Published on April 13, 2018

Suffer from migraines? You’re not aloneSuffer from migraines? You’re not alone

If you suffer from migraine headaches, you are not alone. Approximately 26 million people in the United States have migraines, according to Karen Lynch, MD, a neurologist at Cape Cod Hospital.

“They are so common and so widespread that one in four households will have an adult who has migraines,” she said. And most sufferers are women between the ages of 30 and 60.

“Migraine headaches are a biological disorder just like asthma, diabetes or hypertension” she said.

Migraines begin when the nerve cells in the brain react to triggers or stimuli. When that happens, it causes a cascade of events. Inflammatory substances are released into the blood vessels and tissues of the brain and activates pain, explained Dr. Lynch.

Once the neurons get stimulated by a trigger and then activated, patients may experience mood changes, yawning, fatigue, and visual changes, such as wavy lines and tingling in the face.

“The headache is usually the second component of a migraine,” said Dr. Lynch.

A migraine can last an hour, a day or longer and once it stops, symptoms of feeling tired, overall malaise or confusion can occur.

How do you know if you have headaches or migraines?

Here are symptoms that differentiate a headache from a migraine, according to the U.S. Department of Health and Human Services’ Office on Women’s Health.Migraine Headache

What Can You Do?

There are steps you can take to help you and your physician assess the intensity, frequency, type, duration and triggers of migraines.

One tool is a migraine journal that patients can either write in or download onto their computer or cell phone to keep a record. The National Headache Foundation’s journal includes date, time, intensity of the headache (scale 1-10), preceding symptoms, triggers, medication and relief from treatment.

While some people may not have any triggers that cause the migraine, many will have one or two on the list, according to Dr. Lynch.

Some triggers are:

  • Sleep deprivation
  • Certain foods, such as chocolate
  • Artificial sweeteners
  • Lights
  • Scents
  • Changes in weather, especially with low pressure systems
  • High caffeine intake or lack of caffeine
  • Alcohol
  • Hormones, changes in estrogen levels in women
  • Allergies
  • Stress

“Over time, patients start to know what their trigger is and avoid it when possible,” said Dr. Lynch.

In addition to the journal, a good medical history will provide information to help your physician diagnose you with migraines, the type, triggers and treatment.

“We don’t generally need to do brain imaging because people who have true migraines shouldn’t have any structural abnormalities in the brain per se to cause it. In established migraines, unless there has been a significant change in headache pattern or severity, brain imaging is not warranted. There are ‘red flags’ in symptoms and signs associated with certain headaches that suggest a more sinister cause for a headache disorder which your physician will ascertain by history and examination,” said Dr. Lynch. There are also no laboratory tests that help with diagnosis.

Treatment Options Vary

“If it’s an episodic migraine, intermittently every month when there is a trigger, then it’s a matter of trying to manage it when it happens,” said Dr. Lynch. There are many over-the-counter medications that work very well, such as Excedrin Migraine or Tylenol.

“Patients generally come to see me when these medications haven’t worked or headaches become more problematic,” she said.

Dr. Lynch will start an abortive regimen to prevent the condition from worsening using a migraine-specific prescription medication. The migraine sufferer can take it up to three times a week when a migraine starts. She usually prescribes Sumatriptan, the most common medication to stop a migraine. It can be injected, inhaled, sprayed into the nose or dissolved under the tongue.

Patients who need to take an abortive medication more than three times a week are often started on a daily medication, which helps reduce the potential for a migraine. These medications are varied and range from those used to treat high blood pressure, to seizures, and mood stabilizers.

For those who have chronic migraines, which is a lingering moderate headache most of the time, or more than 16 headache days per month, Dr. Lynch recommends Botox© treatments. These have proven to be very successful in reducing the number of migraines per month and the severity of them, she explained.

Other treatment options on a case-by-case basis for women with hormonally-driven or menstrual-related migraines may include low-dose combined contraceptive pills. Other treatments for migraine headaches, including alternative herbal preparations, can also be quite effective and include magnesium supplementation, feverfew and butterbur.