Why does your head hurt?
If you’ve ever had a headache, you know how painful it can be. Sometimes, it can be downright debilitating. Migraines are extreme forms of headache that can severely impact a person’s life. How are they different from regular headaches? What can be done to treat them? Are they preventable?
Definition
Migraines are a type of headache that is usually on one side of the head and causes severe throbbing pain or pulsing sensation. Often, the pain is so intense it interferes with daily activities. The cause of migraines isn’t understood but thought to be related to genetics and environmental factors. Changes in how the brain stem interacts with the trigeminal nerve or imbalances in brain chemicals might also play a role. Many things can trigger a migraine to occur, such as alcohol, caffeine, stress, loud sounds, bright/flashing lights, too much/too little sleep, intense physical exertion, changes in barometric pressure, certain foods (ex. aged cheeses, salty or processed foods), food additives (ex. MSG or aspartame), some medications (ex. nitroglycerin), and hormonal changes (ex. fluctuations in estrogen for women). Women are three times as likely to suffer from migraines than men. How often migraines occur depends on the person. Some individuals have them rarely, and others get them several times a month. While migraines can begin at any age, they typically start during adolescence and peak during your 30s before gradually becoming less severe and frequent.
There are four stages of migraines: prodrome, aura, attack, and post-drome. Not everyone who has migraines experiences all four stages. Prodrome starts one to two days before and are subtle changes that indicate a migraine is coming, like constipation, mood changes (range from depression to euphoria), food cravings, neck stiffness, increased urination, fluid retention, and frequent yawning). Auras can happen before or during migraines, with symptoms beginning gradually and building up over several minutes. This stage can last up to 60 minutes. Symptoms include visual phenomena (ex. seeing various shapes, bright spots, or flashes of light), vision loss, pins and needles sensations in an arm or leg, weakness or numbness in the face or one side of the body, and difficulty speaking. The attack phase lasts 4 – 72 hours, depending on if the migraine is treated. Symptoms during this phase are pain usually on one side of your head, but often on both sides, pain that throbs/pulses, sensitivity to light, sound, and sometimes smell and touch, and nausea/vomiting. Post-drome is after an attack is over, and during this stage, you’ll feel drained, confused, or washed out (some individuals report feeling elated). It’s possible to have a brief return of the pain if you move your head suddenly. This stage lasts about a day.
Treatment
Migraine treatment is focused on stopping symptoms. Pain-relieving medications are taken during an attack to suppress symptoms. They work best when taken at the first sign of an oncoming migraine. Over-the-counter options include aspirin, ibuprofen, or combination medications (these have caffeine, aspirin, and acetaminophen in a single pill). Prescription medications, like sumatriptan and rizatriptan, block the brain’s pain pathways and come in pill, shot, or nasal spray form. Dihydroergotamine is used for migraines that tend to last longer than 24 hours. Lasmiditan is a newer tablet approved for treating migraine with or without aura. Ubrogepant is approved to treat acute migraine with or without aura in adults. For people who can’t take other migraine medications, narcotic opioid medications might help. Obviously, they’re highly addictive, so they’re usually only used if no other treatments are effective. If your migraine is accompanied by nausea and vomiting, medicines, such as chlorpromazine, metoclopramide, or prochlorperazine, may help.
If you take painkillers too often, it can trigger serious medication-overuse headaches. These happen when medications stop relieving pain and begin to cause headaches. You then use more pain medication, which continues the cycle. They seem to be more common with aspirin, acetaminophen, and caffeine combinations. However, they can also occur if you take aspirin or ibuprofen for more than 14 days a month or triptans for more than nine days a month.
Besides taking medication, when you feel a migraine coming, there are other things you can do to lessen your discomfort. The first step is to go to a quiet, darkened room. Try closing your eyes and resting or taking a nap. It can be helpful to place a cool cloth or ice pack wrapped in a towel/cloth on your forehead. It’s also essential to drink lots of water. It’s a good idea to keep a headache diary. You want to record your symptoms, what you’re doing when a migraine starts, and what treatments you’ve tried. This will help you determine what triggers your migraines and what treatment is most effective.
Prevention
Preventative medicines are taken daily to reduce the severity or frequency of migraines. There are many options. Blood pressure-lowering medications, including beta-blockers (ex. propranolol and metoprolol tartrate) or calcium channel blockers (ex. verapamil), can help prevent migraines with aura. Tricyclic antidepressants, like amitriptyline, are also used, but due to their side effects, other antidepressants might be prescribed instead. Anti-seizure drugs, such as valproate and topiramate, might help if you have less frequent migraines. Botox injections about every 12 weeks help prevent migraines in some adults. CGRP monoclonal antibodies are newer drugs approved by the Food and Drug Administration (FDA) to prevent migraines and are given monthly or quarterly by injection.
You can make lifestyle changes that might help reduce your migraines. To help reduce stress, learn relaxation techniques, such as biofeedback. It’s vital to develop a sleeping and eating routine. You want to set and follow a consistent sleep and wake schedule daily. Also, try to eat meals at the same time every day. Make sure you’re hydrated by drinking plenty of water. Another critical component is getting regular aerobic exercise because it reduces tension. Just be sure to warm up slowly since sudden, intense exercise can cause headaches.
No one wants to have to deal with migraines. Fortunately, if you suffer from them, there are many ways to manage your condition, so you can get back to living your life. If you have any questions or concerns about migraines, please speak with your doctor. If you would like more information, please visit MedlinePlus’ migraine page at https://medlineplus.gov/migraine.html