Full Steam Ahead on Migraine Prevention and Treatment
Those of us who have been either suffering with or treating migraine syndrome for a number of years are stunned by the advances of the past few years. One great help in getting research funding to find better treatments and get those treatments to patients is the new wide understanding that migraine syndrome is a major source of neurologic disability. There is nothing like new money pouring into an area and major pharmaceutical firms spending billions on migraine research to get the attention of ambitious, bright, young scientists excited and energized to make a difference. They’re discovering where migraine pain really comes from (and it’s not blood vessel expansion). Migraine is a complex brain network disorder, a brain condition with overlapping phases that build to a migraine pain attack. This intricate mechanism which has gone awry has been overlooked too long and managed poorly.
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Migraine Headaches and Migraine Syndrome
Migraine is a neurological disorder. Worldwide about 10% of the population have migraines. It’s common and debilitating. The main symptom of migraine syndrome is the headache, which typically lasts from four to 72 hours. The pain is severe and typically affects one side of the head. Often described as intense and at times throbbing, it is worsened by routine physical activity. Nausea and painful sensitivity to light and sounds are part of the syndrome. These are not your usual garden-variety tension or sinus headaches. The nausea can progress to vomiting. Motivation to do anything is gone. There’s no desire to do anything except hide somewhere and try to make the world to go away. A migraine headache can drive a person into their bed, and maybe even to the Emergency Department.
Migraine Headaches With and Without “Aura”
Okay, so what’s an “aura”? The term can confuse people because dictionaries give as the first definition something like an invisible emanation or field of energy believed to radiate from a person or object. A later definition, fit for our purpose, is that an aura is something like a sensation of a bright light or cool breeze that comes before the onset of some medical disorders, such as an attack of migraine or an epileptic seizure. An aura before a migraine is an experience or sensation that comes just before the headache starts. About a third of the people with migraines have an aura before the headache, the other two-thirds don’t. So, migraine attacks are often divided into two types, with or without aura. A common aura is bright lines or lights flashing before one’s eyes. Other auras can be odd odors or smell, or odd tastes, or even an unusual feeling when you touch something. Yet another type can be tingling in the hands or face, or changes as simple as feeling foggy-minded, not mentally alert.
The Warning Signs Before a Migraine
Some individuals who get migraines can tell the day before or the evening before that a headache is on the way. They might feel irritable, or “blue” (depressed), or yawn a lot. Or they might feel fatigue, or an upset stomach. Their neck might feel uncomfortable and stiff. Or, the evening before the attack they might feel even better than normal, more mentally clear and full of energy.
A Reader Asked: Since migraine headaches are so painful and awful, can they actually hurt you or kill you?
A migraine attack won’t kill you in the way your question implies. There are rare, rare case reports of someone having a stroke during a migraine attack, but whether the headache caused the stroke is never known. However, there is good evidence from many studies that people who get migraines have a higher risk of eventually dying from heart disease or from a stroke. It’s not known why migraine would increase the risk for these vascular diseases that might eventually result in a fatal outcome.
How to Stop the Migraine Pain
Medications designed specifically to treat acute migraine headaches have been around since 1991. Even better medications have recently been FDA approved. Some of the newer ones are designed for prevention. Or, if while taking them the person does get a headache, it will be milder and they will come less often. Others of these newer ones treat the acute migraine that you have now. If you use a medication to prevent a headache and still get one you can still take one of your tried-and-true medications to treat it. For more information on medicines for migraines go to our free page on migraine treatments. The “triptans” are well known and often used. Sumatriptan (Imitrex®) in 1991 was the first. It started a revolution in migraine headache treatment. The newest medications work by blocking CGRP, blocking it so that it can’t make the nerves involved in migraine more sensitive.
(CGRP is calcitonin gene-related peptide.)
First Steps Treating the Headache While Waiting for the Medications to Work
In the first 30 to 90 minutes of a headache, while waiting for any of the needed medications to start working, many people get a bit of relief from a cold pack on the aching side of the head and lying down in a quiet, darkened room.
The Tendency to Have Migraine Headaches Is Inherited from Family Members
The risk for getting or the tendency to get migraines is often genetically inherited. About 67% of the people with migraine syndrome have a parent or grandparent, or an aunt or uncle, or other family members who also suffer with migraines.
The World Around You Can Affect Your Headaches
Doctors who treat people with migraines describe headache “triggers”, things that bring on a migraine. Many things around you can trigger a headache and the list of known possible triggers is long. It’s up to each person who gets migraines to discover if they have any triggers and, if so, what are their triggers. For some it’s one or another food, like hot dogs because of the nitrates in them. For others it’s alcohol or smoking. Stress, being stressed out, is another pressure that can bring on a migraine in some people. Or, being overly tired. There are people for whom skipping meals invites a migraine. For others, weather changes, when sunny skies turn to clouds and rain, or the other way ’round, can bring on a headache.
Hormones Going Up and Down Can Cause a Migraine
Before teenage years and the onset of girls’ periods the percentage of boys who get migraines is a bit higher that the percentage of girls. After puberty about twice as many or three times as many women have migraine headaches as men. The variable levels of estrogen and progesterone through the month that start in puberty can be problems for those susceptible to migraine syndrome. Another medical term for migraines linked to the menstrual period is catamenial migraines.
How to Tell If That Headache is Really a Migraine
The way in which a migraine starts, the way the pain and other symptoms develop over time, and then the pattern with which they go away are so typical of migraine that just this information can be a big part of knowing a headache is a real migraine. If the headaches you get don’t fit the picture they might not be migraines. It could be something more than migraine syndrome, so see your doctor. She might need to do tests or brain imaging to confirm that no other medical condition, such as a sinus headache or tension headache, is the cause of the pain occasional pain.
Beyond the Head Pain – More About Migraine Syndrome
Everyone knows about migraines because the headaches are so severe. However, mild or severe, a migraine is not just the headache, as we mentioned above. When a person has a migraine a lot changes in their body. For example, the nausea and maybe vomiting are from gastric/digestive system changes. The aura mentioned above, that starts before the headache, is from altered vision circuitry and other brain changes. There are changes in energy level, in motivation, and in the ability to think clearly. That’s why a person with a migraine has no desire to do anything. Some people who don’t get migraines view them as just “bad headaches”. They are so, so much different than bad headaches.
More Migraine Details
There are mild and moderate migraines, but when people say migraine they’re usually talking about the severe ones. The pounding, pulsating pain, which usually affects only one side, is made worse by movement or action. During a migraine people want to stay still and be left alone. These headaches can be as short as two hours or last as long as 72 hours. Many people say they go to sleep with a migraine and wake the next morning feeling fine. Others are not so lucky. When there’s nausea at times some sufferers feel a bit better once they can “lose the contents of the stomach.” In addition to being sensitive to lights and sounds, there can be sensitivity to aromas and odors. Sometimes even a good smell, like the aroma of food cooking, can seem awful and “turn one’s stomach”.
As We Keep Saying – It’s Not Just a Headache
With the good medications we have now people have noticed another thing about migraine headaches. After taking the right medication, the headache, nausea, and other more obvious and awful symptoms ease and within a few hours go away. But there are other less obvious symptoms of which we become aware when those worse symptoms are gone. Such as no motivation, little energy, and dragging tiredness that might stay around a bit longer as the medicine starts to work. When one is crushed by a headache and nauseated to near vomiting it’s hard to worry about or maybe even notice these other symptoms. But people who get migraines have noticed that when the bigger problems are gone the smaller ones are easier to see. It’s not just a headache, it’s a whole body illness. Once the right medicine has time to be fully effective the person feels just fine.
The Benefit, If There is One, of Migraine Headaches and Migraine Syndrome
There’s an old folklore saying in medicine. If you want to live a long and healthy life, develop a minor medical condition at a young age, and then take care of that condition and yourself for the rest of your life. Though you might feel like you want to just plain die and get it over with in the midst of that worst migraine, migraine syndrome is one of those minor medical conditions.
The Lifelong Migraine Syndrome Benefit
Migraines don’t kill you. They make you sensitive to your surroundings and sort of force you get to know yourself. Migraines can make you aware of what is good for your health and what bad behaviors you need to avoid. They make you examine more carefully what and when you eat and drink. Maybe you’ll decide to cut back on alcoholic beverages or to smoke less. You might considered following a better schedule and to get regular exercise and reserve adequate time for sleep. Realize that you need to stay away from too much stress and get away from stress if it comes your way. And, last but not least, you’re motivated to see your doctor now and again for your headaches. Pain is a great motivator. So, oddly enough, your suffering provides for you a good roadmap for a long and healthy life.
NIH, National Institute of Neurological Disease and Stroke Migraine Information Page
National Library of Medicine Medline Plus on Migraine
The Mayo Clinic on Migraine
The Journal of Headache and Pain article Evidence-based Treatment Options in Chronic Migraine
American Headache Society journal Headache article on A Phase-by-Phase Review of Migraine Pathophysiology
Journal of Neurology article on Migraine: Current Understanding and Future Directions
Therapeutic Advances in Chronic Disease: The Diagnosis and Treatment of Chronic Migraine