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Migraines: Getting Help Shouldn’t Be a Headache

Unfortunately, many people overlook migraines as simply “headaches.” Despite the intense, concentrated pain, many sufferers often assume there are no surefire remedies to alleviate their pains and continue to live with the migraines for years. In this article we’ll describe the various remedies for migraine headaches and show how sufferers can get help.

Advanced technology and newly discovered information have just begun to give us the knowledge to understand the debilitating condition migraine sufferers (migraineurs) endure. However, many people still have dangerous and outdated misconceptions about migraines, the most common being the notion that migraines are just bad headaches. Such misconceptions may prevent a migraine sufferer from receiving proper treatment, which will reduce quality of life and possibly lead to stroke, life-threatening dental infections, aneurysms, coma, and/or death.

Migraine, affecting approximately 11 to 18 million Americans (mostly women), is a disease of which headaches are only a symptom. We now know that the tendency toward migraines is a biological and often inherited condition. Migraine sufferers need to understand why they have their headaches, learn how to recognize other symptoms, and identify common triggers of migraine.

The pain of a migraine is associated with a dilation (widening) of the blood vessels in the head, as an end result of the migraine process. When neurotransmitter levels in the brain fall, a switch is tripped that activates the nerves that go to the blood vessels, causing the inflammation and pain of a migraine. Unfortunately, medicines often prescribed to treat a regular headache dilate the blood vessels and can make a migraine worse. Preventive treatments to reduce headache frequency now focus on stabilizing these neurotransmitter levels.

Unlike a headache, migraine disease has many symptoms, including:

• nausea
• vomiting
• auras (light spots in the field of vision)
• sensitivity to light and sound
• numbness and tingling in the lips, face, hands, arms, or legs
• drowsiness
• confusion
• difficulty with speech
• feeling cold or sweaty
• a stiff or tender neck
• nasal congestion and/or severe head pain

Two migraine types exist: common and classic. Common migraines begin without any warning and typically start more slowly and last longer than classic migraines. Classic migraines start with a warning sign (aura), which often involves changes in visual perception such as the sight of flashing lights and colors or temporary loss of some of your vision. After the aura, head pain usually follows. A single migraine attack can last for hours, several days, or even weeks. There is no known cure for migraine disease, but there is advice on what triggers should be avoided, as well as treatments for the symptoms when these triggers are unavoidable.

The “triggers” that cause migraines vary from person to person, but those common amongst sufferers include changes in weather or altitude, bright sunlight, glare, fluorescent lights, strong odors, being tired or stressed, missing meals, sleep pattern changes, menstrual cycles, and certain foods (see Table I).

Keeping a headache diary may help identify these triggers. With each migraine, write down any food or drink, change in sleeping pattern, your mood and emotions, the weather, any physical activities performed, or other changes to your daily routine that occur before the migraine. A pattern may appear after several headaches. Look back through the diary and see if any triggers appear throughout that can be avoided. Recognition of these symptoms is very important on behalf of patients and their physicians, as they are key factors in the diagnosis of this condition for which no medical diagnostic tests exist. Your doctor can also utilize your diary to help pinpoint triggers and identify the best approach for treatment. For ways to manage your migraines before an appropriate treatment regimen has been prescribed by a healthcare professional, see Table II.

If recognizing these triggers and attempting to avoid those that are controllable is unsuccessful at impeding migraine attacks, medications may be prescribed to prevent attacks in persons who experience them twice or more per month (migraines may occur only once per year or as often as daily). Many drugs, including Elavil, Inderal, Depakote, and Topamax, have been shown to prevent migraines in clinical trials. In general, these medications act over time to prevent blood vessel swelling; however, they do not treat the migraine-associated symptoms.
Mild or even moderate headaches can be treated by inexpensive analgesics, such as aspirin, acetaminophen, ibuprofen, or naproxen sodium, or by compounds of these analgesics, such as those containing caffeine, acetaminophen, and aspirin. Severe headaches seldom respond to such medications. Relief from these generally requires the use of a class of medication known as triptans, other more potent drugs, or even prescription opioids (narcotic medications).

When more potent drugs are needed to alleviate migraines, triptans (such as Amerge, Axert, Frova, Imitrex, Maxalt, Relpaz, and Zomig) are usually preferable. These are not painkillers, but work by shutting off the pain at the point where the nerve connects to the blood vessel. They are very specific for migraines, and must be used with caution because of potential side effects; they are generally not recommended for persons at risk for coronary artery disease or with uncontrolled high blood pressure or high cholesterol.

Another migraine drug, dihydroergotamine (DHE) works well as an injection; it is also available in a much less effective nasal spray version, but is not available in pill form. Cafergot, which is available as a pill, sublingual tablet (a tablet you hold under your tongue until it dissolves), or suppository, is generally less effective and produces more adverse side effects than the triptans.

As a last resort, those with migraine can turn to general pain management, which is likely to include the use of narcotic analgesics (opioids). Though effective, narcotic analgesics are to be taken with caution, as they may be addictive and lead to worse problems than the effects of migraines.

Migraine sufferers will for the most part want to avoid over-the-counter (OTC) pain medications, which, in general, do not work for migraine. Though some drugs can help relieve the nausea and vomiting, and others may ease head pain, overuse of OTC drugs can cause rebound headaches—which occur as a dose wears off, leading patients to take even more medication—and a downward spiral in a migraineur’s condition. That is not to say all OTC drugs should be avoided. In fact, the FDA approved Excedrin Migraine in 1998 specifically for migraines. Yet even with the availability of this remedy, patients should think twice if they are considering self-treating their pain solely with OTC drugs in the hopes of avoiding seeing their doctor. It is important that professional advice is given and that the possibility of a more serious condition be ruled out.

Now that you know your options, it’s important to find a doctor who is experienced in treating migraine, preferably one who is a migraine specialist. A migraineur can call neurologists’ offices in his or her area and ask if that doctor is a migraine specialist or can recommend another close by who is. Another option is to call your state medical board and ask for neurologists in your area who specialize in migraine.

Once you have selected a doctor, he or she should conduct a physical and neurological exam. This is a good time to find out about the doctor’s previous experience with migraineurs and his or her thoughts on what causes migraines. Patients should be wary of doctors who say there are no differences between tension headache and migraine and the treatment of both. If the doctor prescribes a drug for your migraines, he or she should inform you that many medications for migraines exist and that if the one you were prescribed doesn’t work, you should come back and explore other options. Questions to ask your doctor about the medication prescribed to you are listed in Table III.

You will want to actively participate in your care, as doing so can mean the difference between successful treatment and failure. You may be asked to keep a diary to identify migraine triggers in your environment, track the effectiveness of medications you’ve been prescribed for your migraines, and monitor benefits of lifestyle changes and treatment. The more you understand about your own condition, the greater chance of success. Scheduling regular follow-up visits to discuss your progress (or lack thereof) leads to the most effective migraine care.

The key to battling your migraines is to recognize the symptoms listed above (don’t dismiss them as merely the signs of a bad headache), avoid the triggers that are likely causing them, and seek the help of a healthcare professional for further advice or, if necessary, prescription medication therapy.

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