Understanding and Alleviating Migraines

You don’t have to — and shouldn’t — suffer through it



Just about everybody gets a headache now and then, but migraines can feel like a world apart from what we think of as garden-variety, everyday headaches. At their worst, they bring nausea and vomiting, obscured vision and pulsating pain, leaving their victim unable to do much other than wait it out.

But the effects of migraines can span hours or even days, and with more than 37 million Americans experiencing migraine headaches, that’s a lot of time devoted to misery. Migraines can occur in anyone at any age, but are three times more common in women than men.

What causes migraines is not fully understood, but they stem from an inherited neurological disorder that causes the central nervous system to be hypersensitive, says Karen P. Lauze, MD, a neurologist with a subspecialty in headache and facial pain at Portsmouth Regional Hospital. “It’s a biological abnormality that you’re born with,” Lauze says. Many migraine sufferers have a family member who has a history of migraines.

What it feels like

Migraine symptoms vary, but often progress through phases, beginning with what are called “prodrome” warning signs that can signal an approaching migraine up to one or two days before the headache pain hits. Prodrome symptoms include irritability, excessive yawning, fluid retention, constipation and nasal congestion, Lauze says. And, “some people actually feel euphoric a day or so or hours before a migraine,” Lauze says.

In some individuals prodrome symptoms are followed by a visual aura, during which flashing lights or jagged lines appear and partially obscure their vision, or they experience other neurological symptoms, such as numbness or tingling in their hand or difficulty putting words together. Auras usually last for 10 to 60 minutes and precede headache pain, but some people have auras without ever feeling pain.

In fact, despite the common assumption that migraines bring searing head pain that prompts sufferers to seek refuge in a dark, quiet room, migraine pain can be moderate or even mild, so much so that some people don’t realize that they’re having a migraine, believing instead that they’re feeling the effects of a less-intense tension headache, Lauze says.

In other cases, though, migraine pain is “incapacitating,” says Andreja Packard, MD, PhD, a neurologist and neurophysiologist at Foundation Neurology and Southern New Hampshire Medical Center in Nashua. Typically, migraines cause throbbing pain on one side of the head. The pain can last for hours, and be accompanied by nausea and vomiting. In addition, migraines often induce sensitivity to light and sound, Packard says.

"Migraines can occur in anyone at any age, but are three times more common in women than men."

Unlike tension headaches, which can be alleviated by exercise, migraine-associated pain typically is aggravated by activity, even low-key movement, such as standing, walking and bending over, Lauze says.

After the headache pain subsides, some people experience “postdrome” symptoms, as remnants of headache effects linger. Some individuals “feel hung over for a few hours,” Lauze says, “or the following day, they feel a little achy, a little run down.”

Feeling better

Doctors commonly prescribe medication to treat migraine headaches, but patients who have frequent migraines might find themselves going under the needle— the Botox needle — as a preventive measure.

Botox injections, well known for their cosmetic application in smoothing wrinkles, can decrease the frequency and severity of migraines by about 50 percent, Packard says. “We inject it in the muscles that are involved in the spread of neck pain and head pain within the migraine,” she says. Small-gauge needles loaded with Botox are used to target seven areas of the face and neck, Packard says, amounting to about 30-plus injections. Botox prevents strenuous tightening of the muscles, relaxing them along with the surrounding area. The injections typically need to be re-administered every three months to maintain effectiveness.

Migraine sufferers can also benefit from changing personal behaviors that make migraines more likely to occur. Keeping a headache diary, for example, helps people identify and avoid headache triggers. Noting the timing of headaches leads many people to find that changes in their biological rhythm set off migraines, Lauze says. You might find that not eating regularly, eating certain foods, drinking red wine, sleeping in or not getting enough sleep, or smelling particular odors precipitates migraines. Or you might notice that you’ve been stricken with migraines while on vacation, which by definition disrupts routine, and might involve altitude changes —another known migraine trigger, Lauze says.

Doctors have found that, ideally, a mix of therapeutic approaches will be in a migraine patient’s anti-migraine toolbox. “You need to have a combination of treatments,” Packard says. In addition to receiving medicine for the headache pain and recognizing and avoiding triggers, people who experience migraines should try stress relievers like yoga, relaxation training and massages, and if needed, they should see a psychologist to help them handle stress and anxiety, she says. Behavioral therapies such as biofeedback, in which electronic monitoring is used to enhance control over bodily functions, have also proven beneficial to migraine sufferers.

But don’t try to just ignore or live with migraines. Otherwise, they might occur more frequently since being in a migraine state can become the default mode for the brain, or more commonly, frequent self-treatment with over-the-counter medicine can spur withdrawal headaches, also known as rebound headaches, on the days that you try to go without the medication, Lauze says. Left untreated, migraines can become increasingly frequent until “you’re having them almost every day, and that can just basically ruin your life and make you chronically debilitated,” Lauze says.

And trying to live with discomfort can have meaningful health consequences, particularly in people who experience pain on a regular basis. Chronic pain shortens life expectancy and increases the chance of developing many long-term disorders, Packard says, “so treatment of any chronic pain issue is wise.” 

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