What Are Migraine Headaches?
Over 38 million people are affected by migraine headaches in the U.S. alone. Besides the human cost of pain and suffering, migraines cost more than $20 billion in direct expenses annually, which includes medical bills, and indirect expenses, such as missed workdays.
Migraines are extremely painful and can be accompanied by aural (visual) symptoms that can be alarming. They are considered the most severe form of headaches, and occur with the enlargement of blood vessels, releasing pain-causing chemicals.
What causes Migraine Headaches?
Some researchers believe that migraines are the result of a chemical imbalance caused by the way the trigeminal nerve interacts with the brainstem, but that is just one theory. Although the exact cause of migraines is still being researched, it is understood to be a combination of genetics and environment.
A pain management chemical in the body, called serotonin, can trigger a migraine if it is too low by letting too much blood flow through vessels that should be constricted—causing a throbbing sensation.
The exact cause of migraines isn’t fully understood, but there are many factors that can induce a migraine.
They vary by person, however, some of the known migraine triggers include:
- Stress
- Bright lights
- Caffeine
- Alcohol
- Hunger or dehydration
- Food additives
- Odors
- Skipped meals
- Loud noise
- Sudden changes in weather
- Female hormones
- Some medications
- Overexertion
- Not enough sleep or jet lag
- Certain foods (e.g., fermented or pickled foods, or those with nitrates)
Misuse of medication can lead to increased migraine attacks and chronic migraine symptoms.
What are the ‘phases’ and symptoms of Migraine Headaches?
There are four phases of migraine headache, each with their own symptoms.
Prodrome
This phase can occur a few hours or days before the migraine, during which migraine sufferers may notice subtle changes warning of an upcoming attack include:
- Irritability
- Depression
- Food cravings
- Difficulty concentrating
- Sensitivity to light
- Constipation
- Mood changes, from depression to euphoria
- Neck stiffness
- Increased urination
- Fluid retention
- Frequent yawning
They may also feel tired but have difficulty sleeping.
Aura
An “aura,” or sensory warning, sometimes precedes a migraine attack. An aura can include visual disturbances, such as flashes of light or blind spots, or other disturbances, such as tingling on one side of the face or in an arm or leg and difficulty speaking.
These visual disturbances can last from five minutes to an hour.
Headache
The headache itself can last from four hours to up to three days if left untreated. How often migraines occur varies from person to person. They may occur rarely or several times a month. Pain is often described as sharp as an icepick and may be accompanied by a burning sensation.
During this phase, some also experience:
- Nausea and vomiting
- Pain usually on one side of the head, but oftentimes on both sides
- Pain that throbs or pulses
- Anxiety
- Depression
- Extreme sensitivity to light and sound, and sometimes smell and touch
Postdrome
As the pain subsides, patients may experience a variety of postdromal symptoms that include depression, fatigue, and euphoria. They may have an inability to concentrate and feel confused.
Not every migraine sufferer will have the exact same symptoms every time a migraine hits, but most will be able to recognize their own personal warning signs.
What are my treatment options for Migraine Headaches?
Getting a proper diagnosis is key to successful treatment of migraines.
For a proper diagnosis, be sure to document the:
- Details of your headaches
- Possible causes and triggers
- What migraine treatment you attempted (i.e., medication, herbal remedies, dark room, etc.)
- The effects of that treatment
Another diagnostic tool is a physical or neurological exam. The neurological exam, which may include imaging, is used to rule out any other causes of your headaches. You may also have blood tests for the same reason.
Migraine treatment varies depending on the patient and symptoms. Identifying triggers helps in determining environments to avoid. By avoiding too much stress, exercising regularly, and eating properly, you can help reduce the chance of migraines and reduce the need for more complicated treatment options.
For example, those who experience migraines when exposed to bright, flickering, or pulsating lights may be instructed to wear sunglasses in the sun and consciously avoid staring into artificial lights. Other common preventive lifestyle changes include avoiding certain odors, foods and beverages or adjusting sleeping conditions. Using these proactive strategies can help eliminate migraines or reduce their frequency. There are also medications that may prevent the reoccurrence of migraines.
Once migraines hit, the focus shifts to pain and symptom management.
Using anti-nausea medications and pain relievers can help in treating specific symptoms to reduce your discomfort. Once you are in the headache phase, rest in a dark room, drink plenty of fluids, and use ice packs or cool washcloths on your forehead to help. There are also newer treatments involving Botox injections and other forms of pain management.
