Understanding Migraines

Migraine is the sixth most disabling illness worldwide, affecting nearly 40 million Americans and approximately one in every four households. More than just a headache, a migraine is a complex neurologic disorder. It not only causes pain, but it can also result in light and sound sensitivity, vision changes, difficulty concentrating, nausea, vomiting, and other neurologic symptoms. Certain triggers can alter the brain’s ability to maintain its chemical balance. Once this balance is overwhelmed, a migraine may occur.

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A migraine is the second most common type of headache, with tension headache being the most common. A migraine is a headache that causes moderate to severe pain. This pain is often on one side of the head, and can be located behind the eyes, along the temples, or at the back of the neck. Patients will feel a pounding or throbbing sensation with a migraine headache. Before the pain kicks in, some patients may have changes in their vision. This change is called an aura, and can have effects such as streaking lines, blurring, or fog. People with migraines will also have increased sensitivity to light, sounds, and certain odors; all of which can make their pain worse. While having a migraine, patients may also become nauseous and even vomit.

All of these symptoms can add up for a pretty miserable experience, and inevitably cause a patient to call out of work or impede them from accomplishing their daily activities. When patients suffer from migraine headaches for at least eight days out of a month, for three straight months, they become a chronic problem.

When to Seek Treatment

If you’re noticing symptoms associated with Migraines and suspect an issue, it’s crucial to consider consulting a board-certified neurologist in order to obtain an accurate diagnosis and timely treatment. Early intervention can significantly improve your overall well-being and provide a broader range of treatment options, which may decrease as symptoms persist. The key to a successful and speedy recovery lies in addressing the root of the pain with your specialist as soon as symptoms arise.

While many people experience day-to-day headaches, this may not be the case for everyone. If your pain persists for more than 10 days, it should be taken more seriously. Evaluate such prolonged pain with a specialist to identify the root issue and determine the appropriate treatment. Additionally, be attentive to other signs related to pain that should not be ignored, including pain accompanied by fever, pain associated with loss of bladder control, and weakness/tingling/numbness in your arms or legs.

It’s important to note that these are general guidelines based on our expertise over the past three decades, recognizing that each patient’s symptoms may be unique.

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Common Causes

Our brains work at their best when they can maintain a chemical balance. Stress from outside the body (arguments, work deadlines, etc.) and inside the body (hormones) can overwhelm the brain’s ability to keep this balance. When the brain cannot maintain this balance, it releases proteins that lead to pain and the other symptoms above.

The exact way a patient develops a migraine is not completely clear, but we have started to discover the way a migraine develops. Certain triggers can throw off the brain’s pain regulation. This disruption causes a release of many substances that trigger a sensation of pain that spreads throughout the brain. Spread of these substances from the back of the brain may first come to the vision centers, causing the aura, or change in vision. Increased spreading to the rest of the brain may explain the pain that comes after the vision changes.

In patients with migraines, avoiding headache triggers is a major part of managing their attacks. Once you identify your triggers, you can work on reducing them and having fewer migraines. Many patients have found it helpful to keep a diary of what triggers set off each migraine attack.

Below is a list of the four most common migraine triggers.

  • Stress (a trigger for almost 70% of people with migraines)
  • Irregular sleep schedule
  • Hormones (migraines are far more common in women)
  • Caffeine and alcohol

Diagnosing Migraines

Migraine is diagnosed clinically based on the description of the headache and the symptoms associated with it. Headaches lasting 4 – 72 hours, occurring at least 5 times, and having some of the following characteristics are consistent with migraines:

  • Pain on one side of the head
  • Pulsating, throbbing pain
  • Moderate to severe pain
  • Worsening pain with physical activity (such as climbing stairs or walking)
  • Pain associated with nausea or vomiting
  • Pain associated with light or sound sensitivity
solutions being pipetted into various test tubes
solutions being pipetted into various test tubes

Treatment Options

The good news for patients who suffer from migraines is that we have a growing list of medications that can help. If a patient is having less than ten migraines per month, we focus on prescribing medications to stop headaches as they occur. If a patient is having migraines more than ten days per month, then our treatment approach has two parts. The first plan of action is to provide medications to stop the bad headaches. The second piece is to give other medications aimed at reducing the number of headaches as well as the pain level associated with each headache. For patients who still have severe migraines after using medications, we can even do Botox injections around the head and neck. These injections work by weakening muscles that may be pulling against the head and worsening the pain.

It is best to treat a migraine as soon as you start feeling that you might have one. This may mean different things to different patients with migraines. For patients who have auras, such as vision changes before their migraines, this means taking medication as soon as you feel your aura starting. Patients who have migraines without auras should take medication as soon as they feel the pain start. Timing can be difficult for patients who wake up with a headache, but taking medication first thing in the morning may be the best option. The later into a headache you are, the less likely a medication aimed at stopping a headache is to work.

Common migraine treatments include:

  1. Avoid migraine triggers
  2. Over-the-counter pain medications (do NOT take more than three days out of the week as this can cause rebound headaches)
  3. Prescription migraine medications
  4. Intranasal, subcutaneous, or intravenous medications if necessary
  5. Prescription medications to prevent migraines
  6. Physical therapy

Frequently Asked Questions about Migraines

The pain associated with a migraine is a sharp throb that tends to be more bothersome than the dull ache associated with more mild headaches. Additionally, other neurologic symptoms such as light or sound sensitivity, difficulty concentrating, dizziness, vision changes, nausea, and vomiting all suggest that it is a migraine rather than an ordinary headache.

Migraines typically start at a young age, usually by adolescence and sometimes as early as childhood. They typically peak in the 30s. Some, but not all, people will notice their migraines become milder and less frequent with age. Patients who at one point needed migraine medications may not need them later in life.

Some people have genes that make it harder for their brains to keep their chemical balance, making them more likely to have migraines. Due to hormone cycles, women are more likely to have migraines than men. Also, people who have had prior injuries to the brain such as concussions or surgeries are more likely to have migraines.

Classically, there are four phases of a migraine, though not every patient with migraines experiences all four.

  1. During the premonition phase, patients feel they may experience a migraine and can have mood changes and fatigue. This phase typically occurs the day before the headache phase.
  2. During the aura phase, patients have an unusual feeling, which may include vision changes, numbness, changes in speech, and muscle weakness. Approximately one-third of patients with migraines experience this phase, and it usually occurs just before the headache phase.
  3. During the headache phase, the pain begins and gradually builds up to a sharp throb, either on one or both sides of the head. Nausea, vomiting, light and sound sensitivity, and dizziness are all common during this phase. This phase can last several hours to, in severe cases, several days.
  4. During the resolution phase, the pain gradually lessens but is replaced with depressed mood, difficulty concentrating, and decreased energy.

Migraines, when severe, can completely limit the ability to concentrate. However, even the severe migraines fortunately do not cause any brain damage.

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