What Is a Migraine?
When your head is pounding, the first thing you probably ask yourself is: Could this be a migraine? “It’s very common for people to think that a migraine is a tension, sinus, or allergy headache. A lot of people are either undiagnosed or misdiagnosed,” says Bradley Katz, MD, a neuro-ophthalmologist at the University of Utah’s Moran Eye Center who specializes in treating migraine-related light sensitivity.
Migraines affect more than 36 million people in the United States, and those who are at higher risk include women, those in their 30s and 40s, and those with a family history. Migraines can be episodic (you get them sporadically) or chronic (you get them 15 or more days a month for more than three months).
Wade Cooper, DO, director of the University of Michigan’s Headache and Neuropathic Pain Clinic in Ann Arbor, thinks of a migraine as a neurologic reflex. “During a migraine, the lining of the brain gets an inflammatory signal that irritates the pain nerves, and those send the signal deep into the brain. Then the brain activates a cascade of hypersensitivity to lights, sounds, and smells,” he says. “Anything that irritates the nervous system can activate that reflex.”
The following info can help you figure out what might be going on in your head. “The sooner you find out if you are having migraines, the sooner and better they can be treated before their frequency increases,” says Santiago Mazuera Mejia, MD, a neurologist at the Sandra and Malcolm Berman Brain & Spine Institute at LifeBridge Health in Baltimore, Maryland.
What causes migraines?
It’s not fully understood what, exactly, causes a migraine, though researchers believe some people are likely more vulnerable to migraines due to genetics. Scientists are also aware of many common triggers that can set off migraines in people who are already susceptible to them. Migraine triggers can include:
- Consuming certain foods/beverages/additives (like aged cheeses, alcohol, smoked meats, caffeine, aspartame, MSG)
- Stress
- Certain kinds of light
- Certain smells (like perfumes)
- A change in temperature—up or down—of at least 10 degrees or a barometric pressure change
- Skipping meals or becoming dehydrated
- Hormonal changes (like in women who get migraines just before or during a menstrual cycle)
- An infection
- Getting too little or too much sleep
What are the signs of a migraine?
A migraine often causes severe, throbbing pain in the head—sometimes on just one side and sometimes on both sides—that lasts anywhere from roughly four to 72 hours. What distinguishes it from other headaches is that the pain is usually accompanied by vomiting or nausea and extreme sensitivity to lights and sounds. This constellation of symptoms can make it hard to function. In other words, if you find yourself having to leave work early or bail on a fun happy hour that you’d been looking forward to, you’re probably dealing with a migraine.
How are migraines treated?
If you’ve ever had a migraine, then you probably understand why preventing them from happening in the first place is just as important as stopping symptoms after they’ve already started. That’s why migraine treatment generally falls into two categories: preventive (stopping headaches before they start) and acute/abortive (stopping headaches as soon as they occur). Each type of treatment is critical in different ways.
Lifestyle changes
Many patients begin by making lifestyle changes, since those are free and don’t require a doctor’s prescription. These lifestyle changes fall into the realm of “basic things your parents always told you to do” like get enough sleep, manage your stress, don’t skip meals, and stay hydrated. They may sound obvious, but with a busy schedule, they’re often easier said than done.
Medications
A primary care physician or neurologist can prescribe a preventative medication to help ward off migraines. In fact, the FDA approved a groundbreaking new drug called erenumab (Aimovig) in May 2018, so patients have more options than ever.
Other non-drug remedies
There are also non-pharmacologic options such as physical therapy, massage, acupuncture, seeing a chiropractor, Botox injections, tinted glasses, biofeedback, or wearing a headband-like device that uses electrodes (this is called transcutaneous supraorbital nerve stimulation or t-SNS).
Nutritional supplements
Your doctor may discuss taking certain nutritional supplements such as magnesium, coq10, or vitamin B2 or B12. Butterbur is another herb that can be used, but recently there have been some concerns about its safety.
ACUTE/ABORTIVE
Over-the-counter medications
Some are basic pain relievers (like aspirin, ibuprofen, naproxen, and acetaminophen) and others are combos (Excedrin Migraine, for instance, is a mix of acetaminophen, aspirin, and caffeine, and Alka Seltzer is a mix of aspirin and two antacids). Pro tip: Any pills that come in a liquid-gel form work faster, which is beneficial when treating a migraine.
Prescription drugs
A primary care physician or neurologist can prescribe various drugs that can help in the moment.
