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The Truth About Migraines

Triggers, Symptoms, and Possible Solutions

Today is Jennifer’s fortieth birthday. The gang has spent a month planning a celebration. At the last minute, you get a text from the guest of honor. Sorry. Can’t go. Migraine

If you’ve never had a migraine, you’re annoyed. Blowing off your own birthday party just because of a headache?

But if you get migraines – and about a quarter of us do, mostly women – you know that Jennifer is spending her big day in bed, in the dark, coping with the pain. Your heart goes out to her. You’ve been there yourself.

Migraines are a complex condition with a wide variety of symptoms. The head pain can be the worst part, so intense that a person can barely function. There also might be changes in vision, emotional upset, and cognitive fog that makes it hard to enjoy even simple tasks.

Migraine headaches are caused by multiple factors that are hard to define. The easiest way to describe what is happening is that people who suffer from migraines have what is considered a sensitive brain. Due to some combination of genetics, hormones, or trauma to the brain, migraine sufferers over-respond to various normal stimuli, such as light and fatigue. This causes the onset of a cascade of inflammatory agents to be released in the brain. In this sense, it’s not so different from a sprained ankle. As migraine sufferers will tell you, this painful, swollen brain can last for hours, even days. Migraines are different from ordinary headaches, which are usually caused by muscular tension and don’t lead to the brain inflammation migraines cause.

Migraines are like bullies. They lurk in the background, leading many sufferers to tiptoe through life, always afraid of when the next one will strike. They often announce themselves with a wide range of unpleasant signs and symptoms, such as emotional upset, frequent yawning, craving for sweets, or even neck pain that can occur up to a day before the head pain begins. Once the full migraine strikes, there’s often little you can do to ease the pain; for most people, ordinary pain medication does little or nothing to help. Any physical activity, even sitting upright, can make it worse. Sound hurts, light is unbearable, nausea and vomiting are common. And a birthday party is not going to be any fun at all.

Up to 30 percent of sufferers also experience what’s called a disorienting aura period shortly before the headache hits. These can be visual disturbances that can include blind spots or distorted colors, sparkling and flashing, tunnel vision, dizziness, or even temporary blindness. These auras are a particular concern as they can increase a person’s risk for stroke.

Headache professionals are knowledgeable about the factors that influence migraines, and we have an ever-growing arsenal of treatments to help reduce the frequency of attacks, or at least decrease the pain associated with them. As one in four people suffer from migraines, this is one of the most common issues doctors treat.

Family history is a strong predictor, and if migraines run in the family, you are more likely to have migraines as well. Migraines can begin at any age, although most people have their first migraine between adolescence and age forty. In childhood, they affect boys more than girls, but after puberty, women are three times more likely than men to have migraines.

Stress is a common trigger for a migraine, but every sufferer has his or her triggers, and most of them are part of everyday life:

Food Aged cheeses, salty foods, and processed foods, particularly those with additives like aspartame or MSG, are known triggers, as is skipping meals.

Drink Alcohol, particularly wine, and heavily caffeinated beverages.

Sensory stimuli Bright lights, glare, loud sounds, irritating noises, or unusual smells.

Sleep Specifically, not getting enough.

Hormones Women are especially prone during or before their periods.

Physical factors Intense physical activity, including sex, can trigger migraines.

Environment As seasons change, migraines often increase.

Medications Oral contraceptives and vasodilators, such as nitroglycerine, can aggravate migraines.

There’s no foolproof way to stop migraine headaches. Partnering with a headache specialist can help you find strategies that will work best for you. After years of living with migraines, people sometimes assume that four disabling headaches a month is just part of life, so migraines often go undiagnosed and untreated. In reality, there is hope, and there are many options out there that can lead to relief.

One of the keys is identifying the triggers that overstimulate your sensitive brain. Avoidance of the stimuli can sometimes keep your brain from overreacting and help you avoid the migraine altogether. Try keeping a record of your attacks, what was going on before onset, and what you’ve done to try to treat them. Your doctor will help you identify your triggers, and may recommend lifestyle changes.

Certain over-the-counter pain relievers, such as ibuprofen, do help some sufferers by reducing inflammation. But if you have frequent migraines and take large doses of ibuprofen, it should be noted that this can cause serious complications. Ibuprofen should be taken sparingly under the direction of your doctor.

Some patients get relief from daily preventative medications that can be anti-depressants, blood-pressure drugs, antiepileptic medications, or even Botox injections. Researchers continue looking, and are having success finding new answers.

The one good thing about migraines – the only good thing – is that they usually go away with no aftereffects other than a feeling of relief.

Meaning, it’s over! As the pain vanishes, Jennifer feels wonderful, and sends another text: Can we still get together? 

Of course we can, you respond. Friends understand.


Catherine Ham, MD, is assistant clinical professor and department of neurology director with VCU Health Headache Clinic in Richmond.
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