Disease Management

Migraine is more than a bad headache

While migraine is a type of headache, it can cause more severe symptoms and different symptoms than an occasional headache brought on by tension or eye strain and can occur more frequently. Migraine is a neurological condition that can be disabling for some of the 10% of women and men around the world who live with this headache disorder, a percentage specialists believe may be too low due to underdiagnosis.

Migraine is divided into two categories: episodic migraine (fewer than 15 headache days a month) and chronic migraine (more than 15 days a month for three or more months). Symptoms can include four phases, although not every person experiences all these phases:

  • Prodrome: Subtle changes a day or so before the onset of a migraine. Symptoms can include tiredness, yawning, mood swings, problems concentrating, and food cravings.
  • Aura: Symptoms of this phase include changes in vision, tingling, numbness, and trouble speaking.
  • Attack: This is the active headache phase. It typically includes throbbing, pulsing pain on one or both sides of your head that lasts hours to three days, nausea, vomiting, and sensitivity to light and noise.
  • Postdrome: Symptoms including fatigue, body aches, dizziness, trouble concentrating, and light sensitivity can occur after the active headache phase ends.

Migraine causes

Physicians and researchers don’t fully understand what causes migraine headaches, but they believe that genetics (migraines tend to run in families) and environmental factors (changes in weather and barometric pressure, bright or flickering light, extreme heat, loud sounds, and strong smells) may play a role in your risk of developing this condition. There are also triggers that can bring on a migraine, including:

  • Hormonal changes in women
  • Alcohol and excess caffeine consumption
  • Stress
  • Sleep problems
  • Intense exertion
  • Medications such as hormonal birth control and vasodilators (medicines that dilate blood vessels to treat high blood pressure and heart failure)
  • Foods and food additives, such as salty foods, processed foods, MSG, and aspartame
  • Skipping meals
  • Smoking
  • Traveling

Who gets migraines

While anyone can experience migraine, the condition is more common in women, with migraine occurring three to four times more often in women than men. You’re more likely to experience migraine headaches if other people in your family have them. Migraines usually begin during adolescence, for people assigned female at birth usually after their first period, and become less frequent in your 30s, although some people continue to have migraines beyond that age.

Treatment options

If you have frequent or severe migraine attacks, working with a neurologist who’s experienced treating migraine can help you build a treatment plan to manage your symptoms and reduce the frequency of your headaches.

Your treatment plan will be affected by a number of factors, including your age, how often you get migraines and how severe your headaches are, and any other health conditions you’re being treated for.

Treatments fall into two groups—preventive and acute. Preventive treatments work to decrease the frequency, length, and severity of migraines. Acute treatments are taken when you have a headache to relieve symptoms and keep symptoms from getting more severe.

Treatment options include:

  • Over-the-counter pain relievers
  • Triptans, prescription medications that block pain pathways in the brain. These medications come in pill, injectable, and nasal spray form.
  • Dihydroergotamine, a nasal spray or injectable ergot alkaloid that’s usually prescribed for people who don’t respond to triptans or pain relievers
  • Gepants, calcitonin gene-related peptide (CGRP) receptor antagonists and monoclonal antibodies that come in injectable or IV, pill, and nasal spray form
  • Botox
  • Ditans, medications that target serotonin receptors on brain nerve endings to stop migraine attacks as they occur
  • Medications that lower blood pressure, including beta blockers and calcium channel blockers
  • Antidepressants
  • Anti-seizure medications
  • Neuromodulation devices, which change the way nerves send information to the brain or adjust how the brain turns on and off pain signals. These devices can be used both preventively and during a migraine attack.

A health advisor or health navigator can connect you with a migraine specialist who can work with you to build a treatment plan tailored to your needs.

 

Susan Walker

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