Migraine Headaches 101

Migraines are severe, near-disabling headaches. They are divided into two categories: Classic migraine (migraine with aura) and common migraine (migraine without aura). Migraine headaches typically last 2-72 hours and can last to several days. They follow the trigeminal nerve pathway and have been related to dilation and excessive pulsation of branches of the external carotid artery. A wide variety of components impact migraines. It is important to find the root cause of the headache to best treat it.

Migraines Statistics

Migraines affect millions of people. 1 in 5 Americans suffer from migraine headaches. They cost society $17 billion a year, and affect women more than men. A headache is a main complaint in the ER and the most frequent pain reported amongst workers. Often there is a family history and onset is usually in adolescence or early adult years. There is a wide spectrum of triggers to migraines. Lack of sleep or changes in the weather can spark a migraine.

Causes

There is a multitude of causes and triggers of migraines. The whole picture for each individual case must be assessed to get to the root cause. Emotional and physical stress, lack of sleep, missed meals, specific foods, alcoholic drinks, menstruation, oral contraceptives, weather changes, and nitrate-containing foods can all cause migraines. Genetics, food allergy to eggs, hypoglycemia, exercising out in the heat, gut dysbiosis, food additives like aspartame, magnesium deficiency, and hormone imbalances can all cause a migraine as well. It is important to know your triggers and avoid them at all costs, if possible.

Signs and Symptoms

Migraine headaches usually present with unilateral, severe throbbing pain that occurs episodically. They present with or without a preceding aura and occur once a year to 3 to 4 times per week. Individuals are able to sense that a migraine is coming when they get the aura. Not everyone who has migraines has an aura. The headache may be dull or throbbing and lasts several hours to several days. Nausea and vomiting, photophobia, visual disturbances, noise sensitivity, numbness, tingling, and difficulty speaking may also accompany the headache. The pain is usually so severe that the individual usually appears ill. The migraine is so debilitating that is decreases the ability to perform everyday activities and go to work.

Dx + Testing

Testing for migraines consists of a comprehensive patient health history, physical exam, initial lab testing, and a CT scan of the head. Other tests include food allergy testing, saliva test for hormonal imbalance, urine organic acids, and basic metabolic panel. A CT scan is performed to rule out a brain tumor. Many times exam findings are normal even when the individual experiences neurological deficits mentioned above. This can be frustrating as finding the root cause is difficult. A comprehensive patient history is critical in assessing potential triggers and causes.

Tx +Mgmt

Treatment for migraine headaches is tricky. Most medications have poor effectiveness and a lot of side effects. Avoidance of triggers is key for migraine prophylaxis. Relaxation and stress management techniques help prevent migraine attacks. Medication therapy consists of sumatriptan, propanolol, magnesium, topiramate, gabapentin, clonidine, amitriptyline, and divalproex. There are many more medications used to prevent and treat migraines. Management of an acute migraine attack includes rescue medications like sumatriptans, rest in a dark quiet room, and a simple analgesic like aspirin. Avoidance of triggers, elimination of food sensitivities, and Botox to the neck muscles are a few ways to manage chronic migraines. Daily supplements for migraines include a multivitamin, vitamin B2 riboflavin, magnesium, and CQ10.

Keys to success + Self-awareness

The number one key to success is to be aware of triggers and avoid them. An optimal diet free of food additives and eliminating food allergies and nitrate-containing foods is crucial for migraine prevention. Daily exercise, yoga and meditation practices, and consistent high-quality sleep are simple ways to prevent migraines attacks.

Keep a migraine journal. Document before, during, and after a migraine attack to share with your healthcare provider. If you experience any irritability, feelings of hopelessness, mood instability, or financial stress due to migraines seek a professional mental health expert. Eat regular meals and get consistent sleep. Develop an individualized diet, exercise, and sleep regimen that you will actually follow. Reach out to people who support you and believe in you. Talk with family and friends about what you experience.

Final thoughts

Migraines are severely painful headaches that last hours to days. They impact cognitive function, mood, sleep, vision, speech, energy, appetite, and usual everyday activities. Headaches are the number one reason why people visit the ER. It is important to discover to the organic cause of the migraine and find any associated triggers and avoid them.