Migraine

Migraine is a common headache disorder affecting many people. It's estimated that 1 in 5 women, 1 in 16 men, and even 1 in 11 children experience migraines. Women are more prone to migraines, likely due to hormonal differences. Genetics and environmental factors also play a role. If a parent has migraines, there's about a 50% chance their child will develop them as well.

Triggers for migraine attacks are diverse and don't mean you are to blame for getting a migraine. Hormonal changes, especially fluctuations in estrogen during menstruation, pregnancy, or perimenopause, can be triggers. Other common triggers include certain medications, alcohol (especially red wine), too much caffeine, stress, bright lights, strong smells, changes in sleep patterns, weather changes, skipping meals, and certain foods like aged cheeses and processed foods.

Migraine symptoms can vary, but the hallmark is intense throbbing head pain on one side (or sometimes both). This pain can be severe enough to disrupt daily life. It's often accompanied by nausea, vomiting, and sensitivity to light and sound.

Some people experience prodrome symptoms—subtle warning signs before the main migraine—such as constipation, mood changes, food cravings, neck stiffness, increased urination, or frequent yawning. These prodrome symptoms can be difficult to recognize.

In about one-third of people with migraines, an aura may occur before or during the attack. An aura is a temporary, reversible neurological event, usually involving visual problems like seeing flashing lights, geometric patterns, or blind spots. Other neurological symptoms include numbness, tingling, or difficulty speaking. Aura symptoms typically build up over minutes and last for up to an hour.

After a migraine attack, a "post-drome" phase may follow, leaving you feeling drained, confused, or unwell for a day or so.

Diagnosing migraine is based on a clinical evaluation of symptoms reported by the patient. There's no lab test or scan to confirm a migraine diagnosis. If you have headache pain accompanied by light sensitivity, decreased function, and nausea, it's likely a migraine. Seeing a healthcare professional is essential for diagnosis and appropriate treatment.

Because migraine severity varies, treatment approaches also differ. Some people only need medication for immediate relief (acute treatment) during infrequent attacks, while others need both acute and preventative treatment. Preventive treatments aim to reduce the frequency and intensity of attacks. These might include daily medications, monthly injections, or injections/infusions every three months. The right combination of medication and lifestyle changes can significantly improve quality of life.

Managing migraine often involves lifestyle changes. The SEEDS method can help:

• Sleep: Establish a regular sleep schedule, limit screen time before bed, and create a relaxing bedtime routine.
• Exercise: Start with short, enjoyable physical activity and gradually increase duration and frequency.
• Eat healthy: Focus on a balanced diet, and stay well-hydrated.
• Diary: Track your migraine days, symptoms, and potential triggers in a diary (calendar, app, or notebook) to share with your doctor.
• Stress management: Practice techniques like therapy, mindfulness, biofeedback, or relaxation exercises to manage stress.

Remember, migraines are a significant health issue, and seeking professional medical help is important for appropriate diagnosis and treatment.

Migraines, a type of headache, can happen to people of all ages, from children to adults. They often progress through four stages, though not everyone experiences all of them. Understanding these stages can help you recognize and manage your migraines.

Prodrome (The Warning): This is the period of subtle changes that often happen a day or two before a migraine. Your body might give you signals that a migraine is coming. These warning signs can include:

• Digestive issues: Feeling constipated or having unusual food cravings.
• Body changes: Neck stiffness, increased urination, fluid retention, and frequent yawning. These are all signs your body is preparing for the migraine.

Aura (The Pre-Headache Signals): Some people experience an aura before or during their migraine. An aura is a temporary change in how your nervous system works. Auras are usually visual, but they can also affect other senses. The symptoms of an aura usually develop gradually, intensifying over several minutes and lasting up to an hour. Here are some examples:

• Visual disturbances: Seeing patterns, bright spots, flashing lights, or even temporary vision loss.
• Sensory changes: Tingling or numbness (pins and needles) in an arm or leg, or weakness or numbness on one side of the face or body.
• Communication problems: Difficulty speaking clearly.

Attack (The Headache Itself): A migraine attack typically lasts from a few hours to three days if left untreated. The frequency of migraines varies greatly; some people only get them occasionally, while others have them several times a month. During an attack, you'll likely experience:

• Head pain: The pain is often on one side of the head, but sometimes it can be on both. It typically throbs or pulses.
• Sensitivity: Your eyes, ears, nose, and skin may be extra sensitive to light, sound, and sometimes smells or touch.
• Nausea and discomfort: You may experience nausea and even vomiting.

Post-drome (The Aftermath): After the migraine attack, you might feel exhausted, confused, or drained for a while, perhaps for up to a day. Some people, though, might feel a temporary sense of excitement or elation. Sudden head movements can sometimes trigger a brief return of the headache pain.

Many people don't get diagnosed with migraines because they're not sure what's going on. If you frequently experience migraine symptoms, it's helpful to keep a log. Write down when your headaches happen, what seems to trigger them, and how you treat them. Then, schedule an appointment with your doctor to discuss your headaches.

Even if you've had headaches before, see your doctor if something changes. If the pattern of your headaches shifts or they feel different in any way, make an appointment.

However, some headaches are serious and need immediate attention. Go to the emergency room or call your doctor right away if you have any of these warning signs:

• A sudden, very intense headache, like a powerful thunderclap. This could be a sign of something more serious.
• Headaches with other symptoms, such as a fever, stiff neck, confusion, seizures, blurry vision, or weakness or numbness in your body. These could be symptoms of a stroke.
• A headache after a head injury. This is especially important to check out right away.
• Headaches that are made worse by coughing, physical activity, straining, or sudden movements. This is another situation that needs prompt medical attention.
• A new headache after age 50. New headaches in older adults can sometimes be a sign of an underlying health problem.

By keeping track of your headaches and knowing when to seek immediate help, you can better protect your health.

Migraines are tricky because scientists haven't pinpointed all the exact causes. It seems that a mix of your genes and things in your environment might be involved.

Inside your brain, there's a part called the brainstem, and it works closely with a nerve called the trigeminal nerve, which is important for pain signals. Problems with how these parts of the brain communicate might play a role in migraines. Also, the balance of chemicals in your brain could be off. Serotonin, a chemical that helps control pain signals in your nervous system, is one example. Researchers are still studying exactly how serotonin fits into migraines. Other brain chemicals, like calcitonin gene-related peptide (CGRP), are also thought to be important in migraine pain.

Many things can trigger a migraine. Here are some common ones:

• Hormonal changes: For women, hormonal changes, like those happening before or during a period, pregnancy, or menopause, can be a migraine trigger. These changes in estrogen levels are often linked to headaches. Birth control pills can sometimes make migraines worse, but in some women, they can actually help reduce migraines.

• Drinks: Alcohol, especially wine, and too much caffeine (like coffee) are sometimes migraine triggers.

• Stress: Stress at work or home can lead to migraines.

• Sensory triggers: Bright or flashing lights, loud noises, and strong smells (like perfume, paint thinner, or smoke) can trigger headaches in some people.

• Sleep: Not getting enough sleep or sleeping too much can sometimes bring on a migraine.

• Physical activity: Very intense physical activities, including sex, can sometimes cause migraines.

• Medicine: Birth control pills and medicines that widen blood vessels (vasodilators, like nitroglycerin) can make migraines worse.

• Food: Certain foods, such as aged cheeses, salty or processed foods, and skipping meals might trigger migraines in some people.

• Food additives: Some food additives, like aspartame (a sweetener) and MSG (a preservative), are thought to be migraine triggers for some individuals.

It's important to remember that these are just some common migraine triggers. What works for one person might not work for another. If you're experiencing migraines, talking to a doctor can help you understand what might be triggering your headaches and find ways to manage them.

Migraines are sometimes more likely to affect some people than others. Several factors can increase your risk:

• Family history: If migraines run in your family, you're more likely to get them. This means that if your parents, grandparents, or siblings have had migraines, you might be more susceptible. It doesn't mean you definitely will get them, but your risk is higher.

• Age: Migraines can start at any point in life, but they often begin during the teenage years. People usually have their most frequent and severe migraines in their 30s. As you get older, the migraines may become less intense and less common.

• Gender: Women are about three times more likely to experience migraines than men. This difference in risk is significant.

• Hormonal changes: For women, migraines are often connected to hormonal shifts. Headaches can start or worsen around the time of their period. Changes in hormone levels during pregnancy or menopause can also affect migraine frequency and intensity. After menopause, migraines often lessen in severity and frequency.

Taking pain relievers too frequently can lead to a type of headache called a medication overuse headache. This problem happens when your body gets used to the pain medicine, and it stops working as well. You might take more medicine to try to get relief, which just makes the headache worse and keeps the problem going.

This type of headache is most common when you use aspirin, acetaminophen (like Tylenol), or a combination of these with caffeine. The risk is also high if you take aspirin or ibuprofen (like Advil or Motrin) for more than two weeks in a month, or if you take migraine medications like sumatriptan (Imitrex) or rizatriptan (Maxalt) for more than nine days a month.

Essentially, medication overuse headaches happen because the medicine, instead of helping, starts to trigger headaches. You might find that the pain relief you once got is no longer there. Taking more medication just keeps this vicious cycle going.

Migraine is a problem with how the brain works, even if the brain structure itself looks normal. A brain scan (MRI) only shows the brain's structure, not how it functions. That's why migraines don't show up on an MRI – it's a problem with how the brain acts, not its physical makeup.

Migraine can severely affect a person's life. It's actually the second most common cause of disability worldwide. The problem isn't just the headache; it also includes sensitivity to light and sound, and sometimes nausea and vomiting.

Migraine severity varies. Some people only have occasional migraines and just need treatment for each attack. Others get migraines frequently, perhaps two or three times a week. If they use quick-relief treatments for every attack, this could lead to other issues. These people often need ongoing treatment to prevent migraines. This might include daily medication, monthly injections, or injections every three months.

Preventing migraines is very important. Preventive treatments can reduce how often and how bad migraines are, keeping them from happening more than twice a week. However, some people still have migraines despite preventive treatment. There are other ways to help with the pain, including: relaxation techniques, therapy (like cognitive behavioral therapy), and special devices.

For chronic migraines, an injection of a medicine called onabotulinum toxin A (often shortened to Botox) is another preventive treatment option. A doctor gives these injections every 12 weeks to reduce migraine frequency and severity. There are many other preventive options, so it's essential to talk to your doctor about what's best for you.

Working closely with your doctor is key. Many people with migraines haven't even talked to a doctor about their symptoms. If you have headaches that require you to lie down in a dark room and feel sick to your stomach, please talk to your doctor. They can help diagnose and treat migraines. Migraines are a long-term condition, and understanding it is crucial for effective management. Learn about migraines, join support groups, and share your experiences. This empowerment can help break down the stigma surrounding migraines. Together, you and your doctor can manage the condition. Don't hesitate to ask questions.

A doctor, often a neurologist (a specialist in the nervous system), will likely diagnose migraines based on your medical history, symptoms, a physical exam, and a neurological exam. This is especially true if you have a family history of migraines.

If your situation is unusual, complex, or suddenly gets worse, tests might be needed to rule out other causes for your pain. These tests could include:

• MRI scan: This uses magnets and radio waves to create detailed pictures of your brain and blood vessels. It helps diagnose things like tumors, strokes, brain bleeds, infections, and other problems with the brain and nerves.
• CT scan: This uses X-rays to create detailed cross-sectional images of your brain. It helps diagnose tumors, infections, brain damage, bleeding, and other medical conditions that might be causing headaches.

Migraine Treatment: Understanding Medications

Migraines can be painful and disruptive. Treatment focuses on stopping current attacks and preventing future ones. There are different types of medications for migraines, categorized as follows:

1. Pain-Relieving (Acute/Abortive) Medications: These are taken when a migraine attack starts to stop the pain and other symptoms.

2. Preventive Medications: These are taken regularly (often daily) to reduce the frequency and severity of migraines.

Choosing the right medication depends on factors like:

• How often and how bad your migraines are.
• Whether you experience nausea or vomiting with migraines.
• How much your migraines interfere with daily life.
• Any other medical conditions you have.

Pain-Relieving Medications (for treating an attack):

• Over-the-counter (OTC) or Prescription Pain Relievers (e.g., aspirin, ibuprofen): These can be helpful for mild migraines. However, taking them too often can lead to medication overuse headaches, stomach ulcers, or bleeding. Combining caffeine, aspirin, and acetaminophen (like Excedrin Migraine) might help with mild pain, but not for everyone.

• Triptans (e.g., sumatriptan, rizatriptan): These are prescription medications that work by blocking pain pathways in the brain. They come in pill, injection, and nasal spray forms and can effectively relieve many migraine symptoms. However, they are not suitable for people with a risk of stroke or heart attack.

• Lasmiditan (Reyvow): A newer prescription pill. Studies show it significantly reduces headache pain, but it can cause drowsiness and dizziness, so driving or operating machinery should be avoided for at least 8 hours after taking it.

• Gepants (e.g., ubrogepant, rimegepant): These are newer prescription oral medications. Studies show they're effective at relieving migraine pain and symptoms like nausea, and light/sound sensitivity, within a couple of hours. Common side effects include dry mouth, nausea, and drowsiness. They shouldn't be taken with certain other medications, like some cancer treatments.

• Zavegepant (Zavzpret): A recently approved nasal spray. This gepant type medication provides pain relief within 15 minutes to 2 hours after use, and the effects can last for up to 48 hours. It also helps with other migraine symptoms. Common side effects include changes in taste, nasal discomfort, and throat irritation.

• Opioid Medications: These are strong pain relievers. They should only be used if other treatments aren't working, as they can be highly addictive.

• Anti-Nausea Medications: These are often used in combination with other medications to help with nausea and vomiting that sometimes accompanies migraines. Examples include chlorpromazine, metoclopramide, and prochlorperazine.

• Dihydroergotamine (Migranal, Trudhesa): This medication, available as a nasal spray or injection, is often most effective when taken early in the migraine attack, especially for those lasting longer than 24 hours. Side effects may include worsening nausea and vomiting.

Preventive Medications (for reducing migraine frequency):

These are taken regularly to help reduce the number, severity, and duration of migraine attacks.

• Anti-seizure Medications (e.g., valproate, topiramate): These can help with migraines but may have side effects such as dizziness, weight changes, and nausea. They aren't recommended for pregnant or trying-to-get-pregnant women.

• Botox Injections: Injections of onabotulinumtoxinA (Botox) can help prevent migraines in some adults. These injections are usually given every 12 weeks.

• CGRP Monoclonal Antibodies (e.g., Aimovig, Ajovy, Emgality, Vyepti): These are newer medications that help reduce migraine frequency. They are injected monthly or quarterly. A common side effect is a reaction at the injection site.

• Atogepant (Qulipta): A gepant-type medication taken daily as a pill to help prevent migraines. Potential side effects include nausea, constipation, and fatigue.

• Rimegepant (Nurtec ODT): A unique gepant that can both treat a migraine attack and help prevent them.

Important Note: Always talk to your doctor before starting any new migraine medication, especially if you are pregnant, trying to become pregnant, or have other health conditions. They can help you decide which medication is best for you and discuss any potential side effects.

Managing Migraine Pain: A Practical Guide

Migraines can be debilitating, but there are steps you can take to manage them. When a migraine starts, try these simple tips:

• Find a quiet, dark room: This helps block out distracting sights and sounds that can worsen the pain.
• Rest or nap: Giving your body a chance to relax can significantly reduce discomfort.
• Apply a cool compress: A cool cloth or ice pack, wrapped in a towel for comfort, placed on your forehead can help ease pain.
• Drink plenty of water: Staying hydrated is important for overall well-being and can sometimes help alleviate migraine symptoms.

Beyond these immediate actions, incorporating these strategies into your daily routine can help prevent or reduce migraines:

Lifestyle Changes:

• Stress Management: Learning relaxation techniques, such as biofeedback, can help you cope with stress. Stress is a significant migraine trigger. Biofeedback teaches you to recognize and control physical responses to stress, like muscle tension.
• Regular Sleep and Eating Schedule: Consistency in your sleep and meal times helps regulate your body's natural rhythms, which can be helpful in managing migraines. Getting too little or too much sleep can also be a migraine trigger.
• Regular Exercise: Engaging in regular aerobic exercise, such as walking, swimming, or cycling, can reduce tension and help prevent migraines. Start slowly and gradually increase intensity to avoid causing a headache. Exercise can also help maintain a healthy weight, as being overweight or obese may contribute to migraines. Always check with your doctor before starting a new exercise routine, especially if you have existing health conditions.
• Keep a Headache Diary: Track your migraines, noting when they occur, what you ate, how you felt, and any activities you engaged in. This information can help you identify potential triggers and what treatments are most effective for you. This is also a valuable tool for your doctor to understand your migraines better.

Alternative and Complementary Therapies:

• Acupuncture: Some people find acupuncture helpful for headache pain. This involves inserting thin needles into specific points on the body.
• Biofeedback: As mentioned above, biofeedback can help you control your body's responses to stress.
• Cognitive Behavioral Therapy (CBT): CBT can help you understand how your thoughts and behaviors affect your perception of pain.
• Meditation and Yoga: Regular meditation and yoga can help reduce stress, a common migraine trigger.
• Herbs, Vitamins, and Minerals: Some herbs, like feverfew, may help prevent or reduce migraine severity, but more research is needed. Butterbur is not generally recommended due to safety concerns. Vitamin B2 (riboflavin) in high doses might reduce headache frequency. Coenzyme Q10 may also help reduce migraine frequency, but more research is needed. Magnesium supplements have shown mixed results.

Important Considerations:

• Consult Your Doctor: Always talk to your healthcare provider before trying any new treatment, especially if you are pregnant. Your doctor can help determine what's right for you and monitor your progress. They can also help you identify triggers and recommend appropriate treatments based on your individual situation.

By combining these lifestyle adjustments and, when appropriate, complementary therapies, you can take proactive steps to manage your migraine pain and improve your overall well-being. Remember to consult with your doctor for personalized advice.