Migraine Headaches

Migraine is a very common headache disorder.  It affects approximately 18% of women and 6% of men in the United States.  Though migraine is most prevalent between the ages of 25 and 55, it affects all age groups, including children. While it is commonly believed that migraine is a one-sided headache, many migraine sufferers have pain on both sides of their head.  The pain of migraine is usually throbbing or pulsating, and can last for hours to days.  Associated features include nausea, vomiting, and sensitivity to light and sound.   When attacks occur, people are unable to function, and will often lie down in a dark room until the pain recedes.  Some people have migraines several times a week, while others get them only several times throughout their lives.
About 15% of migraine sufferers have “aura” before the start of the headache. Auras usually last 20-30 minutes and typically precede the headache, although they can occasionally occur during the headache.  Most auras are visual in nature and include bright flashing lights that move across the visual field (known as scintillating scotomata), zig-zagged lines, wavy images, and even loss of vision.   Auras can be non-visual as well, and may involve weakness or numbness on one side of the body, speech or language abnormalities, and dizziness.
The neurological mechanisms that cause migraine are very complex.  We now know that abnormalities in the “trigeminovascular system” are the underlying cause of migraine headaches.  The trigeminal nerve is a large nerve that has many connections to the coverings of the brain and well as blood vessels.  In people that are prone to migraine, the trigeminal nerve becomes stimulated when certain triggers are encountered.  This leads to inflammation and the release of substances that are associated with the pain of migraine.
People who are prone to migraines can have attacks triggered by various food, environmental, and situational factors.  Potential triggers include chocolate, alcohol, aged cheese, weather changes, perfumes or other strong odors, and flickering lights.  Irregular eating and sleeping patterns often lead to headaches.  Stressful situations and “post-stress letdown” are well-known migraine triggers too.  Many women report that their migraines are triggered by the onset of menses.  Different people are sensitive to different things, and in an individual person, some triggers may be inconsistent.
Treatment of migraine includes the use of supplements, medications, and lifestyle modifications.   First, your doctor will ask you to keep a headache diary, in which your headache days and possible triggers are recorded.  This is done to see if your headaches follow a particular pattern.  You will also be advised to eat and exercise at regular intervals and improve your sleep hygiene.
If you have migraines less frequently than 3 or 4 times a month, then acute treatment may be sufficient.  This generally involves the use of migraine-specific drugs such as the triptans (Imitrex, Zomig, Axert, Amerge, Frova, Relpax or Maxalt) or ergotamines.  These medications are taken at the onset of severe headache, as symptomatic treatment.  All these medications are available in oral form, and some are also available as a nasal spray or injection.  If nausea is a significant component of your headaches, an anti-nausea agent may be used as well.  Anti-inflammatory drugs such as naproxen play a role in the acute treatment of migraine too.  When choosing an acute medication, your doctor will take into account the severity of your attacks, how quickly they reach their peak, and the presence of other features such as nausea and vomiting.
Daily preventative medication may need to be added to your acute therapy if you are having migraines more frequently than 3 or 4 times a month, or if your headaches are interfering with your work and personal life.  These include natural supplements, such as magnesium, riboflavin, CoQ10 and alpha lipoic acid, that have been shown to decrease the severity and frequency of migraine headaches.  Some people require prescription preventative medication.  These drugs include blood pressure medications, anti-seizure drugs, and antidepressants that have been shown to be effective in preventing migraine headaches.   Botox is also used as effective headache treatment.  Injections are given in several spots, including the forehead, temples, and neck, and the benefit generally lasts for three months.  These headache treatments are not necessarily long-term.  Depending on your response to treatment, the medications may be weaned off over time.
Though no one can predict what will happen with your headache pattern, migraines do tend to become less severe with age.  The goal of treatment is to reduce the frequency and intensity of your headaches, and improve your quality of life.