Migraines: How to Treat Them
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What is a migraine?
A migraine is an extremely bad headache often described as a throbbing or pounding pain. Typically, it is far worse than the more common headache and it is often accompanied by other symptoms like sensitivity to light, nausea, and fatigue.
Migraines affect more women than men. For many people, the pain gets in the way of everyday activities. They are unable to do anything beyond lying down in a dark room.
Usually, migraines happen repeatedly. Episodes may range in severity from mild to severe. Their exact cause is not completely understood. Treatments are available to reduce the frequency and severity of the migraines, but they are not always effective for everyone.
Most common symptoms
Migraines account for more disability than any other neurological disorder combined. But with the right treatment and prevention strategies—which may include psychotherapy for mental health—migraines are controllable. —Dr. Kathryn Fong
The primary symptom of a migraine is a severe headache. Headache pain may be sharp or dull, pounding or pulsating, confined to a small area of the head or all over.
The pain can be moderate to severe, and may last all day or even after sleep into the next day.
Often the headache stays confined to one side, but sometimes both sides are involved. The pain may start in one area of the head then move to other areas.
Though a migraine centers on a headache, it often causes additional symptoms such as sensitivity to light, sound, or smells. It can cause nausea, vomiting, fatigue, and tingling or numbness in the body.
Many people with migraines experience an aura, such as a visual disturbance, before the pain sets in.
If you experience an extreme and unusual headache and confusion, it could be a sign of a life-threatening condition such as a brain infection or a brain bleed. If you are not sure it is a migraine, go to the ER.
The neurologist is your partner in figuring out the right treatment for your migraines. Believe me, neurologists want to get their patients pain-free as soon as possible, but more often than not there isn’t a quick fix. It can take time to find the most effective combination. —Dr. Fong
Many different kinds of medicines are available to treat migraines, but typically a more effective approach is to pair specific lifestyle changes intended to avoid migraine triggers with medication.
Speak to a neurologist (preferably one who specializes in headaches) about a personalized migraine treatment plan. It often takes trial and error to find treatments that help reduce your migraines.
Don’t try to deal with frequent migraines on your own with over-the-counter (OTC) pain-relievers. Taking too many non-prescription medications can actually cause more headaches, called medication overuse headaches.
If your doctor suggests OTC treatments such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), naproxen (Aleve), or Excedrin, try to limit use to less than 3 times per week in order to avoid medication overuse headache.
It’s helpful to keep a headache journal or calendar to track the number of headaches, headache severity, headache response to medication, and potential headache triggers such as poor sleep, fasting, stress, and menstrual cycle.
If severe and frequent migraines are a problem, your doctor may prescribe a “rescue” medication to treat pain and help stop the migraine when you get one.
They may also prescribe a daily medication that can help reduce the occurrence of migraines in the first place. There are also injections you can take at different intervals, like once a month, to help prevent migraines. Sometimes your healthcare provider may combine medications in order to better treat your symptoms.
Non-prescription medications include:
- Non-steroidal anti-inflammatory drugs (NSAIDs): Advil, Motrin, Aleve, Excedrin
- Acetaminophen - Tylenol
Prescription migraine treatments include:
- Triptans or ditans for migraine pain
- Anti-emetic (anti-vomit) drugs for nausea or vomiting
- Certain antidepressants are also used to reduce migraines
- Steroids for migraine pain
- Vitamin and mineral supplements for migraine prevention
- Anti-epileptic (anti-seizure) drugs for migraine prevention
- Calcitonin gene-related peptide (CGRP) blockers for migraine pain and prevention
- Botox injections for migraine pain and prevention
- Neuromodulation with magnetic or electrical nerve stimulation
Why do migraines happen?
The specific causes of migraines are not well understood. Migraines are thought to come from an overactive and overly sensitive facial nerve called the trigeminal nerve. The trigeminal nerve is responsible for one’s sense of touch in the face and head, and nerve irritation leads to migraine pain.
Calcitonin-gene related peptide (CGRP) is a signaling molecule made by the body that triggers pain in people who get migraine headaches through the trigeminal nerve.
People who get migraines may be experiencing an excessive pain response to triggers such as stress, physical exertion, fatigue, weather, and odors. In women, a migraine may also be related to the higher estrogen levels that occur naturally during the monthly menstrual cycle.
Scientific evidence also suggests a possible genetic connection. For example, one study found that relatives of people who get migraines are three times more likely to also develop migraines.
How do I know if a headache is a migraine?
Pay attention to: 1) pain location, 2) speed with which it goes from 0 to maximum pain, 3) whether the pain location moves, 5) the duration of the headache episode, 6) whether medicine helped, and 7) whether there are funny symptoms that distort function (such as vision changes, tingling/numbness, weakness, clumsiness). —Dr. Fong
You may prefer to lie down in a dark, quiet room because light and sound are more bothersome during a migraine. You may feel an urge to just stay still because any physical movement can make a migraine worse.
Many people who get migraines experience something beforehand called an aura. Auras can vary from person to person but are often characterized by issues such as blurry vision, seeing dark spots, flashing lights, or zigzagging lines. Auras typically last about 20 minutes and sometimes occur without the migraine pain.
Even before the aura, some people may feel physical inklings that a migraine is approaching. Symptoms may occur days before the headache starts and include feeling irritable, tired, or even dehydrated. Difficulty concentrating and food cravings are also possibilities.
But if a severe headache crops up seemingly out of nowhere, like a strike of lightning, and feels like the worst headache of your life, call a doctor or seek urgent care right away. Certain specific conditions need to be ruled out before a migraine can be diagnosed.
Migraines in children and teens
Kids and teenagers can also get migraines. Symptoms for teens are usually similar to those that occur in adults. For younger kids, there are some differences.
- Toddlers/Preschoolers may get very pale, vomit, or have less energy. These types of symptoms may signal any number of different conditions. And toddlers may not be able to clearly explain headache pain. For these reasons, diagnosing migraines in toddlers can be difficult and requires a pediatric migraine specialist.
- Children: Symptoms are a little more similar to those experienced by adults, including nausea, vomiting, belly pain, and sensitivity to light. However, children may not be able to clearly explain these symptoms. They may just seem more cranky and less energetic.
Children of all ages may experience an aura before a migraine comes on. Also, much like adults, lying down in a quiet, dark room may eventually relieve pain.
Since migraines are often the result of certain triggers, you may be able to stop them before they start with key lifestyle changes.
- Eat an overall healthy, balanced diet. An example of a healthy eating plan is the Mediterranean diet. In general, try to avoid processed foods with excess sugar and salt. Take note of common dietary triggers such as cheese, chocolate, or alcohol. Avoid skipping meals because fasting may trigger a migraine.
- Drink more water. Aim for 8 glasses of water each day plus more water if drinking caffeinated beverages, such as coffee, or alcohol.
- Get enough sleep. A good night’s rest gives the brain time to recover from the day and get ready for the next. Lack of sleep may lead to migraines.
- Decrease stress. Reducing stress is much easier said than done, but taking up calming activities such as yoga or meditation can help you deal with typical everyday stressors before a headache starts.
Dr. Gambrah-Lyles is a resident pediatrician at the Children's Hospital of Philadelphia. She is a graduate of the University of Pennsylvania Perelman School of Medicine (2019). She graduated cum laude and received her undergraduate degree in Biochemistry and Spanish from Washington University in St. Louis (2013). Her research explores the intersections between neurology, public health, and infectious disease. She has investigated nutrition and cerebral palsy in Botswana, and completed a year-long project in Brazil, researching growth and developmental outcomes of Zika virus infection in pediatric patients as a Doris Duke International Scholar. Dr. Gambrah-Lyles speaks four languages, loves staying active, and enjoys sharing her love for medicine through teaching and writing.