Everything to Know About Preventing and Treating Migraines

·8 min read
Photo credit: Hiroshi Watanabe
Photo credit: Hiroshi Watanabe

Table of Contents

Causes & Triggers
| Symptoms | Types | Treatments

What is a migraine?

You probably know that migraines are a kind of headache—but they have a few characteristics that set them apart. The throbbing pain from a migraine hits on just one side of the head and lasts for several hours to days, says Melody Merati, D.O., assistant professor in the Department of Neurology at NYU Langone’s Grossman School of Medicine. “They’re also associated with nausea and/or vomiting or sensitivity to light or sound,” she says.

What’s more, not everyone who’s experiencing a migraine realizes that they’re having one. “It’s very common for people to think that a migraine is a tension, sinus, or allergy headache. A lot of people are either undiagnosed or misdiagnosed,” says Bradley Katz, M.D., a neuro-ophthalmologist at the University of Utah’s Moran Eye Center who specializes in treating migraine-related light sensitivity.

Migraines affect roughly 1 in 6 people in the United States, and those who are at higher risk include women, those in their 30s and 40s, and those with a family history. Migraines can be episodic (you get them sporadically) or chronic (you get them 15 or more days a month for more than three months).

Wade Cooper D.O., director of the University of Michigan’s Headache and Neuropathic Pain Clinic in Ann Arbor, thinks of a migraine as a neurologic reflex. “During a migraine, the lining of the brain gets an inflammatory signal that irritates the pain nerves, and those send the signal deep into the brain. Then the brain activates a cascade of hypersensitivity to lights, sounds, and smells,” he says. “Anything that irritates the nervous system can activate that reflex.”

The following info can help you figure out what might be going on in your head. “The sooner you find out if you are having migraines, the sooner and better they can be treated before their frequency increases,” says Santiago Mazuera Mejia M.D., a neurologist at the Sandra and Malcolm Berman Brain & Spine Institute at LifeBridge Health in Baltimore, Maryland.

What causes migraines?

It’s not fully understood what, exactly, causes a migraine, though researchers believe some people are likely more vulnerable to migraines due to genetics. Scientists are also aware of many common triggers that can set off migraines in people who are already susceptible to them. Migraine triggers can include:

  • Consuming certain foods/beverages/additives (like aged cheeses, alcohol, smoked meats, caffeine, aspartame, MSG)

  • Stress

  • Certain kinds of light

  • Certain smells (like perfumes)

  • Weather changes, including bright sunlight, extreme heat or cold, high humidity, very dry air, windy or stormy weather, or changes in barometric pressure

  • Skipping meals or becoming dehydrated

  • Hormonal changes (like in women who get migraines just before or during a menstrual cycle)

  • An infection

  • Getting too little or too much sleep

Some health conditions are also linked to migraines

Many conditions are associated with migraines, including depression, anxiety, fibromyalgia, childhood trauma/abuse, opioid abuse, celiac disease, and irritable bowel syndrome. It’s not clear whether one condition might cause the other—all researchers know is that they are linked (the medical term is “co-morbidity”). In short, if you have one condition, you are more likely to have the other.

People with a history of migraines with aura are also at a slightly higher higher risk of having a stroke or heart attack, research shows. So if you get migraines with visual disturbances, it’s especially important to keep an eye on your cardiovascular health, eat a healthy diet, and exercise regularly.


What are the signs of a migraine?

A migraine often causes severe, throbbing pain in one side of the head that lasts anywhere from roughly four to 72 hours. What distinguishes it from other headaches is that the pain is usually accompanied by vomiting or nausea and extreme sensitivity to lights and sounds. This constellation of symptoms can make it hard to function. In other words, if you find yourself having to leave work early or bail on a fun happy hour that you’d been looking forward to, you’re probably dealing with a migraine.

Migraine vs. headache

Many people don’t realize their intense headaches are actually migraines. In fact, recent research shows 90% of self-diagnosed sinus headaches are actually migraines. Here’s how the different types of headaches typically strike.

The phases of a migraine

There are two phases that may come before a migraine headache, and one that may come after. You may not experience all of these phases each time you have a migraine:

Prodrome

This can hit up to 48 hours before the headache starts. It can include thirstiness, frequent yawning, food cravings, mood changes, or constipation.

Aura

About a quarter of migraine sufferers experience something called an aura immediately before or during the headache, which is usually a visual disturbance that features light flashes, blinds spots, and/or tingling throughout the body.

Post-drome

After the headache dissipates, some people feel drained, confused, or dizzy (kind of like a hangover).


What are the types of migraines?

Up until this point, we’ve focused on classic migraines, but some people who struggle with migraines experience one of these more unusual types. Understanding the type of migraines you’ve been having can help your doctor treat you more effectively, and also give you greater insight into your migraine triggers (so you can be sure to avoid them).

Ocular (or retinal) migraine

You’ll experience roughly 60 minutes of visual disturbances (think: flashes of light, wavy lines, blind spots) in one eye.

Hemiplegic migraine

Expect temporary motor weakness (like one-sided, whole-body paralysis), though this is more common in infants and children.

Migraine with brainstem aura (formerly called basilar migraine)

Signs can include slurred speech, ringing in the ears, gait imbalance, vertigo, double vision, and a lower level of consciousness.

Menstrual migraine

Up to 25% of women who experience migraines get menstrual migraines, which occur just before or during a woman’s menstrual cycle. Menstrual migraines can have classic migraine symptoms or have symptoms associated with other migraine types, like vestibular or ocular migraines.

Abdominal migraine

Most common in children and adolescents, abdominal migraines usually result in severe nausea/vomiting and possible abdominal pain.

Vestibular migraine

You’ll notice extreme sensitivity to motion and dizziness.


How are migraines treated?

If you’ve ever had a migraine, then you probably understand why preventing them from happening in the first place is just as important as stopping symptoms after they’ve already started. That’s why migraine treatment generally falls into two categories: preventive (stopping headaches before they start) and acute/abortive (stopping headaches as soon as they occur). Each type of treatment is critical in different ways.

PREVENTIVE

Lifestyle changes

Many patients begin by making lifestyle changes, since those are free and don’t require a doctor’s prescription. These lifestyle changes fall into the realm of “basic things your parents always told you to do” like get enough sleep, manage your stress, don’t skip meals, and stay hydrated. They may sound obvious, but with a busy schedule, they’re often easier said than done.

Medications

A primary care physician or neurologist can prescribe a preventative medication to help ward off migraines. In fact, the FDA approved the drug atogepant (QULIPTA) in September 2021, which has been shown to reduce migraine frequency by at least 50% for most patients. So patients now have more options than ever.

“Prophylactic medications used for prevention of chronic migraine can decrease the frequency of migraines, which ultimately leads to more pain-free days and better quality of life,” says Merati.

Other non-drug remedies

There are also non-pharmacologic options such as physical therapy, massage, acupuncture, seeing a chiropractor, Botox injections, tinted glasses, biofeedback, or wearing a headband-like device that uses electrodes (this is called transcutaneous supraorbital nerve stimulation or t-SNS). Medical cannabis may also be helpful, suggests a May 2022 review of 12 studies.

Nutritional supplements

Your doctor may discuss taking certain nutritional supplements such as magnesium, coQ10, or vitamin B2 or B12. Herbs like curcumin, citron, coriander, menthol, and chamomile might also be effective, research suggests, though experts say more studies are needed. (Some online sources tout butterbur as a remedy too, but it hasn’t been shown to be helpful and there are concerns about its safety.)

ACUTE/ABORTIVE

Over-the-counter medications

Some are basic pain relievers (like aspirin, ibuprofen, naproxen, and acetaminophen) and others are combos (Excedrin Migraine, for instance, is a mix of acetaminophen, aspirin, and caffeine). Pro tip: Any pills that come in a liquid-gel form work faster, which is beneficial when treating a migraine.

Prescription drugs

A primary care physician or neurologist can prescribe various drugs that can help in the moment.

Isolating and hydrating

Retreating to a dark, quiet room, drinking water, and then trying to sleep.

When should I call a doctor about my migraines?

If you’re not getting adequate relief from over-the-counter medications and lifestyle changes, or if you’re taking over-the-counter medications more than 10 to 15 times per month, talk to your primary care physician about your headaches. They will either treat you or refer you to a specialist, such as a neurologist. Taking over-the-counter medications too frequently can sometimes lead to serious side effects (like liver problems) and/or actually make you get headaches more often.

It’s helpful to keep a diary if you experience migraines because you may discover your triggers, which can inform which type of treatment is best for you. Write down what time your migraines occur, how long they last, how you slept the night before, what you ate/drank that day and when, how you felt emotionally that day, etc. Then bring that information to your doctor.

Don’t assume that migraine pain is something you have to live with—there are many treatment options that may help you find significant relief.

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