?
Are you nauseated or sick to your stomach when you have a headache?
Does light bother you when you have a headache?

Patients who answer positively to two out of these three symptom questions have a 93% chance of a migraine diagnosis and, if all three are answered positively, a 98% chance of a migraine diagnosis. If think you have a migraine, or if you know you have migraines but the previous treatments have not been helpful, you can request an appointment at my Beverly Hills migraine headache office. As always, I’m happy to try to answer any questions you might have.

Respectfully,

Rich Hirschinger, DDS, MBA
Diplomate, American Board of Orofacial Pain
Member American Academy of Orofacial Pain
Lecturer, UCLA Orofacial Pain and Dental Sleep Medicine
www.LoveOFP.com
888.981.8981