Your head is throbbing, your stomach is queasy and bright lights or loud noises make you feel even worse. If you’re one of the estimated 30 million Americans who get migraine headaches, you’re no doubt familiar with these classic symptoms of an attack. Get expert help for migraines, including possible causes, treatments and other resources...
Although “migraine” is often used to describe any splitting headache, a true migraine headache has distinctive characteristics. For one thing, the pain is typically moderate to severe, with a throbbing or pulsating feeling. A migraine attack generally lasts between four and 72 hours, but, in some cases, it can last an entire week.
Other symptoms of migraine headaches include nausea or vomiting or sensitivity to light, sound or odor. In about 60% of cases, the pain centers on one side of the head and face.
An aura, a reversible neurological symptom, may also occur shortly before or at the onset of pain and last 5-60 minutes. The most common type of aura involves visual changes – seeing spots, specks or wavy or shimmering lines, usually in just one side of your visual field.
Less common are sensory auras, which involve numbness or tingling in the hands or face, or language auras, in which people have trouble speaking.
But auras occur less commonly than you may think.
“Only about 20% of migraine patients will experience one,” says neurologist Brian Grosberg, M.D., director of the Inpatient Headache Program at Montefiore Headache Center in New York City.
When headache pain is accompanied by speech difficulties, he says, it’s important to rule out other serious conditions such as stroke and seizures, which can cause similar speech and language problems.
Migraines occur most often in adults between the ages of 20 and 50, and they are three times more common in women than men. It’s not understood why, but experts say hormones play a role.
Many women have migraine attacks around the time of their periods or find their attacks are more severe then.
“Research shows that normal hormonal fluctuations associated with menstruation trigger migraines for many women,” says Ana Recober-Montilla, M.D., assistant professor of neurology in the division of headache medicine at University of Iowa Health Care.
Many other things can elicit migraine attacks, Grosberg says. These include certain foods (such as red wine or chocolate), dehydration, changes in weather or altitude, hormonal fluctuations, stress, lack of sleep, and even bright sunlight or strong odors, such as perfume.
“Not every person with migraines has triggers,” he says, “but some people have multiple triggers.”
But a migraine trigger is not the same thing as a migraine cause, says Frederick G. Freitag, D.O., medical director of the Comprehensive Headache Center at Baylor University Medical Center in Dallas.
“Migraine is almost certainly inherited and definitely familial. Once you have the tendency towards migraine, then a variety of triggers can result in migraine attacks,” he says.
There’s no doubt that migraine headaches are debilitating and interfere with daily activities. But experts say migraines often go undiagnosed or misdiagnosed for months or years.
In fact, less than half of patients whose symptoms met the criteria for migraine had been diagnosed with the condition, according to a 2000 survey conducted by the National Headache Foundation.
Often, migraine patients attribute their symptoms to sinus disease or allergies, Recober-Montilla says.
“Around 90% of patients who believed their headaches were sinus headaches had normal sinuses. Their symptoms were due to migraine,” she says.
To manage your migraine, a critical first step is to keep a detailed headache diary of the days and times you experience migraine pain, how long the headaches last, as well as possible triggers, such as foods, lack of sleep or where you are in your menstrual cycle.
Without such a diary, “the patient may not be able to give an accurate picture of their migraines, and the doctor may not get a true sense of the level of severity and how badly they affect a person’s quality of life,” Grosberg says.
Help for Migraines
Medication. When it comes to migraine treatments, “one size doesn’t fit all,” Grosberg says. “No two people will have the same migraine, so treatment needs to be tailored to each individual.”
Migraine medication falls into two categories: acute and preventive:
Acute medications, taken at the onset of symptoms, work by interfering with the neurological pathways that cause pain and other symptoms. The most commonly prescribed acute drugs are medications known as triptans (Imitrex, Zomig, Amerge, Axert or Maxalt). Most of these medications are marketed in tablet form, but a few are also available as sprays or injections.
Triptans are recommended for patients who need migraine relief relatively infrequently, about once or twice a month. Some patients who rarely get migraines may respond well to over-the-counter pain relievers such as acetaminophen, ibuprofen, aspirin or combination headache medications such as Excedrin (which contains acetaminophen, aspirin and caffeine).
If migraines occur at least once a week, or you’re having migraine attacks that last for several days, or you’re constantly worried about when the next one is going to hit, you’re a good candidate for a daily preventive medication.
Several classes of medications prevent migraines. They include the beta blockers Inderal and Blocadren; the calcium-channel blockers Calan and Isoptin (approved by the Food and Drug Administration to treat high blood pressure but frequently prescribed “off-label” to treat migraines); the anti-seizure medications Depakene, Depakote and Topamax; and the antidepressants Elavil and Zoloft.
“With daily prevention medications, the goal isn’t to cure them, but to cut the frequency by at least 50%,” Grosberg says.
But avoid overusing acute migraine medications, because patients who do so often get rebound headaches.
“I see rebound headache in about 90% of those who have migraines more than 15 days per month,” Freitag says.
Even something as common as caffeine can cause rebound headaches, he says, because it’s in so many over-the-counter and prescription medications, and in people’s diets. The solution is to stop medications cold-turkey and use another type of medicine to deal with withdrawal symptoms.
Lifestyle changes. “Many patients don’t consider lifestyle factors [that] aggravate their migraines,” says Recober-Montilla. “Not paying attention to lifestyle modifications leads to poor migraine control, despite medications.”
A 2010 study by researchers at Ohio University showed that medication and lifestyle changes combined are more effective than one or the other at relieving migraine headaches. Preventive medicine and behavioral changes, such as biofeedback and other stress-reduction techniques, resulted in significant relief for more than 75% of migraine patients, the study found.
Biofeedback using both hand-warming (which shifts blood flow away from the head) and muscle relaxation (which addresses muscle tension) reduce migraines and also “control a migraine as it comes on to eliminate or reduce the need for acute treatment medicines,” Freitag says.
Regular exercise can also be beneficial.
“Brisk walking for 20 minutes four days a week boosts production of the body’s natural pain killers and may reduce migraine frequency,” Freitag says.
But don’t try to exercise during a migraine attack because that can make symptoms worse, he says.
Maintaining a healthy weight is important: “Being overweight is one of the leading causes of migraine becoming chronic, meaning more than 15 days per month.”
Women younger than 55 with excess belly fat have a 37% chance of experiencing migraines, compared with 29% for women with slimmer waistlines, according to a 2009 study by researchers at Drexel University College of Medicine in Philadelphia.
“Losing weight in the stomach area may be beneficial for younger people who experience migraine and especially so for women,” said study author B. Lee Peterlin, D.O., a member of the American Academy of Neurology.
Why the weight-headache connection? It’s not known, but overlapping neurological pathways that regulate feeding and migraines may play a role, according to the American Headache Society.
More Migraine Resources
Recober-Montilla recommends the following online sources for more information about migraines as well as other types of headaches:
American Headache Society
World Headache Alliance
Headache Cooperative of New England
Patient sites:
National Headache Foundation
Migraine Action
Migraine 4 Kids
For more information and expert advice, visit our Headache and Migraine Health Center.
How Much Do You Know About Migraine Headaches?
In the U.S. alone, 30 million people suffer from migraine headaches, and the condition is three times more common in women than in men. However, surveys show that fewer than half of sufferers have received a diagnosis from their health-care providers.
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