- Headache Triggers and Tips
- Stress and Headaches
- Alcohol and Headaches
- Allergies and Headaches
- Caffeine and Headaches
- Eyestrain and Headaches
- Hormones and Headaches
- Hypertension and Headaches
- Light Sensitivity and Headaches
- Smoking and Headaches
- Headaches in Adults; Causes, Treatments
- Migraine affects a billion people, but we still don’t know exactly why
- A disorder of “hysterical women”
- More than
- Are there different types of migraine?
- Headache or migraine?
- What is the treatment?
- What causes migraine?
- Did you find this information helpful?
- What to read next:
- What Causes Ocular Migraines
- Treating Migraines and Severe Migraines
- Severe and Chronic Migraines
- What Are the Different Types of Headaches?
- Migraine Aura and Migraine Triggers
- The Science Behind Migraines
- Treating Severe Migraine
- Migraine Headaches
- How prevalent are migraines?
- What triggers a migraine?
- How are migraines diagnosed?
- How are migraines treated?
Headache Triggers and Tips
Headaches occur for a variety of reasons. Here are several examples of headache triggers and how they affect people.
Stress and Headaches
The most common headache trigger is stress, which releases certain chemicals in the brain that cause vascular changes. Anxiety, worry, shock, depression, excitement, and mental fatigue can cause stress-induced headaches. Stress-related headaches, typically in a “hat-band” distribution, can accompany sleep disturbances.
Lowering stress through relaxation, psychotherapy, behavior modification, and antidepressant drugs (under the watch of a physician) can provide relief for stress headaches.
Alcohol and Headaches
Alcohol can trigger headaches immediately or following prolonged periods of drinking. Ethanol, the key ingredient of alcohol, is a natural diuretic and causes the body to lose vital salt, vitamins, and minerals.
Over-consumption of alcohol can cause dehydration and chemical imbalances in the body and brain, leading to headaches that last for hours to days.
Migraine and cluster headache sufferers can be especially sensitive to alcohol, even in small amounts.
If you suffer from headaches, you should avoid alcohol because it can worsen headache symptoms.
Allergies and Headaches
If you have an allergy, your nasal or respiratory tissues will react by becoming inflamed, which can increase pressure on your sinuses. If you have frequent migraines, you may also have a sensitive nervous system that triggers attacks provoked by specific smells or lighting situations.
You may get a migraine or other headache not because of something you are allergic to, but because that allergen places stress on your body, which can then cause a headache. Migraines can come from nasal congestion or sinus symptoms.
If this happens, it is more helpful to treat the condition as a migraine, rather than as a sinus headache or sinus infection.
Caffeine and Headaches
Caffeine can both help and hurt a headache. Sometimes a cup of coffee offers relief from a headache, but you should limit your daily use of caffeine.
Caffeine is a very common ingredient in prescription and over-the-counter headache medicines because it helps the body absorb headache drugs more quickly, bringing faster relief.
But overstimulation from caffeine can trigger headaches, as can the “rebound effect” when you “come down” from the energy boost of caffeine.
Eyestrain and Headaches
Long hours looking at television, computers, tablets, cell phones, and video games can lead to exhaustion, lack of circulation, and eyestrain, which can cause headaches. Rarely is eyestrain the sole cause of headaches. If we suspect that eyestrain is a problem, we may recommend an ophthalmological exam.
To lessen the risk of headaches, take frequent short breaks, walk for a bit, and stretch your neck, arms, and back while watching TV or using the computer to aid circulation. If you feel headache or migraine symptoms developing, try closing your eyes and breathing deeply to relax.
Hormones and Headaches
Headaches related to hormonal imbalance typically affect women, due to fluctuations in estrogen levels. Few women experience headaches only with menses; often, hormones are just one of many migraine triggers.
Estrogen levels drop around menstruation, causing migraine attacks in up to 60 percent of women who tend to have migraines. After menopause, most women experience fewer migraines.
However, women taking hormone replacement therapy may not see a decrease in migraines.
Typically, migraine symptoms improve during pregnancy, though some women experience the onset of frequent migraines while pregnant.
If you start having headaches, or experience a change in your headaches patterns during pregnancy, you should discuss this with your obstetrician to make sure there is not a more serious underlying cause.
If you use any medications for migraine, including over-the-counter medication, during pregnancy, check with your obstetrician to make sure it is safe.
Hypertension and Headaches
High blood pressure can cause many health problems, headaches, by increasing stress levels. Blood pressure usually has to be quite elevated, above 200/110, to cause headaches. Discuss your blood pressure and the issues surrounding it with a doctor to see if it could be contributing to your headaches.
Light Sensitivity and Headaches
During a headache or migraine, you may be very sensitive to light, especially bright and flashing ones. Research shows that slow, flickering lights are more irritating than rapid ones. To avoid headaches caused by flickering light, try using anti-glare screens on computer monitors and daylight spectrum florescent bulbs.
Smoking and Headaches
Smoking contributes to headaches for both smokers and nonsmokers. Nicotine, a substance found in tobacco, can trigger a migraine. Exposure to second-hand smoke can be a trigger for those with sensitivity and history of migraine.
Smoking increases the risk of stroke in those with migraine. Smoking appears to affect cluster headaches, and quitting can help control attacks. If you experience migraines, you should quit smoking and avoid places with second-hand smoke.
Headaches in Adults; Causes, Treatments
Multidisciplinary team takes new approach to headaches.
Headache is one of the most common and debilitating pain conditions in the world.
According to the World Health Organization, almost half of the adults in the world have had a headache in the past year.
The World Health Organization also names headache the third leading cause of disability in the world and the number one cause of disability in individuals under the age of 50.
Headaches are a major cause of absenteeism from work and school. They also cause a heavy personal toll in terms of social life, family life, and anxiety and depression due to fear of the next headache. Headaches affect people of all races, ages, and geographical location.
A comprehensive headache classification guide was established by the International Headache Society and includes more than 150 headache categories.
research, a practical headache classification divides headaches into two main categories primary and secondary headaches.
Primary headaches are those that are not the result of another medical condition. The category includes tension-type, migraine, and cluster headaches.
- Tension-type headaches are the most common type of headache. Tension-type headaches tend to be mild to moderate, non-throbbing, and occur on both sides of the head (bilateral). They usually do not get worse during routine activities (bending over, walking stairs, etc.) Because tension-type headaches tend to be mild, patients usually treat them successfully with over-the-counter medications. Patients should be aware that using over-the-counter medications too often can lead to long term (chronic) daily headache.
- Migraines are the second most common type of primary headaches. The exact cause of migraines is unknown, although they are caused by changes in the nerves and blood vessels. Migraines are also related to changes in the brain and inherited abnormalities in certain areas of the brain. Migraine pain is moderate to severe, often described as pounding or throbbing. Migraines can last from 4 hours to 3 days and usually occur less than 15 times per month. Migraine symptoms include sensitivity to light, noise or odors; nausea or vomiting; loss of appetite; and stomach upset or abdominal pain.
- Cluster headaches are themost severe, type of primary headache. The pain of a cluster headache is intense and has a burning or stabbing quality that is throbbing or constant. The pain is so severe that most patients with cluster headache cannot sit still and will often pace during an attack. The pain is located behind one eye or in the eye region, without changing sides. The term “cluster headache” refers to headaches that come in a group, or cluster. Cluster headaches occur one to eight times per day during a cluster period, which may last 2 weeks to 3 months. The headaches may disappear completely (go into “remission”) for months or years, only to recur.
- New daily persistent headaches (NDPH) start abruptly as a headache that is new to the patient. The patient is able to pinpoint the brief period of time (within 72 hour) when the headache appeared. While these headaches may not be related to other diseases, they tend to be constant or persistent without any remission, located on both sides of the head (bilateral), and don’t respond to many medications.
Secondary headaches, or those that result from another medical or neurological condition, include sinus headaches, medication overuse headaches, or headaches that occur because of an infection, disease of the blood vessels in the brain, head injury, trauma, or more serious condition such as a tumor.
- Sinus headaches are associated with a deep and constant pain in the cheekbones, forehead, or bridge of the nose. The pain usually gets worse with sudden head movement or straining and occurs with other acute sinus symptoms, such as nasal discharge, foul taste in the mouth, a feeling of fullness in the ears, fever, facial swelling, and pain over the involved sinus.
- Medication overuse headaches occur as a result of the overuse of either readily available over-the-counter analgesics or prescribed painkillers such as opiates and sedative hypnotic tablets designed for headache management (butalbital-containing headache remedies). This is among the most common type of chronic headache seen in specialty headache centers and is referred to as a “transformed” headache. Tension-type or migraine headaches that recur can transform into a chronic headache from the inappropriate “overuse” of medications. These headaches can also happen without the overuse of analgesics. It is believed that 4 percent of the population worldwide has chronic daily headaches of some type, and a good percentage of this population includes headaches caused from medication overuse.
Yes, headaches, especially migraines, have a tendency to run in families. Children who have migraines usually have at least one parent who also suffers from the condition. Headaches also can be triggered by certain environmental factors that are shared in a family’s household, such as:
- Second-hand tobacco smoke
- Strong odors from household chemicals or perfumes
- Exposure to certain allergens
- Eating certain foods
Stress, pollution, noise, lighting, and weather changes are other environmental factors that can trigger headaches for some people.
People with migraines may inherit abnormalities in certain areas of the brain, as well as the tendency to be affected by certain migraine triggers, such as fatigue, bright lights, weather changes, and others.
Headache pain results from signals interacting among the brain, blood vessels, and surrounding nerves. During a headache, specific nerves of the blood vessels are activated and send pain signals to the brain. It’s not clear, however, why these signals are activated in the first place.
There is a migraine “pain center,” or generator, in the mid-brain area. A migraine begins when overactive nerve cells send out impulses to the blood vessels. This causes the release of prostaglandins, serotonin, and other substances that cause swelling of the blood vessels in the vicinity of the nerve endings, resulting in pain.
Headaches that occur suddenly (acute onset) are usually caused by an illness, infection, cold, or fever. Other conditions that can cause an acute headache include sinusitis (inflammation of the sinuses), pharyngitis (inflammation or infection of the throat), or otitis (ear infection or inflammation).
In some cases, the headaches may be the result of a blow to the head (trauma) or, rarely, a sign of a more serious medical condition.
Common triggers of tension-type headaches or migraine headaches include:
- Emotional stress related to family and friends, work, or school
- Alcohol use
- Skipping meals
- Changes in sleep patterns
- Excessive medication use
Other causes of headaches include eye strain and neck or neck and back strain caused by poor posture.
When headaches become progressive and occur along with other neurological symptoms, they can be the sign of a disease process in the brain, such as:
- Hydrocephalus (abnormal buildup of fluid in the brain)
- Meningitis (an infection or inflammation of the membrane that covers the brain and spinal cord)
- Encephalitis (infection/inflammation of the brain)
- Hemorrhage (bleeding within the brain)
- Blood clots along the surface of the brain
- Head trauma
- Toxins (overexposure to chemicals, including certain medications)
Last reviewed by a Cleveland Clinic medical professional on 08/16/2018.
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Migraine affects a billion people, but we still don’t know exactly why
First things first: Migraine is not just a headache. It’s a genetic, neurological disease with an estimated billion sufferers around the world—that’s one in seven people, three-quarters of them women.
Beyond, yes, painful headache, migraine sufferers can also experience nausea; dizziness; sensitivity to light, sound, and smell; slurred speech; even paralysis on one side of their body. Some see flashing lights or zigzag lines before or near the beginning of an attack, known as aura. Symptoms can last for hours, sometimes days.
2018 was supposed to be a revolutionary year for migraine: Along with new neurostimulation treatments, the US Food and Drug Administration approved a new class of drugs, calcitonin gene-related peptide (CGRP) blockers. It’s the first medication specifically developed for migraine prevention, but only about 20% of patients see near-total relief.
Migraine is the second-largest global contributor to years lived with a disability and costs the US economy alone $78 billion annually in direct medical and lost labor costs. There’s a clear need for more effective, reliable preventative treatments, but there’s still a lot we don’t know about what causes migraine and thus, how best to treat it.
A disorder of “hysterical women”
The problem comes down to research. If you look at the public funding migraine research receives in the US and Europe, it gets a fraction of the money diseases of similar burden do.
That disparity is a direct result of the stigma of migraine: the fundamental misunderstanding that it’s not a serious or disabling disease, despite being more prevalent than diabetes, epilepsy, and asthma combined, and as disabling as quadriplegia.
Though medical evidence of migraine dates back to ancient Egypt, around the 18th century, migraine started to be thought of as a mental problem of “hysterical” women who couldn’t handle the stress of daily life and didn’t want to have sex with their husbands. Even today, many doctors still mistakenly believe migraine is caused by women’s stress.
There is also a well-documented bias in the medical community of not taking women seriously. When women report pain in the emergency room, they’re more ly to be perceived as “complaining,” receive lower doses of painkillers, and wait longer for medication.
Doctors, patients, and researchers all say that real change won’t happen without patient advocacy. For example, simply changing the language we use around migraine can make a real difference in people’s minds, i.e. referring to it as migraine, singular, to reinforce the concept that it’s a genetic and chronic disease, asthma, and causes debilitating symptoms during attacks.
Advances in neuroimaging, gene therapy, and advanced computing have headache specialists optimistic we could be on the cusp of a real revolution in migraine science and treatment. But the biggest challenge will be making the invisible pain of sufferers visible, and getting policymakers and the public to take it seriously.
Watch the video above as Quartz News investigates the complicated disease of migraine and learns more about what it will take to truly find relief.
Quartz News is a weekly video series bringing you in-depth reporting from around the world. Each episode investigates one story, breaking down the often unseen economic and technological forces shaping our future.
Click here for previous stories.
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Migraine is a complex condition with a wide variety of symptoms. For many people the main feature is a painful headache. Other symptoms include disturbed vision, sensitivity to light, sound and smells, feeling sick and vomiting. Migraine attacks can be very frightening and may result in you having to lie still for several hours.
The symptoms will vary from person to person and individuals may have different symptoms during different attacks. Your attacks may differ in length and frequency. Migraine attacks usually last from 4 to 72 hours and most people are free from symptoms between attacks. Migraine can have an enormous impact on your work, family and social lives.
Are there different types of migraine?
There are different types of migraine. In 1988 the International Headache Society produced a classification system for migraine and headache which has been adopted by the World Health Organisation.
This has been updated since then and is the established basis for defining types of headaches.
The International Classification of Headache Disorders system gives different names to the different types of migraine and headache that involve different symptoms. This helps doctors to diagnose and treat them.
The most common types of migraine fall into two categories:
- migraine with aura
- migraine without aura.
The ‘migraine with aura’ label is also used for some of the rarer forms of migraine, which also have another name.
These include migraine with brainstem aura, where symptoms such as loss of balance, double vision, or fainting can occur.
Familial hemiplegic migraine, where reversible paralysis occurs, is also classed as ‘migraine with aura’. There are other rare forms of migraine, which are classed separately.
Not everyone will have a ‘typical’ migraine. The experience of the condition will be unique to you.
Headache or migraine?
Distinguishing between different types of headache can be difficult. You can experience different types of headaches at different times of your life for varying reasons. For example, if you have migraine you may also experience other types of headache. Keeping a migraine or headache diary is really useful and can be invaluable in trying to identify a specific headache type.
What is the treatment?
The complex nature of migraine means that the treatments available are varied and differ from person to person. There is currently no cure for migraine.
What causes migraine?
There is no known cause for migraine, although most people with it are genetically predisposed to migraine. If you are susceptible to migraine there are certain triggers which commonly occur. These include stress, lack of food, alcohol, hormonal changes in women, lack of sleep and the environment.
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What Causes Ocular Migraines
A migraine that involves visual disturbance is called an ocular migraine. Ocular migraines can develop with or without the accompanying pain of a classic migraine.
During an ocular migraine, or migraine with aura, you may see flashing or shimmering lights, zigzagging lines, or stars. Some people describe psychedelic images. It may also cause blind spots in your field of vision. Of people who report having migraines, one every five experiences this aura.
Ocular migraines can interfere with your ability to perform tasks reading, writing, or driving. Symptoms are temporary and an ocular migraine is not considered a serious condition.
Ocular migraine is sometimes confused with retinal migraine, but they are two distinct conditions. A retinal migraine is rare and affects only one eye. Loss of vision in one eye can be a symptom of a more serious medical issue. If you have vision loss in one eye, you should seek medical attention to rule out any underlying conditions.
Exactly what causes ocular migraine is not known, but a personal or family history of migraines is a known risk factor. Doctors theorize that ocular migraine has the same causes as classic migraine.
There is a genetic link to migraine. A family history of migraine or ocular migraine increases your chances of having them.
Many people are able to identify individual migraine triggers, but research has shown that it is more ly a combination of factors that trigger migraine. Triggers vary from person to person and may include:
- bright lights
- loud sounds
- powerful odors
- stress, anxiety, relaxation after a period of stress
- changing weather
- alcoholic beverages, especially red wine
- too much caffeine or withdrawal from caffeine
- foods containing nitrates (hot dogs, luncheon meats)
- foods containing monosodium glutamate, also known as MSG (fast foods, seasonings, spices, broths)
- foods containing tyramine (aged cheeses, hard sausages, smoked fish, soy products, fava beans)
- artificial sweeteners
You can try to identify your migraine triggers by keeping a headache diary. The diary should include notes on diet, exercise, sleep habits, and menstruation.
There are two types of migraines that are referred to as ocular migraines. Some people refer to migraines with auras as ocular migraines.
Some people experience an aura approximately 10 to 30 minutes before a migraine sets in. Aura symptoms can include:
- numbness or tingling in the hands or face
- feeling mentally foggy or fuzzy
- disrupted sense of touch, taste, or smell
- seeing blind spots, shimmering spots, flashing lights, or zig-zag lines
Not all people with migraines will experience auras.
Ocular migraines may also refer to eye-related migraines that come with visual disturbances that may or may not come with a headache pain. These are known as ophthalmic migraines. Ocular migraines can include some or all of the aura symptoms listed above. Ocular migraines are typically the result of migraine activity in the visual cortex of the brain.
Some people use the terms “migraine” and “headache” interchangeably, but there is a difference between tension headaches and migraines. The pain from a tension headache will be mild to moderate (contrary to cluster headaches, which can be severely painful). Tension headaches tend to be distracting but not debilitating. Only in rare cases will there be light or sound sensitivity.
In a migraine, however, the pain is moderate to severe. Many patients experience a persistent, intense pounding or throbbing. The pain is often debilitating. Some patients will experience nausea or vomiting, and light and sound sensitivity. Some patients will also experience an aura before the onset of a migraine.
Even if the migraines exist alone and are not a symptom of an underlying condition, they can still be debilitating and impact your life. If you’re experiencing blind spots or vision disturbances, for example, you will want to wait until they pass before driving.
Ocular migraines will typically go away on their own within 30 minutes. You should rest and avoid triggers such as bright lights until the vision disturbances are gone.
There are both over the counter treatments and prescription medications that can be used to treat recurring migraines. Over-the-counter drugs ibuprofen or Excedrin migraine can be used to reduce the symptoms of a migraine once you already have them. Your doctor can prescribe you:
Some of these prescription medications will be taken on a regular basis instead of an as-needed basis when you get the migraines.
If you’re experiencing ocular migraine pain, you can:
- lie down or sit in a dark, quiet room
- massage your scalp with a lot of pressure
- put pressure on your temples
- put a damp towel over your forehead
While ocular migraines may not need treatment, you should consult your doctor if you have them frequently. You should also call your doctor if they are increasing in frequency. Your doctor can make sure there’s no serious underlying condition, and can also prescribe you medications that can reduce the frequency or intensity of the symptoms.
If you experience drastic vision loss, vision loss in one eye, or have trouble thinking, seek immediate medical attention.
Treating Migraines and Severe Migraines
Migraines affect more than 30 million people, or about 12 percent of the U.S. population. Typically migraines affect women more than men. Yet up to half of people who get migraines are not diagnosed. Continue reading to find out if you are one of the millions who get severe migraines.
Severe and Chronic Migraines
The symptoms of severe or acute migraine include pain, which is usually severe and often disabling, as well as intense throbbing. Some people experience nausea, vomiting, or extreme sensitivity to noise or light during attacks. Episodes of severe migraine may last from four hours to three days.
Severe migraine may occur with or without aura. Aura refers to a perceptual disturbance. Examples include experiencing nonexistent smells, lights, or sounds.
A migraine is often considered severe when pain, nausea, or other associated symptoms force a person to avoid normal daily activities. Also, a migraine is classified as severe if the person affected has a history of two to five similar episodes.
Severe migraine is most common among people 25 to 55 years of age, but even children and teens are susceptible.
A chronic migraine occurs at least 15 days a month, for more than three months. This type of migraine can cause a substantial loss in productivity, and can result in a poor quality of life. It’s important to treat acute migraine in order to prevent the development of chronic migraine.
What Are the Different Types of Headaches?
Virtually everyone gets ordinary tension headaches. Tension headaches typically cause a dull pain, as if a tight band is squeezing the head. Triggers may include:
- muscle tension in the neck and scalp
- caffeine withdrawal
- too little sleep
Tension headaches usually respond to treatment with common over-the-counter pain relievers.
A cluster headache is another, less common, type of headache. Cluster headaches more often affect men. The headaches are characterized by sudden severe pain behind or around the eye, on one side of the head. Pain peaks within 10 minutes, but can last 15 minutes to three hours.
Migraines, which are considered a neurological disorder, are distinct from tension or cluster headaches.
Migraine Aura and Migraine Triggers
Some people with migraines report warning symptoms. This is known as migraine with aura. Warning symptoms may include blurred vision, seeing “stars,” or other odd sensations unpleasant smells before the onset of an attack. Affected people may even experience slurred speech or other language difficulties. Temporary loss of vision in one eye has also been reported.
Aura may occur from 10 minutes to one day before onset of a migraine. In some cases, a person may experience an aura without having a migraine. Migraine with aura tends to be less severe and disabling than migraine without an aura.
A number of factors are known to trigger the onset of migraine episodes. More than half of people who experience migraine with aura report having at least one trigger for their migraines. Potential triggers are numerous and may include:
- fluctuating hormone levels (especially among women, and boys going through puberty)
- stress or anxiety
- fermented and pickled foods
- cured meats and aged cheeses
- fruits such as bananas, avocados, and citrus
- skipped meals
- too little or too much sleep
- bright or strong lights
- fluctuations in atmospheric pressure due to changing weather
- drinking alcohol
- caffeine withdrawal
The Science Behind Migraines
A migraine results from a complex cascade of abnormal events in the brain, which are not yet fully understood by researchers.
However, researchers have been able to determine that the abnormal activity originates in the body’s largest cranial nerve, the trigeminal nerve. Changes within this cranial nerve quickly spread to a network of smaller nerves.
These nerves form a web throughout the delicate outer lining of the brain; the dura mater.
Within as little as 10 minutes after a migraine begins, pain-sensing nerves in this network undergo molecular changes. This causes them to become hypersensitive to pressure.
This hair-trigger response creates throbbing pain as blood pressure naturally rises and falls with each heartbeat. Also, certain arteries dilate and blood flow is altered causing pain-producing chemicals to be released.
Some of these changes may persist even after an attack has passed.
Brain messenger chemicals, dopamine and serotonin, are also believed to play a role in developing a migraine.
Another new theory suggests migraines may be related to “abnormal temperature regulation in certain regions of the brain.” The theory goes on to state, “a migraine attack serves to restore the brain temperature.”
Ultimately, scientists think genetic factors and certain environmental factors (and how those genes and environmental factors interact) affect a person’s susceptibility to developing migraines.
Treating Severe Migraine
Emerging research suggest there’s a small window of opportunity to stop the progression of molecular changes that result in a migraine. To do this, treatment must begin within 10 to 20 minutes of the appearance of initial symptoms.
Another window of opportunity closes within one to two hours of headache onset. After this, the skin of the face and scalp may become hypersensitive to touch.
It’s very important to begin appropriate treatment as quickly as possible for best results.
Numerous drugs are available to treat migraine. Over-the-counter drugs, aspirin, ibuprofen, and acetaminophen are often combined with caffeine to combat mild to moderate migraine episodes.
Doctors may prescribe other drugs, too. Examples include:
- blood pressure drugs (beta-blockers)
- anti-seizure drugs
- ergot alkaloids
Triptans, a class of tryptamine-based drugs, have proven quite effective at providing relief from ongoing migraine headache. Some herbal remedies, feverfew and butterbur, have shown some promise in migraine treatment.
There are two main branches of treatment for migraine. Acute treatments seek to stop a migraine headache or to reduce its severity or duration while it is happening.
Preventive treatments seek to keep headaches from starting. They also aim to reduce the frequency and severity of attacks.
When a migraine headache is in progress, ending it or reducing pain and other symptoms is of primary importance.
Individual migraines are moderate to severe in intensity, often characterized by a throbbing or pounding feeling. Although they are frequently one-sided, they may occur anywhere on the head, neck and face — or all over.
At their worst, they are typically associated with sensitivity to light, noise and/or smells. Nausea is one of the most common symptoms and it worsens with activity, which often results in patient disability.
In many respects, migraines are much alcohol-related hangovers.
Migraine pain can be felt in the face, where it may be mistaken for sinus headache — or in the neck, where it may be mistaken for arthritis or muscle spasm.
Complicating the diagnosis of migraine is that the headaches may be accompanied by other “sinus ” symptoms, including watering eyes, nasal congestion and a sense of facial pressure.
Most patients who think they have sinus headache in fact have migraines.
In up to 25 percent of patients, the migraine headache pain may be preceded by an aura, a temporary neurological syndrome that slowly progresses and then typically resolves just as the pain begins.
While the most common type of migraine aura involves visual disturbances (flashing lights, zigzags, blind spots), many people experience numbness, confusion, trouble speaking, vertigo (spinning dizziness) and other stroke neurological symptoms.
Some patients may experience auras without headaches.
How prevalent are migraines?
Migraines are about three times more common in women than men, and may affect more than 12 percent of the U.S. adult population. Migraines often run in families, and can start as early as elementary school but most often in early adulthood.
They often fade away later in life, but can strike at any time. The most common cause of recurring, disabling headache pain, migraines are also the most common underlying cause of disabling chronic, daily headache pain. While migraines are the No.
1 reason that patients see a neurologist, most cases are handled by primary care physicians.
What triggers a migraine?
Things that can make the headaches more ly to occur include:
Lack of sleep
Teeth grinding at night
How are migraines diagnosed?
Despite their dramatic symptoms, migraines are almost never due to an underlying problem that will show up on any testing, even on brain MRIs. Many experts do not recommend brain imaging at all, even in severe cases, as long as the patient's symptoms are typical for migraines and a thorough neurological examination is normal.
There are extremely rare families that have migraines as a result of a single genetic mutation in one of four known genes that can lead to the condition called familial hemiplegic migraine. There are no genetic tests for the vast majority of patients. Because the condition cannot be diagnosed by scan or blood test, the diagnosis is “clinical” — made by an experienced physician.
How are migraines treated?
Migraines that are severe, frequent or accompanied by neurological symptoms are best treated preventively, usually with a combination of dietary modification, lifestyle changes, vitamins and daily prescription medications.
Most of our best preventive medications are often used for other medical purposes as well; the majority are blood pressure drugs, antidepressants or epilepsy medications.
Individual headache attacks are best treated early, often with one or more of the following types of medications: triptans, nonsteroidal anti-inflammatory drugs (NSAIDs), anti-emetics (anti-nausea), and sometimes narcotics or steroids.
Migraines typically last a few hours to a couple of days and respond well to specific treatments. However, in some patients, the migraine is particularly severe and long-lasting — and may even become chronic, occurring continuously for weeks, months or even years.
If improperly managed or left untreated, intermittent migraines may essentially transform into a chronic daily headache, with continuous and smoldering symptoms that periodically erupt into a “full-blown” migraine. This condition is extremely difficult to treat.
Other patients may develop increasingly frequent headaches as a result of overusing their short-acting headache medications. See medication overuse headache.
While they are considered primary headaches, meaning they have no known underlying cause, migraines are associated with an increased risk of stroke, brain scarring as seen on MRI scans, a heart defect called a patent foramen ovale (PFO) and other medical conditions.
At the Johns Hopkins Headache Center, located at the Johns Hopkins Bayview Medical center, we have expert physical therapists, nutritionists and psychologists who work closely with our neurologists to help manage patients with frequent migraines. Biofeedback and relaxation techniques are available to complement our standard medical treatments.