Weather is a common trigger of migraine headaches. Review of studies linking weather to migraines suggests that there are three weather-related triggers. It is high humidity, high temperature, and drop in barometric pressure. Some migraine sufferers, just like many people with arthritis, can predict rainy weather. We can speculate that the drop in barometric pressure causes blood vessels inside the skull to dilate and trigger a migraine. This happens because of faulty regulation of blood vessels in those with migraine. This is also probably the reason why migraines are sometimes caused by exercise or sexual activity – blood vessels dilate excessively and trigger a migraine. High altitude headache or mountain sickness is another example of headaches caused by low barometric pressure. In fact, one study showed that people living at high altitudes, specifically in Denver, are more likely to have mgraines than those living at sea level. Treatment of barometric pressure headaches involves the usual approaches to migraines – regular exercise, biofeedback, magnesium, CoQ10, Botox, and drugs. Diamox (acetazolamide) is a diuretic drug that is particularly effective for mountain sickness and in some patients can also prevent weather-related headaches.
It is not clear why high humidity causes headaches, but high temperature may lead to a) dehydration, which is a trigger of migraines for many and b) again, dilatation of blood vessels which the body uses to cool itself by bringing more warm blood to the surface (this is why we look red in the heat).
There is an easy way to figure out if your headaches are triggered by weather – download our free app into your iPhone or iPad. Headache Relief Diary (also known as Migralex Diary) automatically downloads barometric pressure, humidity and temperature at the time of your headache. Just enter your zip code once and enter your headache information every time you get one and after a month or two you may be able to find your migraine triggers, including those related to the weather.

Headache is one of the most common complaints reported by patients suffering from AIDS, according to a new study by researchers from the University of Alabama. They evaluated 200 patients with HIV/AIDS and discovered that 107 or 54% of them had headaches. Only 4 of these patients had a serious underlying cause, while 88, or 44% had migraines and the rest had tension-type headaches. This is a much higher incidence of migraines than in the general population, where only 12% have migraines. The severity of HIV (CD4 cell count) correlated with the headache severity, frequency, and disability. The findings of this study suggest the importance of diagnosing and treating migraines in this population which already has reduced quality of life and which migraines make even worse.

Smoking by the mother during pregnancy increases the risk that the child will suffer from headaches. Brazilian researchers published results of their study in the journal Cephalalgia. They collected information on over 1,600 children aged 10 – 11 years and discovered that children of mothers who smoked 10 or more cigarettes a day were more likely to suffer from tension or migraine headaches. Surprisingly, exposure to second-hand smoke was not associated with an increased risk of headaches in children.

Depression is more likely to occur in people with migraines, but migraines are also more likely to develop in those who suffer from depression first. A new Canadian study reexamined this link in 15,254 people. They confirmed this association, but unlike in previous studies the researchers from Calgary discovered that this bi-directional relationship is symmetrical. That is, if you have migraines you are 80% more likely to develop a major depressive episode, but if suffer from depression first, you are only 40% more likely to develop migraines. They found that childhood trauma and stress may be a contributing factor to both conditions. The authors of the study discuss the fact that common genetic abnormalities may also predispose people to both conditions.

Genetic analysis of 594 members of 134 families by Spanish researchers confirmed the results of a previous study that discovered a genetic abnormality on the sixth chromosome that seems to be associated with migraines. This genetic marker is present only in a small proportion of migraine sufferers, but it is very likely that there are several or many other genetic abnormalities that predispose to migraine. In patients with familial hemiplegic migraine very specific genes have been identified, but even in this rare form of migraine different families had different genes that were abnormal. This wide variety of genetic factors will make it difficult to develop genetic therapies for migraine, when such therapies become available (probably 10 or more years from now). However, people who have genetic abnormalities are only predisposed to having migraines, but not necessarily will have them. This predisposition makes it more likely that the person will develop migraines, however, avoiding triggers and improving general health may prevent or at least reduce the frequency and the severity of attacks.

Women who suffer from both episodic and chronic migraines are more likely to have widespread chronic pain, which is often diagnosed as fibromyalgia. Brazilian researchers evaluated 179 women with episodic and chronic migraine. They discovered that the more frequent were their migraine attacks, the more likely they were to have widespread chronic pain. A likely explanation of this association is the phenomenon of allodynia. Allodynia is an increased sensitivity of the skin during and after a migraine attack, which affects many migraine sufferers. Patients often report not being able to brush their hair or wear glasses because the skin becomes very sensitive. This skin sensitivity can spread from the face and scalp to involve the upper body. It is logical to assume that with frequent migraine attacks this sensitivity spreads and can involve the entire body. This sensitivity is is a reflection of increased excitability of brain cells, which has been documented to be present in migraine sufferers. If migraines are frequent and are left untreated, this increased excitability can become persistent and may predispose to other chronic pain conditions. The obvious important lesson of this study is that migraine headaches need to be treated aggressively in order to avoid the development of additional pain syndromes and impaired quality of life. This treatment should utilize all available approaches – abortive drugs such as triptans (as well as Migralex and NSAIDs), and prophylactic therapies, including aerobic exercise, biofeedback, magnesium, CoQ10, Botox injections and prophylactic drugs.

Cyclic vomiting in childhood is often a precursor of migraines in adulthood. Usually a child has attacks of vomiting with or without a headache that can occur 10 – 20 times in a 24-hour period. Most children have family history of migraines and as they get older they develop migraines themselves. A study from the Cleveland Clinic led by Dr. David Rothner (a regular speaker at our annual headache symposium) shows that one third of these children may actually have a metabolic disorder and not just migraine. Most children feel perfectly fine between these episodes of vomiting. If these attacks are frequent Dr. Rothner recommends amitriptyline (Elavil), cyproheptadine (Periactin), and ondansetron (Zofran) to treat this condition. Some of the metabolic disorders could be possibly treated with supplements such as CoQ10, riboflavin (vitamin B2), as well as magnesium.

High blood pressure is not a common cause of chronic headaches. The pressure has to suddenly increase (from say 100/70 to 150/90) or to be very high (like 170/110, or higher) to cause a headache. Mild hypertension is called a silent killer because it does not cause headaches or any other symptoms for many years. Doctors have been debating for a long time what to consider normal blood pressure. A study by University of California researchers just published in Neurology looked at 12 previous studies that involved over half a million people. They determined that what was considered normal blood pressure in the past (130-139 systolic and 85 to 89 diastolic, sometimes called “prehypertension”) in fact is associated with a significant increase in the risk of strokes. This has a practical application in people suffering from migraine headaches. One of the three categories of drugs used for preventive treatment of migraines is drugs used to treat high blood pressure. So, someone with blood pressure is 130/85 may want to request that the doctor prescribes a blood pressure medication rather than a drug from two other categories – epilepsy drugs (Topamax, Depakote, Neurontin) or antidepressants (Elavil, Pamelor, Effexor, Cymbalta, etc). Fortunately, in most cases blood pressure medications tend to have fewer side effects than drugs in the other two categories. Some of the blood pressure medications that have been shown to be effective for the prevention of migraines are beta blockers, such as propanolol (Inderal), timolol (Blocadren), atenolol (Tenormin), nebivolol (Bystolic), and ACE receptor blockers (ARBs), such as candesartan (Atacand) although other ARBs, such as olmesartan (Benicar) may be also effective. Not all blood pressure drugs are equally effective for the prevention of migraine headaches. Calcium channel blockers, such as verapamil (Calan) and amlodipine (Norvasc) and diuretics are probably less effective.

Having migraines with aura increases the risk of having increased total cholesterol and triglycerides. This was found to be the case in a population-based study of 1,155 older people (average age 69) presented by Dr. Tobias Kurth at the International Headache Congress in Berlin. Although only 23 had migraines with aura the statistical data seems strong enough to warrant this conclusion. Having migraine with aura carried a six-fold increase in the risk of having abnormal levels of lipids. It is an established fact that people suffering from migraine with aura are at slightly higher risk of strokes and heart disease but the reason for this association is not known. It is possible that elevated cholesterol and triglycerides in those with migraine with aura lead to cholesterol deposits and clogging of the arteries. It is important to screen all older patients with migraine with aura for abnormal lipid levels. They also need to exercise and try to control other risk factors for strokes and coronary artery disease, such as high blood pressure, high blood glucose, obesity, and smoking.

Difficulty thinking and speaking is not unusual at the onset of a migraine attack. It is not always severe as with the reporter Serene Branson who jumbled words and appeared confused on camera. Many patients report that they have difficulty finding words, remembering well known facts, or unable to say what they want to say. This often happens at the beginning of a migraine attack, according to a study presented at the last scientific meeting of the American Headache Society. The doctors tested attention, processing speed, visual-motor reaction, and other brain functions and found that many patients had significantly lower scores at the onset of a migraine than between attacks. They also found that there was no correlation with the severity of pain – you can have severe cognitive dysfunction with a mild headache. Similarly, many patients get a very severe headache after a visual aura but others get a mild headache or no headache at all. There are no acute treatments that would stop an aura or the cognitive brain dysfunction once it starts. However, preventive treatments can be very effective. We always start with elimination of triggers, aerobic exercise, biofeedback, magnesium (sometimes intravenously) and CoQ10 supplements, and then Botox and preventive drugs. Some patients find that after the first Botox treatment they no longer develop a headache, but may still get an aura or have some other warning symptoms, including cognitive dysfunction. However, with repeated injections of Botox both headaches and other symptoms subside. This probably happens because with fewer headaches the brain becomes less irritable and stops generating auras and other neurological symptoms.

Abdominal migraine was the subject of a study by a group of doctors from a children’s hospital in Norfolk, VA was just published in the journal Headache. The physicians examined the records of 600 children with recurrent abdominal pain. They found that 4% of these children had definite and 11% had probable abdominal migraine. Shockingly, they also discovered that none of these children received correct diagnosis. Making a correct diagnosis is the first step to the correct treatment of this condition. Abdominal migraine is defined as a recurring condition which consists of abdominal pain, typically lasting one to 72 hours. The pain is usually in the middle of the abdomen or the child cannot localize it precisely. The pain is dull and aching and is of moderate or severe intensity. During the bout of pain the child usually has two other of the following features: loss of appetite, nausea, vomiting, or paleness. It is also very important for the doctors to make sure that there is no other possible cause for these attacks. Treatment usually involves avoiding foods which may trigger these attacks, including chocolate, caffeine, hot dogs, cheese and other known migraine-inducing foods. Irregular sleep schedule, skipping meals and stress are also frequent triggers. Regular sleep schedule, frequent exercise, biofeedback or relaxation training can all help. Magnesium and CoQ10 supplements have also been shown to help prevent migraines in kids. Migraine medications, such as sumatriptan (Imitrex) can be tried for severe attacks. When abdominal migraine occurs frequently preventive drugs, such as amitriptyline (Elavil), gabapentine (Neurontin), or cyproheptadine (Periactin). Considering its safety and efficacy in regular migraine, acupuncture may also be worth a try.

Dissection of the cervical artery is a dangerous condition which can lead to a stroke and even death, although in some it can be a benign condition with no lasting effects. A recently published study by Germain researchers in the journal Cephalalgia indicates that this condition is two times more common in people with migraine headaches. Dissection means that the wall of the artery is split and this can close off blood flow in the artery. In most people closing off of an artery is not a problem because there are 4 arteries in the neck that carry blood to the brain. However, in some one artery carries a large portion of the blood and the remaining 3 arteries cannot compensate, leading to a stroke. The dissection usually causes severe neck pain and if blood flow is compromised it also leads to neurological symptoms, such as a droopy eyelid, weakness or numbness on one side, difficulty speaking and other symptoms of a stroke. Neck pain is often the earliest and in benign cases the only symptom. Because migraine sufferers frequently have neck pains, this complaint can be dismissed by doctors as a symptom of their migraine. So, if someone’s neck pain is very severe and different from their usual neck pains it is very important to seek medical attention and insist on an evaluation. The diagnosis is made my an MRA (magnetic resonance angiography) scan. This increased risk of dissection is another reason why migraine sufferers particularly should avoid chiropractic adjustments, which can result in dissection even in non-migraineurs.