Anyone who has ever experienced a migraine can tell you it is a pain like no other. Even worse, it often comes with a range other symptoms, from unpleasant to almost crippling. Migraines have a significant impact on those who suffer from them, leading to a poor quality of life during each attack. Migraines can even get so bad at times that the sufferer is unable to carry out their usual daily activities such as getting out of bed, washing, dressing and going to work.
So just what are migraines, how are they different from ordinary headaches, and what are the best pain relief strategies for dealing with migraines? Let’s discuss what migraines are first.
What is a Migraine?
Migraine headaches affect about one in seven Americans each year, around 37 million people. Migraines are one of the leading causes of visits to the doctor and emergency room. Migraines mainly affect those between 15 and 55 years of age, especially women.
The National Headache Foundation (http://www.headaches.org/) estimates that more than 50% of those who suffer from migraines have not been diagnosed. This means they are more than likely suffering needlessly when there are many effective treatments available for migraine pain relief, with new ones becoming available as more research emerges.
Knowledge is power when it comes to most medical conditions. Knowing the symptoms and causes of migraines can help you find effective pain relief so you can get on with your normal life as far as possible despite the migraine.
So what exactly is a migraine? A migraine is a severe form of headache which can cause intense pain. Those with migraine often experience other symptoms in addition to the pain the head. These include vision and hearing problems, and often nausea and vomiting.
No one is sure why migraines occur. They are thought to be caused by abnormal brain activity or stimulation in one of the main nerves in the brain. Migraines might also have a genetic component. If anyone in your family has migraines, you might be more prone to them.
A third main cause is the environment. Neurologists are learning more each day about the kinds of “triggers” that can cause migraines. By identifying these triggers, you can spot potential causes of your migraines in your daily life and environment. This could help prevent painful migraines from ever happening in the first place.
The Five Phases of Migraines
While it is true that migraines vary from person to person and from one migraine episode to the next, most sufferers will experience five phases to each of their migraines.
The five phases are:
1. Prodrome
2. Aura (some people do not have this)
3. Headache
4. Headache termination
5. Postdrome
Let’s look at each of these five phases in more detail.
1 – Prodrome
Many migraine sufferers report “warning signs” before their migraines begin. Some report a change in mood, such as feeling “high,” irritable, or down in the dumps. They also report their food tasting strange or think they can sense funny smells. Many people also report tiredness and tension in the muscles. This can often lead doctors to believe they might have a tension headache when in fact they are suffering from migraines.
2 – Auras
Auras can affect a sufferer’s vision in a number of ways. The most common is an aura, or “halo” or bright light appearing to them, giving everything they look at a strange glow. Some migraine sufferers develop blind spots, which are referred to as scotomas. Geometric patterns, flashing, colorful lights, or loss of vision in one eye have also been reported prior to migraines.
3 – Headache
When the migraine arrives, it will usually occur on one side of the head only, though it is possible for it to occur on both sides. The pain has been described as both stabbing and throbbing.
In addition to the pain in the head, visual disturbances can continue, including an extreme sensitivity to light (photophobia). Some sufferers also become sensitive to sound (phonophobia). Many with migraine feel nauseous and might even vomit.
The migraine can last anywhere from 4 to 72 hours, causing extreme disability in many if the steps they take to relieve the headache do not work.
4 – Headache Termination
Migraines can sometimes be treated successfully with medication and lifestyle measures. Even if these fail, the migraine will usually go away by itself at some point, most often if the person goes to sleep. However, even after the migraine is gone, there can be some lingering effects.
5 – Postdrome
Migraine sufferers have reported a number of symptoms after their migraine has ended, including a loss of appetite, problems with concentration, and extreme tiredness. This migraine hangover can also have a negative effect on your daily life.
Those who have chronic migraines, about 3% of the population, suffer these symptoms on average about 50% of each month. This can cause severe disability, diminished the quality of life, plus poor productivity and lost income if the symptoms are very severe. Therefore, the more you can do to prevent migraines from happening in the first place, or to treat them effectively, the better.
For those who are not sure if they have migraines or not, let’s look in the next section at how migraines are different from other types of headaches.
How is a Migraine Different from Other Kinds of Headaches?
There are a number of different kinds of headaches in addition to migraines. The four main kinds to be aware of are:
1. Tension headaches
2. Cluster headaches
3. Sinus headaches
4. Rebound headaches
Let’s look at each one of these in a bit more detail to see the similarities and differences.
Tension Headaches
Most headaches are tension headaches, triggered by stressors at some points in our daily lives. They usually affect the entire head and the pain is consistent throughout the duration of the headache until the headache finally goes away.
Cluster Headaches
Cluster headaches are different from tension headaches in a number of ways. They usually affect only one eye, and the pain can come and go several times during an attack rather than remain steady. These multiple headaches are referred to as a cluster. Most people who report experiencing these kinds of headaches are men.
Sinus Headaches
Sinus headaches can attack anyone at any age. The sinuses are cavities or pockets within the bones of the skull that give it strength and stability and also filter the air we breathe. The sinuses are located above and below our eyes on both sides of the nose. Sinus headaches are caused by a build-up of pressure in one of more of the sinuses, leading to aching or throbbing in the face or whole head.
Rebound Headaches
Rebound headaches can be triggered by taking too much headache relief medication. Experts are not sure why this might be the case, but they have two theories. The first is that medicines such as Tylenol can make the brain more excited, triggering more pain. The second theory is that the brain starts to suffer from withdrawal symptoms once the level of medication in the body starts to go down, and the headache returns or a new one forms.
We have already discussed what migraines are, but how do they differ from an ordinary headache?
Migraines are different from ordinary headaches in a number of ways. Headaches usually come on only occasionally, not regularly. Headaches involve some sort of pressure or throbbing in our heads or perhaps the base of the skull, but do not usually affect other parts of the body such as our eyes or hearing. The pain usually comes on slowly but can often go away by itself as well within a short period of time.
When we have a normal headache, most of us can still function. If our headache is severe enough, we might take an over-the-counter pain reliever such as aspirin or Tylenol and will usually start to feel better shortly afterwards. Most of us do not have to lie down in bed because we are unable to function due to the pain.
Migraines, on the other hand, often come regularly, such as each week or every month. They can last for many hours or even days. The pain might be on one side of the head, or both. The pain of migraine has been described as stabbing and throbbing. The pain can be particularly bad in one of the eyes, or next to one of the eyes around the temple.
Migraine can often affect other parts of the body, such as vision and hearing, making even the smallest amount of light or the slightest sound almost unbearable. It can also trigger severe nausea and even vomiting. Every movement can seem like agony.
With such excruciating symptoms, most migraine sufferers have little choice but to take to their beds in a dark room and stay as quiet as possible until the migraine subsides. Sleep is often the only thing that provides real relief. The crippling nature of migraines can lead to a poor quality of life and loss of productivity and earnings. It can damage home life and relationships.
As bad as migraines are, there is hope. The more people who are diagnosed and report their symptoms, the more we are learning all the time about migraine headaches and what causes them. Knowing the signs and symptoms of migraines and what could be leading up to your migraines are your first steps towards getting effective pain relief.
The best option, as for most medical conditions, is to try to prevent migraines from ever happening in the first place. How is this possible? In the case of migraines, it is by learning more about the most common reasons for migraine to determine if any of these known “triggers” might be causing your headaches. Let’s look at some of the most common migraine triggers in the next section.
What are the Known Triggers that Cause Migraines?
Experts have tracked down a number of potential triggers for migraines. While every person is different, anyone suffering from migraines should consider whether or not any of these known triggers might be causing their headaches.
The 17 most common migraine triggers are:
1 – Food – Mature cheese such as aged cheddar, salty foods like pretzels and crackers, and processed foods such as cold cuts may trigger migraines. Chocolate is also a known trigger.
2 – Food additives – Many packaged foods contain artificial coloring, flavoring and preservatives. One common trigger is the meat tenderizer and flavor enhancer monosodium glutamate (MSG). It is found in many convenience foods and is a common ingredient in Chinese food from a restaurant or takeaway. It may be labelled “natural flavoring” on some products because it is derived from the sugar beet. MSG can produce a range of reactions, from migraines to temporary lock jaw as your muscles tighten.
3 – Artificial sweeteners – In terms of artificial sweeteners, aspartame has been linked to migraines. It is common in diet sodas and sugar-free cakes, cookies, candies and so on.
4 – Hunger – People who do not eat regularly or fast for religious reasons will experience migraines more often.
5 – Alcohol – Alcohol such as wine is a known trigger, most likely due to the chemicals and high levels of sugar used in the fermentation and bottling processes.
6 – Caffeine – Coffee, tea and so-called energy drinks like Red Bull have been linked to migraines. So too has trying to cut down or give up these beverages, as the body goes into caffeine withdrawal.
7 – Stress – Too much stress at work or home can lead to tension headaches, and those prone to migraines are at increased risk of migraine if they feel stressed.
8 – Bright lights – Bright lights such as at clubs and in video games can trigger migraines. So can too much sun, especially if the migraine sufferer does not wear sunglasses.
9 – Loud music and other noises – Loud music at clubs, high levels of sound at the movies, the noise of drilling and jackhammers, can all provoke migraines.
10 – Strong smells – A number of strong-smelling items have been linked to migraines. These include perfume, cologne and aftershave, paint, paint thinner and other solvents, and cigarette or cigar smoke.
11 – A lack of restful sleep – Most people who are stressed do not tend to get a full eight hours of sleep each night. Even if they do try to get to bed at a decent time, they might toss and turn with insomnia. Or they might have trouble staying asleep throughout the night until morning. On the other hand, too much sleep can also trigger migraines. One other common trigger is jet lag if you travel across time zones.
12 – Physical factors – High levels of exertion, such as when playing sports, can trigger migraines. Some people also report migraines after sexual activity.
13 – Changes in the environment – A change in the weather or barometric pressure can trigger a migraine.
14 – Medications – A number of medications such as oral contraceptives and heart-related drugs like nitroglycerin have been known to aggravate migraines.
15 – Hormonal changes in pre-menopausal women – Changes in the hormone estrogen before and during a woman’s periods have been associated with migraines; these are times when estrogen drops significantly. Birth control pills can affect the frequency and severity of migraines, though some women report fewer migraines and some more.
16 – Hormonal changes during pregnancy – Hormone can fluctuate radically during pregnancy. Women with a history of migraine have reported a difference in their migraines while pregnant.
17 – Hormonal change during perimenopause or menopause – Perimenopause and menopause are the result of major decreases in hormone levels as a woman ages and moves beyond her childbearing years. The prefix “peri” means “around,” so these changes occur around the time of menopause.
A woman can start to go through perimenopause as early as her 30s. Most women will go through menopause in their late 40s or early 50s. Menopause symptoms are sometimes relieved through the use of hormone replacement therapy (HRT), which some women report as helpful in relieving migraines.
As you can see from this brief list, there are a range of triggers all around us in our daily lives. How can you possibly know what is setting off your migraines?
A headache diary can help you keep track of your headaches to determine how often they are occurring and what might have triggered them. Any pattern spotted can help prevent a migraine from happening in the first place. Let’s look in the next section at ways you can reduce your migraine triggers and stay pain-free as long as possible.
How Can You Reduce Your Migraine Triggers?
As we discussed in the last chapter, there are a number of known triggers that can cause migraines. The headache diary you create can be shared with your GP and other healthcare professionals in order to determine what the best treatments might be for your migraines.
Many of the triggers are related to food and drink, so try to cook for yourself using fresh ingredients. Avoid diet foods and convenience foods. Don’t allow yourself to get so hungry that you feel stressed and might make bad food choices because you are so hungry. Steer clear of wine and caffeine. If you have to have alcohol, drink in moderation and try a wine spritzer. As for avoiding caffeine, try decaf or herbal tea or coffee.
In terms of your lifestyle, anything you can do to reduce stress is good for your overall health and wellbeing, not just for your migraines. Try light exercise, meditation, or doing something you enjoy to help you relax.
Walking, cycling around the block a few times, tai chi and yoga can serve as both cardio and strength training. They should not trigger migraines because they are not as strenuous as other forms of exercise such as jogging or spinning. In terms of strength training, try light weights or resistance bands to tone and trim muscles.
Try to keep your home as clean as possible. Do not use a lot of strong-smelling products such as air fresheners. Avoid burning scented candles in the house or using potpourri and essential oils, especially if these items are manufactured outside of the US, since they can be loaded with chemicals. Use unscented toiletries if possible.
Use soft light types of bulbs in shaded lamps. Avoid fluorescent or strobe lighting. If the main rooms in your house get direct sunlight, make sure you have adequate blinds and curtains, especially in your bedroom. Avoid loud music or noisy activities such as loud video games, concerts and so on.
In relation to getting enough sleep, make sure you do not exercise 30 minutes before your regular bedtime. Exercise actually energizes you, which is a bad idea when you should be trying to relax and go to sleep. Avoid watching TV or DVDs before bed. Try a favorite old book instead so you do not stay up all night with the latest page turner. Do not let your bedroom become an extension of your office. Reserve your bedroom for rest and relaxation only.
If you smoke, it is time to quit. You may suffer from nicotine withdrawal for a few days, but gum and patches can help you get over the worst symptoms. If anyone you live with smokes, tell them to take it outside to protect your health and that of every person or pet in the household who is exposed to the second-hand smoke.
In terms of hormonal activity, there is not much you can do about this as a woman except to trace the patterns to see when your migraines are at their worst or their most frequent. Once you do this, you can select the right treatment and pain relief for your migraines. While it is true that you can’t do much about your hormones, you can take charge of your health by trying to avoid as many of your triggers as possible.
Preventing migraines is the best choice for your health. However, if your migraine diary isn’t conclusive about your triggers, or you are avoiding your triggers but still getting migraines, it will be time to consider all your pain relief options. Let’s look at some of the most effective treatments in the next part.
How Can You Deal with Your Migraine Pain Effectively?
There are a number of natural, over-the-counter and prescription treatments which can help relieve pain if all your preventive steps have not worked and you still suffer from migraines. We will discuss each of these briefly below.
Natural Treatments
Those who suffer from migraines have reported that the following natural remedies can help prevent their headaches and/or offer pain relief if they have a migraine.
- Meditation
- Biofeedback and other relaxation techniques
- Massage therapy
- Acupressure
- Acupuncture
- Eating a balanced diet, especially one rich in B vitamins
- Avoiding alcohol
- Avoiding caffeine
- Using ice packs on the head and neck to reduce inflammation and throbbing sensations
- Stress management
- Aromatherapy using mildly-scented essential oils
Many of these can be used in combination with one another, such as meditation, massage using aromatherapy oils, stress management techniques and a better diet. Try them one at a time and note your results in your migraine diary to see which, if any, help prevent migraines and which offer pain relief if you do get a migraine.
One other non-drug treatment available is the Cerena Transcranial Magnetic Stimulator (Cerena TMS), which was approved by the FDA in December 2013.
Users apply it to the back of the head and press a button to release a small burst of magnetic energy to stimulate certain areas of the brain. The burst of energy is supposed to stop the migraine in its tracks.
The Cerena TMS can be used once every 24 hours; success rates at relieving migraine have been reported as high as 40%. It is available for those over 18 who have migraines with aura.
Link – http://www.eneura.com/springtms.html
Over-the-Counter Medications (OTCs)
There are a number of over-the-counter remedies for migraine which can offer varying degrees of help for your headaches. Many of the commonly-used OTCs are pain relievers you would take after your migraines starts. One of the most popular is Excedrin Migraine. Tylenol, however, might also help prevent migraines.
Other OTCs such as herbal supplements claim they offer a formula that can prevent migraines. The trouble with many of these supplements is there is little science to back up the claims. Thus far, the only herbs which have shown promise in clinical trials are feverfew and butterbur.
Even though herbal remedies are natural, they can still carry a risk of side effects and interactions with other herbs, supplements and medications, so be sure to keep track of everything you are taking and look up each item in a good drug database to learn what side effects to look out for and interactions that might be harmful.
Many herbal supplements have not been tested in labs to determine the most effective dosage to treat a particular condition. Contrary to popular belief, they do not need to be approved by the Food and Drug Administration (FDA) because they are not considered to be a food or a drug.
Many of these products are made outside of the US or European Union and are therefore unregulated in terms of formulation and manufacturing standards.
One further consideration is that when some herbal supplements were tested in relation to the amounts of active ingredients they claimed to contain as printed on the label, more than 75% of the products did not contain the amounts listed.
Of that 75%, the majority had too little of the active ingredients. However, some had too much, which could lead to accidental overdose and/or interactions with other supplements and medications you might be taking.
If you do want to use any of these products, therefore, it is a case of buyer beware. Read the labels, don’t pay a fortune for the product, and keep track of your results in your migraine diary to determine if any of these remedies are worth the money.
Prescription Medications
If we look at WebMD, we will find that there are more than 80 medications currently being used to treat migraines, with more on the way all the time. Some are listed as OTC. Some of the OTCs and prescription medications are also listed as “off-label.” This means the medicine is normally prescribed for another medical condition but there is some indication that it can be helpful for migraine.
There are three different types of prescription medications being used for migraines: preventive, abortive and pain relieving.
Let’s look at how each type works.
Preventive
These medications seek to stop the migraine before it ever happens. This group of medications includes certain classes of drugs, including:
Antiepileptic drugs – Valproic acid and Topiramate (Topamax) alter brain chemistry and have been shown to be effective in preventing migraines. Valproic acid is administered in emergency rooms to anyone who has had a migraine lasting more than 72 hours.
Beta blockers – These are normally used to treat heart conditions and high blood pressure. They can shrink blood vessels in the head to reduce pain. The best drugs for migraine relief are propranolol (Inderal) and Timolol.
Tricyclic antidepressants – Amitriptyline, nortriptyline (Pamelor) and doxepin (Adapin) have all been used not just to relieve depression but to treat migraine as well. Amitriptyline has been proven the most effective of this class of drugs.
Calcium channel blockers – These drugs are used to relieve blood pressure and can ease the pressure and throbbing that comes with migraines. The most well documented is verapamil (Calan, Isoptin SR), though it is not as effective as some of the other drugs we have discussed.
Selective serotonin reuptake inhibitors (SSRIs) – SSRIs are another class of antidepressants which are also helpful for migraines. They include paroxetine (Paxil), fluoxetine (Prozac) and sertraline (Zoloft). This class of drugs has fewer side effects than tricyclic antidepressants. Prozac has been proven effective for people with chronic migraines; that is, migraine taking place 50% of each month or more.
Botulinum toxin – Commonly referred to as Botox, this is derived from botulism and freezes nerves which might be triggering pain the head.
Abortive
These drugs try to treat the migraine by “nipping it in the bud” during the first two phases, prodrome and aura, or shortly after a migraine headache starts. This group of medications includes certain classes of drugs, including:
Selective serotonin receptor (5-HT1) agonists (triptans) – These work on the blood vessels and nerves of the brain to relieve inflammation. The triptan group of drugs has been shown to be safe and effective in many people with migraines. Sumatriptan (Imitrex) is available via injection, pills, nasal spray and transdermal patches (Zecuity), with a high rate of rapid migraine relief (within 20 minutes) for the injectable form. Naratriptan offers slower relief but the relief lasts longer. It is also a good choice because it does not interact with other classes of drugs that might be used to treat migraine, such as MAOIs.
MAOIs (monoamine oxidase inhibitors) – These are a type of antidepressant used to treat depression and migraine by altering the chemistry of the brain. Examples include rasagiline (Azilect), selegiline (Eldepryl) and phenelzine (Nardil).
Ergot alkaloids – Ergot is actually a form of fungus that can affect rye and other grains. These were the first successful anti-migraine drugs. The most common drugs in this class is Dihydroergotamine mesylate. The triptans have been derived from this class of drug.
Pain Relieving
These medications offer pain relief once the migraine has progressed to the headache stage. This group of medications includes certain classes of medications, including:
- Analgesics – Analgesics relieve pain. The most common is aspirin, which can be helpful for migraine and other forms of pain provided you are not allergic to it.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) – NSAIDs include Tylenol and ibuprofen. In some studies, Tylenol was shown to be preventive if taken in the early phases of migraine.
- Analgesics containing opium – These are used for more extreme pain and include Tylenol 3 and oxycodone (OxyContin). They need to be taken with care because they can be very addictive. Opiates also tend to cause constipation.
- Antiemetics – These relieve nausea and vomiting. Effective ones for migraine include droperidol (Inapsine) and prochlorperazine (Compro)
- Serotonin antagonists – This class of drugs helps relieve nausea. The most commonly prescribed for migraine are ondansetron and granisetron.
All of these medications require a doctor’s prescription. Take your migraine diary with you to your appointment so your doctor can discuss your best treatment options with you.
One final consideration is to see your doctor for regular check-ups. If your symptoms worsen, schedule an appointment, or go to the emergency room if the pain is very severe. Valproic acid or dihydroergotamine can be administered in the emergency room if the headache lasts more than three days. Any headache that lasts more than 72 hours should be treated as a medical emergency.
Migraine can be one of the most severe and disabling pains anyone can ever experience. Those who have regular migraines want to do all they can to prevent migraines from happening in the first place, or to treat them effectively if they do occur so they can get on with their daily lives. If your migraines are holding you back from work, home life, a social life and your normal activities, we hope you will use this guide to get the relief from migraines that you’ve been looking for.
Resources
Mayo Clinic – Migraine
http://www.mayoclinic.org/diseases-conditions/migraine-headache/basics/definition/con-20026358
Migraine Relief: 15 Natural Ways To Ease The Pain
http://www.huffingtonpost.com/2012/07/12/natural-migraine-relief_n_1666726.html
Feverfew – Information and Interactions
http://www.webmd.com/vitamins-supplements/ingredientmono-933-feverfew.aspx?activeingredientid=933migraineactiveingredientname=feverfew
Butterbur – Information and Interactions
http://www.webmd.com/vitamins-supplements/ingredientmono-649-BUTTERBUR.aspx?activeIngredientId=649&activeIngredientName=BUTTERBUR&source=2
Drug Interactions and Headache
http://www.achenet.org/resources/drug_interactions_in_headache_what_to_watch_for_and_why/
