There are headaches—and then there are headaches. Migraines are in a category all their own. About 12 percent of Americans suffer from these pounding headaches, according to the National Institutes of Health. A type of vascular headache, migraines are notable for their severity and unique characteristics that some people experience, such as visual disturbances, stomach upset and a notably one-sided quality.
“Unfortunately, we don’t have a laboratory test or imaging technique that diagnoses migraine headaches,” says Dr. Siddharth Kaul, a headache specialist with SSM DePaul Neurosciences Institute. “Migraine headaches are diagnosed by careful and detailed personal history of the disease, its course and associated symptoms. This can take up to an hour during the initial consultation in clinic and involves a verbal interview, detailed questionnaires and personal account of the life impact that the headaches have.” Because there are more than 100 types of headaches, additional testing sometimes is needed to rule out other diagnoses.
Family history is important to the diagnostic process because migraines do tend to run in families, and women are more likely to develop migraines. However, some migraines seem to strike randomly, and physicians urge patients to think about behavioral or dietary patterns that may uncover specific headache triggers.
“Stress is the most common migraine trigger,” says Dr. Jo Bonner, a neurologist with Mercy Clinic Headache. “Other common triggers include weather changes, irregular sleep patterns and dehydration. For many migraine sufferers, specific foods are triggers, especially alcohol. For women, menses is a trigger in more than 50 percent of cases.” If specific triggers are identified, the information can help individuals avoid migraine onset. Keeping a detailed headache diary is useful in discovering individual triggers.
Fortunately, there are treatments to help prevent and manage migraines. The type of treatment varies by individual depending on overall health and symptoms. For instance, migraine with stroke-like aura (a sensation of seeing lights at the onset of the headache) restricts use of certain medications, while migraines without aura are treated in a different way, Kaul notes. “The most effective headache management is usually a combination of acute and long-term preventive therapies.”
Good sleep, hygiene, a balanced diet that avoids specific food triggers, proper hydration, minimal use of caffeine and regular exercise can all help prevent migraines for many people. A variety of medications are available to control pain and nausea.
“Preventive medications are needed if the migraine frequency is high or if the migraines are not manageable with acute mediation,” Bonner says. “The preventive medications include several anti-seizure medications, antidepressants, beta-blockers and many others. There is also evidence that some herbal therapies such as feverfew and butterbur are effective, as well as magnesium, riboflavin (vitamin B2) and coQ10.”
Bonner adds that for chronic migraine (consistently greater than 15 headache days per month), Botox injections often are recommended. “Preventive medications are chosen based on other conditions the patient may have, such as a mood disorder or hypertension. Alternative therapies such as physical therapy, biofeedback, relaxation training or acupuncture may be recommended.”
Although migraines are serious, Bonner urges patients to “learn about migraines and own them.”
Don’t suffer in silence if you are one of the millions who experience the debilitating effects of migraines. Talk to your primary-care physician and start controlling the pain instead of letting it control you.