If you don’t suffer from migraines, you likely know someone who does. The prevalence of migraine headaches is high, with attacks occurring in 17 percent of women and 6 percent of men each year. Many people with recurrent headaches actually have migraine without realizing it. Migraines are often very debilitating and adversely affect the quality of life of those that suffer from them. Despite this, there are many things that can be done to help treat migraines.
There are primarily two types of migraines. Migraine without aura is the most common type, representing 80 percent of migraine cases. It consists of a throbbing or pulsating headache, typically on one side but occasionally on both sides. The pain may be centered on one’s forehead, eye or temple but may also include a larger area. Nausea with or without vomiting may accompany both types of migraines.
Migraines may last as long as 72 hours, but frequency and response to treatment vary significantly from person to person. A migraine with aura usually refers to a migraine preceded by an “aura.” An aura typically consists of visual changes like seeing zigzag lines or flashing lights approximately 30 minutes before the headache starts but sometimes may include sensory symptoms such as tingling in one of the extremities. Someone suffering from a migraine will usually be sensitive to light and sounds and will find it more comforting to be in a dark, quiet room until the migraine resolves.
Migraine headaches are often confused with “sinus headaches” due to the similarity in pain patterns. True sinus headaches occur in conjunction with sinus infections, fever, and colored nasal discharge. Absence of these features should bring one to consider migraine as the cause of a headache associated with sinus pressure or pain. As many as 80 percent of people who attribute recurrent headaches to sinus problems actually have migraines.
The best way for doctors to diagnose migraines is by symptoms and the person’s description of the headache. CAT scans or an MRI of the head may occasionally be done to look for other causes of headaches but do not aid in diagnosing migraines.
Many migraines can be treated with over-the-counter medications. Anti-inflammatory medications such as ibuprofen or naproxen, when taken early enough, are often helpful. Some people may find that aspirin or acetaminophen work best for them. Caffeine is available in combination with some of these medications and often helps to alleviate symptoms more quickly. Some migraines will not entirely go away with pain relievers alone and may require migraine-specific prescription medications such as triptans. You may contact your doctor to discuss whether these are the best fit for you if over-the counter medications aren’t working. Triptans typically should not be used in older adults or people with vascular disease, high blood pressure, or liver or kidney disease.
Prevention is the key to treatment for those who suffer from frequent migraines. It is helpful to keep headache diaries in order to aid in identifying particular triggers. Some of the more common triggers include stress, hormonal changes in women, birth control pills, physical exertion, too much or too little sleep, weather changes, and certain foods or beverages, particularly alcohol. Once identified, avoidance of particular triggers is important to help decrease migraine frequency.
If avoidance of triggers still does not keep migraine frequency to a minimum, numerous prescription and alternative treatments have been clinically shown to reduce migraine frequency. Prescription medications that help to treat high blood pressure, depression and specific neurologic disorders have also been found to be helpful in decreasing migraine frequency.
Several good alternative treatments also exist. Some that have the best evidence behind them include vitamin B-2 and the herbs butterbur and feverfew. Migrelief and Migravent are two common supplements that combine these remedies and are available on the Internet. Some people swear by magnesium for their migraines, but studies demonstrating its efficacy have shown mixed results. A small trial showed CoQ10, a supplement often used for its cardiovascular benefits, to be helpful at reducing frequency. Acupuncture has also been shown to be more effective than placebo in treating migraines.
Neurologists often recommend trying to keep a regular daily routine in order to keep headaches controlled. They also suggest at least 30 minutes of aerobic exercise three times a week to help decrease the frequency and severity of migraines.
Most importantly, the vast majority of migraine sufferers can achieve good prevention control if they work closely with their physician.
Dr. Doreen Telisak is a partner in New West Physicians’ Evergreen office.