Have you ever had a headache that was so severe that light and noise made the pulsating pain on the side of your head feel like a hot stabbing knife for hours on end, and you wanted nothing more than to lie still in a dark and quiet room until the stabbing pain in your head stopped? If this sounds familiar, you’ve experienced a migraine headache.

What is a migraine?

Migraine is one of the most common neurological conditions in the world. Some might refer to these headaches as a “sinus headache” or a “stabbing headache,” but these are often actually migrainous in nature and respond readily to migraine treatment. The formal diagnosis of migraine requires a person to have had at least 5 attacks of moderate-to-severe head pain, usually pulsating on one side of the head and worsened by activity, plus nausea and/or vomiting or light and sound sensitivity, with each attack lasting at least 4 hours. Some people experience an “aura” with their migraine, consisting most commonly as visual changes or tingling of a limb, or perhaps mild confusion. There are many variations in the way migraine manifests, and everyone’s migraine experience is unique.

Up to 1 in 3 people will experience a migraine at some point in their life, with 1 in 8 people having migraines regularly. Women tend to have more migraines than men, but more than 20% of men have a migraine during their lifetime as well. It is not uncommon for migraines to run in families, with many family members suffering migraines from an early age, but migraine can also strike those with no family history.

How is a migraine different from a headache?

There are many types of headaches, and only some of them are migraines. Common headaches (also called “nuisance” headaches) might involve the entire head rather than just one side (as in dehydration headache and hypertensive headache), or might seem to originate in tight muscles in the neck (cervicogenic headache). Some medications may cause a headache as a side effect. Seasonal allergies might give you a headache that can be exacerbated by congestion. In contrast, the hallmark of migraine is the presence of nausea and/or vomiting or light and sound sensitivity in a person who gets headache relief by being in a still, dark, and quiet room.

Can migraines be cured?

Unfortunately, migraines are often a lifelong problem for sufferers, something to be battled over time. The goal of any treatment is relative improvement – improvement from where you were before. Success is often defined as a 50% or better decrease in the frequency and/or severity of migraine headaches, so that going from 10 migraine days per month to 5 migraine days per month is an excellent outcome. It is quite rare to get rid of 100% of migraines – this is not generally a “curable” condition.

How can I treat a migraine?

Although migraines can’t be cured, they can be managed and corralled in a way that the sufferer can resume the activities that make their day-to-day life enjoyable, with fewer migraine days per month, or perhaps less severe or debilitating pain when they do get migraines.

Behavioral changes to help avoid migraine triggers, supplements and over-the-counter medications, and prescription medicines can all help alleviate the pain of a migraine.

How do I know what behaviors trigger a migraine?

The first step to gaining control of your migraines is to get to know how your own migraines behave. Different people experience their migraines in different ways, and sometimes a simple behavioral change can greatly lessen the frequency and severity of migraine attacks.

First, mark the letter “M” (for migraine) on the calendar every day that you have a migraine headache lasting at least 4 hours. When you count them up over a month’s time, the number you get represents your “migraine days per month.” This is a very important number to know, and this is how you track your average migraine frequency over time so you can know whether you are getting better or worse.

Next, pay attention to and make note of factors that might influence your migraine.

Common Migraine Triggers

  • red wine 
  • cured meats
  • strong cheeses
  • lack of sleep
  • artificial sweeteners
  • weather changes
  • stress
  • hormonal changes

Sleep hygiene is important and setting aside time in a purposeful manner for exercise and relaxation if possible is also a valuable intervention for many.

Smoking tobacco is another factor that should be modified–while tobacco is not necessarily a “trigger,” smokers are unlikely to obtain meaningful long-lasting migraine relief so long as they continue to smoke tobacco.

Some migraine triggers are not so easily modified, though. For instance, the amount of stress a person might be feeling is not easily changed, and no one has the power to change the course of a large storm system rolling into the area, which often brings low-pressure migraines along for the ride. This makes it all the more important to identify the easily modifiable triggers in your life.

Once you’ve identified your individual migraine triggers, you can attempt to modify your behavior to avoid them. Making a written list of the triggers and the steps needed to modify your lifestyle to avoid the triggers is the first concrete step a person can take toward gaining the upper hand on their migraines.

Which supplements and over-the-counter medications help with migraines?

Beyond these behavioral changes, treatment options become more supplement- and medication-based. Speak with your primary care provider (PCP) before starting any supplement or medication, as rare interactions can occur with medications you may already be taking.

Daily magnesium and riboflavin (vitamin B2) supplementation has been shown in trials to lessen the frequency and severity of chronic migraines. Non-steroidal anti-inflammatory drugs (NSAIDs) are highly effective for some people, but taking high doses frequently can actually worsen the severity of migraine, a phenomenon known as “medication overuse” or “rebound” headache. Dehydration is another overlooked contributor to migraine, so always drink plenty of fluids, especially on hot days.

When should you talk to your primary care provider (PCP) about your migraines?

If these milder treatment options don’t offer enough benefit, it might be time to speak with your PCP. Many of the first-line as-needed prescription migraine medications such as the “triptan” class of medication can be prescribed by your PCP depending on your other health problems and medications. For more complex or difficult to control migraine cases, a consultation with a neurologist might be needed.

Oral medication options

The last ten years have been an exciting time for migraine neurology, with the development of many new classes of highly effective medications. There are several oral medications that target a pain pathway associated with migraines that can be used as-needed or daily for prevention. The triptan class remains the gold standard for as-needed treatment, while a variety of anti-seizure, anti-depressant and anti-hypertensive medications do wonders for chronic migraine sufferers.

Other migraine-management options

Botox injections into the head and neck every three months is often effective if all else fails. Once-monthly self-injectables and once-quarterly intravenous infusions are newer options as well. There are even electrical stimulation devices that can be worn on the forehead that can help a great deal. For many people, these medications can be life changing in a good way, and for the vast majority at least some improvement in quality of life is noticed.

The take-home message is that if you are a migraineur, you do not have to live your life subject to the whims of your migraine attacks. Instead, you can gain the upper hand through self-observation, behavioral modification and the judicious use of medications.

Talk with a primary care provider first about your migraines. If more advanced treatments are needed, Newport Neurology is here to help.

 Preston W. Douglas, MD

Preston W. Douglas, MD

Dr. Preston Douglas is a board-certified neurologist with Newport Neurology. Dr. Douglas specializes in epilepsy and EEG; neuromuscular disease and electromyogram and nerve conduction studies (EMG/NCS); and stroke and vascular neurology.