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What You Need to Know About Migraines

A female patient touching her temples to indicate the location of her pain to the doctor she's speaking with.

Is that pain in your head a headache or a migraine? If you’ve ever had a migraine, you are painfully aware of the difference.

Nearly 40 million Americans experience migraines, a statistic that means someone is living with migraine in one out every four households in the United States. Sirisha Sanamandra, MD, a neurologist at Yale New Haven Hospital and assistant professor of Clinical Neurology at Yale School of Medicine, explains how a migraine differs from a headache.

Who is most likely to get migraine? Are there specific risk factors that make people predisposed to getting them?

There is a significant genetic component to migraine. Many people who are diagnosed with migraine have a family history of them. However, other risk factors do play an important role in progressing to chronic migraine, which is when you have a headache on more than 15 days a month. Some of the modifiable risk factors include anxiety, depression, obesity, sleep apnea/snoring, excessive consumption of painkillers and caffeine. 

Both men and women get migraines, but women are three times more likely to have migraine headaches than men. The incidence of migraines is also higher in young people between the ages of 18 - 44. 

What differentiates a migraine from a headache? What are the symptoms?  
The symptoms of migraine can vary from person to person. Migraine pain is characterized by throbbing head pain, usually localized to one side of the head. You may also experience sensitivity to light, sound, nausea and sometimes dizziness, sensitivity to touch and odors. It may last up to two or three days and often prevents you from performing daily activities. 

In a small number of patients, neurological deficits such as difficulties with speech, vertigo, vision loss or weakness may be associated with headaches. Some people with migraine experience what is known as an “aura,” where they see light flashes, spots in the vision, shimmering lights or zigzag lines. 

Are there triggers for migraine? How can I figure out what my triggers may be?
Your physician will talk to you about starting a headache diary, which can help identify triggers. Some people may already be aware of certain triggers such as changes in weather pressure, alcohol and specific foods. I usually recommend avoiding artificial sweeteners and anything that contains monosodium glutamate (MSG), a flavor enhancer often added to restaurant foods, canned vegetables, soups, deli meats and other food items. 

Caffeine and caffeinated drinks, especially when consumed in excess, may also trigger headaches. Other triggers may include hormonal changes, variations in the sleep schedule, strong sensory stimuli (such as bright lights, strong perfumes, cleaning agents, smoke), exercising in hot environments or overexercising when out of shape. While stress is often considered a migraine trigger, many find that the release of stress is an even bigger trigger than the stress itself – which can lead to what are called “let-down migraines.”  

What are some treatments for migraine?
Patients who experience migraine headaches often benefit from modifying certain behaviors. For example: Do not skip meals; stay well hydrated; and keep a regular schedule on weekdays and weekends, if possible. Also keep tabs on your caffeine intake and how many caffeinated drinks you consume. Relaxation techniques can help, as does avoiding any behavior or situations that may trigger an attack. 

Migraine can be effectively managed with medications on an appropriate treatment regimen that is recommended by your healthcare provider. Medications are generally classified as preventive and abortive. 

Preventive medications are taken daily or monthly to prevent headaches from happening. Some of the classical treatments include beta blockers, calcium channel blockers, antidepressants or antiepileptics. For migraines that are difficult to treat in patients who experience more than 15 headache days per month, Botox is often recommended.

Abortive medications are taken as needed to treat the symptoms after a migraine begins. These medications may range from regular over-the-counter ibuprofen or Tylenol with or without caffeine to triptans and more recently another category of medication called “gepants” and “ditans.” 

When should I seek medical attention or talk to a doctor?
If your headaches are frequent and they are disrupting your life, have a conversation with your physician. There are so many therapeutic possibilities, and they can be individualized for each patient. You can get relief from migraines.

Seek immediate medical attention if your headaches have appeared suddenly, and if you also experience changes in vision and hearing, fever, weight loss, an altered mental status or any neurological deficits. That can be a sign of a more serious condition.