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When it comes to headaches, migraines are among the most notorious. They can be truly disabling, driving the victim to take refuge from light and sound and causing nausea, as well as intense pain. Visual disturbances also may precede or accompany these severe headaches.

Women are more likely to suffer from migraines than men, and the headaches may coincide with menstruation, stress, poor sleep, hunger, weather or altitude changes, perfumes and chemical exposure, tobacco use, physical exertion and coughing. Certain foods also can trigger migraines, most notably chocolate, cheese, alcohol, citrus and food additives such as nitrates, aspartate and monosodium glutamate (MSG).

“Migraine treatment is individualized by identifying the responsible triggers,” says Dr. Patti Nemeth, a neurologist at the Brain and Spine Center at St. Luke’s Hospital. “Non-pharmacological strategies, or those that do not involve drugs, include behavior modifications, such as getting regular sleep, using relaxation and stress management techniques, and avoiding alcohol, tobacco and other specific triggers.”

In fact, a recent study published in the journal Headache suggests that behavioral treatments, such as relaxation training, can be a cost-effective alternative to preventive medications for some individuals.

In any case, identifying individual migraine triggers, if possible, is useful for developing an effective preventive and treatment strategy. Physicians often recommend that patients keep a log of the circumstances surrounding the onset of a migraine, including time of day, activity, diet, hormonal shifts, etc.

Scientists have not identified a specific biological mechanism that can be pinned as the cause of a migraine. Studies indicate that there is a genetic predisposition among some people and that the headaches are related to abnormal nerve responses to certain stimuli. “We believe migraines are mediated by neural pathways in the brain stem,” says Dr. Cheryl Faber, a neurologist with Neurology Associates.

Migraine medications are divided into two categories. “Preventive drugs are taken on a regular schedule, and so-called ‘abortive’ drugs are taken at the onset of the headache,” Nemeth says. Physicians select the most appropriate medication based on the patient’s medical history and health conditions.

In late 2010, the FDA approved Botox as a preventive migraine treatment. Indicated for chronic migraines, Botox is injected at specific sites on the head and neck. The treatment lasts about three months.

“This is an effective way to prevent migraines for some people who have them multiple times per month,” Faber says. “And for those who do have frequent migraines, prevention is a better strategy than treating each headache as it happens.”

Individuals who have only occasional migraines may find that abortive medications are adequate. “The newest class of abortive migraine medications is triptans,” Nemeth says. “They are exceptionally effective in treating migraines and readily restoring normal function.”

The bottom line is that migraines don’t have to be endured. Don’t let migraines cramp your style. See your doctor to learn more about the best options to keep you migraine-free.