Migraines

Migraines are a recurring type of headache that cause moderate to serious pain, often on just one side of your head. They can cause other symptoms like nausea and sensitivity to light and sound.

Migraines can put your life on hold

Migraine attacks can last for hours to days, and the throbbing, pulsating pain can stop you from doing your daily activities. Women are more likely to suffer from migraines than men.

Preventing and treating migraines

Your primary care provider can help you identify your triggers to prevent some migraine attacks, and can develop a treatment plan with medications and lifestyle changes to help make your migraines less painful so they do not interfere with your life anymore.

Causes and risk factors for migraines

We don’t fully understand the cause of migraines, but we do know that genetics and environmental factors are involved.

Several factors can trigger a migraine, which can vary for each patient:

  • Alcohol.
  • Anxiety and stress.
  • Excess caffeine or caffeine withdrawal.
  • Foods such as chocolate, cheese, some fruits and nuts, fermented or pickled foods, some processed meat, monosodium glutamate (MSG) and yeast.
  • Genetics: Migraines tends to run in families.
  • Hormonal changes in women.
  • Medical conditions, including depression, bipolar disorder, sleep disorders and epilepsy.

  • Overexertion.
  • Sensory stimuli, such as bright or flashing lights, loud noises and strong odors.
  • Side effect to some medicines and to medication overuse (taking medicine for migraines too often).
  • Sleep changes.
  • Sudden weather or barometric changes.
  • Tobacco.

Signs and symptoms of a migraine

(and when to see your primary care provider)

Common migraine symptoms

A migraine attack usually lasts from 4 to 72 hours, and typically causes these symptoms:

  • Pain on one side of your head that throbs.
  • Sensitivity to bright lights and sound.
  • Nausea and vomiting.

Duotone Surfer with board

 

Depending on the type of migraine, you might not experience all of these symptoms, and you might experience others.

Certain symptoms can indicate a serious condition

You might also experience other symptoms during the different phases of a migraine. A migraine is not fatal by itself, but it could be a symptom of a life-threatening condition like a stroke.

See your provider immediately or go to the emergency room if you have any of the following signs and symptoms:

  • Chronic headache that spikes after coughing, exertion, straining or a sudden movement.
  • Headache plus fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or trouble speaking.
  • Headache after a head injury.
  • Sudden, severe headache like a thunderclap.

Different types of migraines

According to the American Migraine Foundation, there are several subtypes of migraine:

  • Cervicogenic headache. Actually caused by pain in your neck or from a lesion on the spine, which is often confused with pain in the back of your head.
  • Chronic migraine. A migraine headache more than 15 days a month.
  • Cluster headaches. One of the most severe types of headache pain you can experience, with a burning pain around and above your eyes, at your temples and even moving toward the back of your head. These headaches often cause red or swollen eyes or a runny nose, among other ymptoms.
  • Complicated migraine, or migraine with aura. About 25% of people who get migraines experience the aura phase.
  • Common migraine, or migraine without aura. Usually lacks the prodromal and aura phases that other types of migraine have.
  • Hemiplegic migraine. A migraine that feels more like a stroke, with weakness on one side of the body, visual aura symptoms, and a “pins and needles” sensation or loss of sensation on one side of the body.
  • Ice pick headache or Primary stabbing headache. Incredibly painful, it feels like you are getting stabbed in the head with an ice pick. It often comes on suddenly but usually only lasts 5-30 seconds, and occurs on the orbit, temple and parietal area of your head.
  • Retinal migraine. Causes you to temporarily lose vision in one eye, this is a condition we know very little about. We do know that a retinal migraine may be a sign of a more serious issue, and those who experience it should make a point to see a specialist.
  • Silent migraine, acephalgic migraine or migraine without head pain. You experience dizzying aura and other visual disturbances, nausea and other phases of migraine, but no head pain.

Treatment options for a migraine

Your primary care provider can develop a treatment plan to help relieve your symptoms and prevent attacks. It may include:

Lifestyle changes.

  • During an attack, going to a quiet and dark room, closing your eyes, and resting with a cool cloth or ice pack on your forehead until the attack passes.
  • Hydrating every day.
  • Keeping a written log of things that seem to trigger a migraine.
  • Stress management strategies, such as exercise, relaxation techniques and biofeedback.

Pain relief medications.

  • Over-the-counter (OTC) pain relievers. These include aspirin and ibuprofen (Advil, Motrin IB and others).
  • Triptans. Prescription drugs such as sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt).
  • Dihydroergotamines (D.H.E. 45, Migranal).
  • Lasmiditan (REYVOW).
  • Ubrogepant (Ubrelvy).
  • Opioid medications. Usually prescribed only if no other treatments are effective.

Hormone therapy.

  • For some women, hormones like estrogen might play a role in migraines. Using a journal to record your migraine symptoms and your monthly cycle can indicate a possible link.


Women doing yoga outside

Preventative medications.

  • Blood pressure-lowering medications may help, such as propranolol (Inderal, InnoPran XL, others), metoprolol tartrate (Lopressor) and verapamil or Verelan.
  • Antidepressants, such as a tricyclic antidepressant (amitriptyline).
  • Anti-seizure drugs, such as Valproate and topiramate (Topamax).
  • Botox injections.
  • Calcitonin gene-related peptide (CGRP) monoclonal antibodies, such as Erenumab-aooe (Aimovig), fremanezumab-vfrm (AJOVY) and galcanezumab-gnlm (Emgality).