Migraine. Just the word alone is enough to make you wince, especially if you’re one of the 18 percent of women who’ve experienced this intense, often debilitating, type of headache.
Sometimes we throw the term around casually – “Sorry, can’t make it; I’ve got a migraine.” But not every intense headache is a migraine. Most headaches, about 61 percent, are caused by tension or other factors – things like screaming children or a stressful day at work or an interminable day at the amusement park…well, you get the picture.
Wondering whether your headaches might be migraines? Read on to learn how to identify migraines, prevent and treat them, and why women, in particular, should take notice.
A migraine is different from other headaches in that it is recurrent and usually concentrated on one side of the head, rather than on both sides or the entire head. Migraines are typically more throbbing or pulsating than tension headaches, and they often get worse with ordinary activities. They’re also frequently accompanied by other symptoms such as nausea, vomiting and sensitivity to light, smell or noise.
About one third of migraine sufferers also have auras, neurological warning signs that can include flashes of light, blurred vision, difficulty speaking, numbness or weakness. (If these symptoms sound similar to stroke symptoms, you’re right. Learn more about how migraine and stroke symptoms differ and when to see a doctor.)
Migraines are believed to be genetically determined. People with migraines can typically point to others in their family who also suffer. The migraine is a neurobiological disorder, meaning that it originates in the brain and is related to changes in brain chemicals, such as serotonin, that lead to inflammation of tissues, enlarged blood vessels and pain.
Although the exact causes remain unknown, doctors have been able to identify common migraine triggers. “Triggers don’t cause migraines, but they can bring on these headaches in people who are already susceptible,” explained neurologist Dr. Joanne Cooper, with East Bay Medical Foundation in Berkeley, Calif.
Migraine triggers include:
The best way to prevent a migraine is to identify your triggers. Dr. Cooper suggests creating a headache calendar. “Buy a month-at-a-glance calendar and use it to mark the intensity of the migraine (1-10) and note what you did differently on that day or the prior day,” she says. “Keep it brief. A succinct record is easier for your doctor to analyze.”
Once you and your doctor identify possible triggers, you can begin making lifestyle changes to eliminate the avoidable ones. For instance, if you always get migraines on the weekend when your stress level is lower, your may need to work on systematic stress reduction to reduce the adrenaline surge during the week. If perfume causes your migraine, pack away the Chanel and gently ask your friends to keep their scents to a minimum when visiting.
In some cases, the triggers are less avoidable like, say, the weather. In those cases, medications may be the best option. Individuals with frequent migraines – such as several times a week – may need to take a prophylactic drug, which helps to reduce the frequency and severity of migraines in most people. Prophylactic or preventive drugs can be taken daily, or right before an anticipated trigger – for example, around your period.
Prophylactic medications include medications like beta-blockers, antidepressants, the antihistamine cyproheptadine, and several anti-seizure medications, which are specifically approved by the FDA for preventing migraines. These medications are usually helpful for those who have one or more debilitating headaches a week, or who take pain-relieving medication more than twice a week. They can also work well if pain medications don’t impact your headaches, or your side-effects from those drugs are worrisome. However, the prophylactic medicines may have side-effects of their own, such as dizziness and drowsiness, so discuss the pros and cons with your doctor.
One more option: If your migraines are strictly hormone-related, you may consider hormone replacement or birth control pills to regulate the level of hormones; or, in some cases, stop taking birth control pills altogether. But talk first with your doctor, since birth-control pills can increase the risk of stroke in a small percentage of women with migraines. (Read more on this below.)
When it comes to treating a migraine, the name of the game is speed. Abortive medicines, aptly named because they abort the headache once it has begun, work best if taken as early as possible, before the migraine is at full intensity. Unlike prophylactic drugs, they do not prevent the migraine, but they help to interrupt it or reduce its severity.
Abortive medicines for migraine are available both over-the-counter and through prescription, and they range from the aspirin and acetaminophen to drugs like sumatriptan that are specifically designed to target migraine attacks. Abortive medications can effectively stop the headache pain. However, many of these medications have possible side-effects, ranging from stomach ulcers to throat or chest tightness, dizziness and nausea. So seek the advice of your physicians when selecting which type of medication suits your needs. The good news is that one strong dose of aspirin alone (1000 mgs) may be effective in helping more than 50 percent of people, according to one recent study.
Once you take the medication, try to reduce stimuli that intensify the headache, ideally retreating to a dark, quiet place and taking a nap.
If a migraine goes on for more than a couple of days, or returns more than twice in one week, visit your doctor. The headache may be a symptom of a more serious problem. Or, more commonly, the headache may actually be caused by overuse of headache medication – something known as a “rebound headache.” In that case, your doctor may want you to refrain from taking certain medications to rid you of the effects.
Some good news on the horizon: New drugs are currently being developed that, in clinical trials, appear to help those not benefiting from current drugs. They will likely have fewer side effects and may be safer for patients with heart-disease, high blood pressure and stroke history. Dr. Cooper anticipates these should be available within the next two to four years. For more on when to consider medication, see our article on treating migraines.
Women are more susceptible to migraines. According to the National Institutes of Health, approximately 18 percent of women experience migraines compared with only 7 percent of men. The reason for that isn’t clear, although hormones are a likely factor
There’s also some evidence that women who get migraines may be slightly more susceptible to stroke, especially young women who experience migraines with an aura. This risk is higher if the woman smokes and also takes birth control pills. However, that increased risk is quite low and shouldn’t cause alarm. Dr. Cooper suggests that young women with migraines start by eliminating other potential risk factors, such as smoking. They may also want to look at alternative contraception to birth control pills. And, certainly, they should talk with their doctor about treating the migraines, which can help reduce the risk.
Most primary care doctors have become adept at diagnosing and treating migraine headaches. However, if you or your doctor feels the problem is not effectively being controlled, you may choose to see a neurologist for further testing and treatment.
Before you do, however, consider that most physicians – general practitioners and specialists alike – may have a different definition of success than you do. “Our goal is usually to reduce the frequency and intensity of headaches,” says Dr. Cooper. “It’s typically not possible to eliminate 100 percent of migraines, that shouldn’t be the expectation. But we can make significant improvement. And with abortive therapy, we can prevent those trips to emergency rooms.”