If you've ever had a migraine, you know the feeling of wanting to put a drill to your head to somehow rid yourself of the pain, pressure, and throbbing. Migraines destroy your day, forcing you to seek a dark, quiet room for hours on end.
Unfortunately, this is a relatively common problem: Nearly 11 percent of men report experiencing migraines or other severe headaches, according to research published in the journal Headache. And there might be many more out there.
“Migraine is undertreated and underdiagnosed in the United States, including in men,” says Sait Ashina, M.D., assistant professor of neurology and anesthesia at Harvard Medical School, and a director of the Comprehensive Headache Center at Beth Israel Deaconess Medical Center. “That means that a lot of people walk around without actually having an actual diagnosis and getting the right treatment for their headaches.”
On average, men with migraines start experiencing headaches at age 24, according to research published in the journal Cephalalgia. “It usually affects men in their 20s, 30s, and 40s when we have our active lives—and during our most productive years,” Dr. Ashina says.
While there's no cure for migraines, there are ways to treat them. But to treat them, you have to understand what causes them. Here's our guide on how to alleviate the hell that is migraines.
What are migraines?
A migraine can be best described as a headache on steroids.
“Most of the time, it's a moderate to severe headache,” Dr. Ashina says. “It is usually one side that is really throbbing or pulsating.”
Migraines are worsened by physical activity, strong emotions, light, sound, and even odors. You may also experience nausea or vomiting, dizziness, or a feeling of brain fog or trouble focusing, Dr. Ashina says.
About a third of migraine sufferers also experience auras, says Dr. Ashina.
“These are visual, or sensory, or speech disturbances occurring anywhere from five minutes to 60 minutes before the onset of the headache,” he says. “And usually, these headaches associated with auras are very bad to severe and much more disabling.”
What causes migraines?
There’s no simple answer.
“Migraine is a very complex neurological disorder or neurological disease, and it has multiple etiologies or causes,” Dr. Ashina says.
While we're not entirely sure what causes migraines, according to the American Migraine Foundation, if one of your parents gets migraines, you are 50 to 75 percent more likely to get them as well.
Apart from genetics, migraines are often caused by environmental factors, hormonal fluctuations, and lifestyle factors. In a recent study published in Cephalalgia, men reported stress, bright lights, and sleep deprivation as their most common migraine triggers. Stress, hunger, dehydration, and even certain foods can bring on the pain for some guys, Dr. Ashina says.
How to get rid of migraines
As of now, there is no cure for migraines—but there are many strategies to reduce their frequency and severity.
“They can get under control, and people can have their normal lives back when they're treated efficiently for their migraines,” says Dr. Ashina.
Here are a few ways to prevent and treat them:
1. Know (and avoid) your migraine triggers. When Dr. Ashina sees a migraine patient for the first time, they always discuss the patient’s migraine triggers, which can vary from person to person. Some triggers might be obvious, like if you get a headache every time you’re tired. Other times, they’re more subtle.
“One of the best ways of identifying triggers is keeping a headache diary,” Dr. Ashina says. Whether you use a pen and paper or a headache app, log what you were doing and how you were feeling before the headache started. Discuss the results with your doctor and see what patterns you can identify. The more triggers you can avoid, the better you might feel.
2. Keep your tank full. Dehydration is a common but easily preventable migraine trigger, Dr. Ashina says. Men need to drink about a gallon of water per day, which sounds like a lot but is achievable if you drink steadily throughout the day.
”What I recommend to my patients is make sure you have bottles, especially when you're on a road trip,” he says. He also keeps two or three water bottles on his desk every day. Since hunger is another common trigger, keep small snacks like protein bars with you, too.
3. Minimize stress. Stress can set off migraines, so you need to find calming strategies that soothe you. Mindfulness meditation, acupuncture, and exercises like yoga and Pilates are often effective, says Dr. Ashina. “Or simply close your eyes and do some deep breathing exercises at work,” he says. “It will help.”
4. Get a prescription for medications. If you haven’t talked to a doctor about your migraines in the last four years, you’re in for a surprise: Your doctor has a larger arsenal of prescription drugs to recommend than ever, which could lead to some serious relief for you.
Migraine medications are divided into two different categories: abortive and preventative. You take abortive medications when your migraine begins so that you can stop it in its tracks, ideally within 15 to 20 minutes. One of the most commonly prescribed are called triptans, which work by stimulating serotonin in the brain that constricts blood vessels and reduces inflammation to reduce pain.
There are a few options when it comes to preventative medications. Older drugs for this purpose include beta blockers, typically used to decrease blood pressure, and anti-seizure drugs, including divalproex sodium (Depakote), sodium valproate (Depacon), and topiramate (Topamax).
Since 2018, new drugs that target a molecule called calcitonin gene-related peptide (CGRP), which is elevated in patients who have migraines, have been approved by the FDA. Injectable monoclonal antibodies that target CGRP for migraine prevention include erenumab (Aimovig®), fremanezumab (Ajovy®), galcanezumab-gnlm (Emgality®), and eptinezumab (Vyepti®). Oral medications that block CGRP for both migraine prevention and relief include ubrogepant (Ubrelvy®), rimegepant sulfate (Nurtec ODT®), and atogepant (Qulipta®).
Getting an Rx for a migraine drug might be better in the long run than toughing it out with over-the-counter pain relievers like ibuprofen. One reason is that overuse of OTC pain meds on 10 or more days per month has been associated with a phenomenon called rebound headaches where your head pain can paradoxically worsen over time.
“It’s very important to establish the relationship with the healthcare provider early on because, at some point, migraine can progress and become more chronic and severe,” Dr. Ashina says. “And in order to prevent that, in order to have more effective treatments, it's better to do it early on.”
5. Cut back on processed foods. Your junk food habit might be making your migraines worse. “Processed foods can have a lot of ingredients that can actually trigger migraines,” says Dr. Ashina. “That's why we emphasize a healthy diet as much as possible in our patients.”
For example, hot dogs and other processed meats are thought to trigger headaches because they contain nitrite preservatives, which might increase blood flow in a way that makes your head pound. And certain components in chocolate might have similar effects. Fruits and vegetables for the win!
6. Watch your drinking. Compounds in red wine have been shown to exacerbates headaches and congeners—a byproduct in fermented and distilled alcohols like wine, beer, and whiskey—have it, too. Clear liquor like vodka, on the other hand, may not have the same effects—although too much of any alcohol can leave you with a pounding headache.
7. Get Botox. It's not just for wrinkles: Since the FDA approved its use for migraines in 2010, Botox has become a popular migraine treatment. While this treatment is reserved for people with chronic migraines (defined as 15 days a month or more with migraine symptoms), those who received only two treatments reported a 50% decrease in symptoms. “A lot of patients get a great amount of pain relief from this treatment, and it's also very well tolerated,” Dr. Ashina says. It works by injecting the botulinum toxin into nerve endings that makes its way to the brain and blocks chemicals sending pain signals. Each treatment typically involves 31 injections throughout your head and neck.
8. Invest in your sleep habits. A night of bad sleep can trigger a migraine. And over time, sleep disorders like sleep apnea, where you spend part of the night gasping for air, can make your migraines more severe, says Dr. Ashina. “If you have sleep problems, address them, and speak to a doctor,” he says.
9. Consider a dietary supplement. Migraine sufferers who took vitamin D supplements reduced their headaches by two to three days per month, according to a study review published in the American Journal of Emergency Medicine. Vitamin D might help by suppressing neuro-inflammation or even reducing CGRP. Studies have also suggested that riboflavin and magnesium might also help to ease the pain, and emerging research points to coenzyme Q10 and zinc as potentially helpful supplements. Talk to your doctor before starting any new supplements, of course.
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