Migraine is the third most common disease worldwide. Migraine affects 38 million Americans, 85 percent of whom are women. Migraine pain can occur from a couple days each month to daily and can greatly interfere with day-to-day activities. Unfortunately, at least half of all migraine sufferers are never diagnosed, and the majority never seek treatment for their pain.
The purpose of Migraine and Headache Awareness Month (#MHAM) is to bring attention to this neurobiological disorder, to encourage headache and migraine sufferers to seek treatment, and to apprise sufferers of the new treatments that are available.
Migraine Symptoms
Migraines are characterized by a throbbing pain in the head. They may first appear in childhood and tend to run in families, but they can be environmentally caused as well. The pain associated with migraine typically affects one side of the head, although one-third of sufferers experience pain all over the head. Pain can be accompanied by nausea, dizziness, sensitivity to light and sound, and aura (flashes of light, blind spots, tingling in the face or extremities, and vision changes). Attacks last between four and 72 hours.
Most migraine sufferers resort to self-treatment in the form of over-the-counter (OTC) pain relievers, only seeing a physician when symptoms become more severe. A neurologist should be consulted if symptoms change, are disabling, or do not respond to OTC medications.
What Is Migraine?
Migraine is a neurological disorder involving nerve pathways and brain chemicals. Whereas older theories regarding migraine suggested pain was due to fluctuations in blood flow to the brain, new theories point to chemical compounds and hormones as the causes of pain. It is now believed that migraine pain occurs when waves of activity in certain groups of excitable brain cells trigger chemicals and hormones, like serotonin and estrogen, to narrow blood vessels throughout the body. Shifts in serotonin levels can affect both men and women, while estrogen, as a female hormone, only affects women.
Estrogen levels vary over a woman’s lifetime and even over the month in fertile women, which may explain why more women than men suffer from migraines. In fact, severe headaches that occur during premenstrual syndrome (PMS) in some women are attributed to drops in estrogen levels and actually are migraines. As well, “sinus headaches,” whose common symptoms include extreme facial pain and pressure without nasal discharge, are now considered a form of migraine.
Migraine Patterns and Triggers
People who suffer from migraine often notice signs that an attack is coming on. These triggers can include: 
- Stress
- Biological and environmental conditions (hormonal shifts or exposure to certain smells)
- Fatigue and a change in sleep patterns
- Glaring or flickering lights
- Weather changes
- Certain foods or drinks
- Dehydration
There are four stages of a migraine, although not everyone experiences all of them. They are:
- Prodrome—From a few hours to a day or two prior to migraine, people may experience constipation, mood changes, food cravings, depression, problems concentrating, a stiff neck, increased thirst and urination, fatigue, and frequent yawning.
- Aura—From an hour before to during migraines, people may have visual disturbances and temporary vision loss, and experience numbness and tingling in the face or arm and leg or on one side of the body.
- Attack—Between the typical four to 72 hours most migraines last, people may experience a throbbing or drilling pain in the head, insomnia, nausea and vomiting, depression, anxiety, and a sensitivity to light, sound, and smell.
- Postdrome—After a migraine, people may feel drained of energy, depressed, confused, and fatigued.
Diagnosing Migraine
Since there is no actual test to diagnose migraine, keeping a headache diary can help pinpoint triggers. A headache diary simply is a log of when headaches occur and the environmental factors accompanying them. It should be brought to a doctor’s appointment to help the physician discern a patient’s migraine patterns.
At an appointment, the doctor will ask for the following information:
- What the headaches are like, how often they occur, how severe the pain is, and what symptoms accompany them
- How the headaches are interfering with everyday activities
- Whether there is a family history of headaches and/or migraines
The doctor may suggest a CT (computed tomography) or MRI (magnetic resonance imaging) scan, but these tests can only rule out other reasons for pain and not diagnose migraine.
Relieving Migraine Pain
Fast action can help prevent migraine from increasing in intensity. At the first sign of migraine, retreating to a dark, quiet room, trying a hot or cold compress over the head or neck, and drinking a caffeinated beverage may ease symptoms.
If these simple remedies do not work, seek pain relievers. There is a variety of drugs that treat migraines. Individuals should consult with their doctor as to what is safe and most effective for their type of migraine and their health profile.
Migraine medications include:
- NSAID pain relievers: Typically containing ibuprofen, naproxen, or aspirin, these pain relievers are for milder headaches but can help migraine pain if taken immediately.
- Triptans: Drugs such as sumatriptan (Imitrex) and rizatriptan (Maxalt) are prescription medications that block pain pathways in the brain. They typically come in pill form but may be administered by nasal spray or injection. They may not be safe for people who are at risk for stroke or heart attack.
- Dihydroergotamines (Migranal): This type of drug comes in nasal spray and injectable forms and is most effective when taken shortly after a migraine starts in people whose pain lasts longer than 24 hours. Dihydroergotamines are not recommended for people with heart disease, hypertension, or kidney and liver disease.
- Lasmiditan (Reyvow): This drug can help with pain as well as nausea and sensitivity to light and sound. Lasmiditan can cause sleepiness and dizziness.
- Galcanezumab (Emgality), erenumab (Aimovig), and fremanezumab (Ajovy): These drugs target calcitonin gene-related peptide (CGRP), a molecule that is produced in nerve cells of the brain and spinal cord. They work by blocking certain proteins from attaching to the sensory nerve endings that cause pain. They are administered by subcutaneous injection by way of a prefilled pen or syringe. Skin irritation at the injection site may result, and syringes need to be refrigerated.
- Ubrogepant (Ubrelvy): This new drug is a CGRP receptor antagonist that comes in pill form and, therefore, can be taken anywhere. Side effects are slight and include nausea and sleepiness.
- Opioid medications: Some opioid medications with codeine can help with pain for patients who cannot tolerate other drugs. These drugs are highly addictive and are a last resort.
- Anti-nausea drugs: These medications can help people who experience aura that is accompanied by nausea and vomiting. These do not take away pain but are used in conjunction with pain relievers.
- Antidepressants, anticonvulsants, and beta blockers: Antidepressants, which regulate serotonin levels; anticonvulsants, drugs that prevent seizures; and beta blockers, drugs typically used to manage blood pressure, are other medications sometimes used to prevent migraines from occurring.
Alternative Remedies
Some patients seek other forms of relief, including the following:
- Acupuncture—piercing specific areas of the body to slow pain transmission
- Botox injections—U.S. Food and Drug Administration–approved for people with 15 or more headaches a month, Botox is a form of botulinum toxin that has been purified and injected into nerve endings to block the release of pain-causing chemicals
- Magnesium—a mineral that helps reduce stress and migraine frequency
- Butterbur and feverfew—plant extracts
- Essential oils—lavender, peppermint oil, rosemary, chamomile, and eucalyptus may aid in relaxation
Sleeping well by establishing regular sleep and wake patterns, unwinding at the end of the day, staying away from food and drink that can trigger migraines (such as cheese, chocolate, and alcohol), getting regular exercise, and managing stress can all help keep migraines at bay.
As with any pain, seek medical attention when headaches can no longer be controlled.
Sources: American Migraine Foundation, https://headaches.org/2020/05/19/national-migraine-and-headache-awareness-month-2020/, https://americanmigrainefoundation.org/resource-library/botox-for-migraine/, https://americanmigrainefoundation.org/resource-library/understanding-migraineacupuncture-and-migraine-finding-a-combination-that-sticks/, https://americanmigrainefoundation.org/resource-library/sinus-headaches/; https://americanmigrainefoundation.org/resource-library/understanding-migraine-catpreventive-treatmentsmythbusters-migraine-remedies/, https://americanmigrainefoundation.org/resource-library/timeline-migraine-attack/; Johns Hopkins Medicine, How a Migraine Happens, https://www.hopkinsmedicine.org/health/conditions-and-diseases/headache/how-a-migraine-happens; Migraine Research Foundation, https://migraineresearchfoundation.org/about-migraine/what-is-migraine/; The Migraine Trust, https://www.migrainetrust.org/living-with-migraine/seeking-medical-advice/diagnosis/; National Headache Foundation, Menstrual Migraine, https://headaches.org/2007/10/25/menstrual-migraine/; Personalized Cause, National Migraine and Headache Awareness Month, https://www.personalizedcause.com/health-awareness-cause-calendar/migraine-awareness-month
Graphics: www.americanmigrainefoundation.org; www.headaches.org
