Learn More About Migraines
Here are some commonly asked questions about migraines.
How Do I Know if I Have Migraine Headaches?
There are many classic symptoms of migraine headaches, but a visit to a neurologist is necessary to diagnose migraines. Some people have a warning (aura) before the migraine develops, consisting of blurred vision, bright spots, eye pain, and/or tunnel vision. Migraine headaches are typically one-sided with throbbing or pulsating pain that worsens as it develops. Migraines can also be associated with nausea or vomiting, trouble concentrating, sensitivity to light (photophobia) or sound (phonophobia), and increased urination. A neurologist will ask you many questions and perform a full physical exam to determine if you have true migraine headaches. Other tests may be ordered to help diagnose your condition.
Why Do I Have Migraine Headaches?
You have probably wondered why you have migraine headaches. Migraines may run in your family or may be triggered by a number of different factors. Migraine triggers may include alcohol, stress, anxiety, specific odors, loud noises or bright lights, exercise, hunger, and smoking. Withdrawal of caffeine, changes in sleep patterns, and changes in hormone levels (such as a normal menstrual cycle, birth control pills, or pregnancy) can also trigger migraines. Certain foods are classic migraine triggers, including monosodium glutamate (MSG), aspartame (NutraSweet) or other artificial sweeteners, red wine, aged cheese, onions, chocolate, dairy products, pickled or fermented foods, and meat containing nitrates (bacon, hot dogs, cured meat). It is important for you to keep a migraine diary so that you may try to identify your specific migraine triggers – when, where, and why they occur.
The true underlying cause of migraines is unknown, but there are several events that are linked to the development of migraines. When specific nerves in the head and neck area become irritated, usually by surrounding muscles, the body releases chemicals that cause blood vessels to spasm. These chemicals then cause further irritation of the nerves and blood vessels, resulting in inflammation and dilation (enlargement) of the blood vessels, which causes pain.
How Can I Stop My Migraine Headaches?
First, start keeping a migraine diary with details about when, where and why you develop migraines. Pay special attention to details of your day, the weather, your hormone cycle, stressful events, foods you have eaten, etc. You will likely see a trend in your migraine triggers over several months. Some people find relief of migraines using regular exercise, massage, cold therapy, reflexology, biofeedback, or acupuncture.
Over-the-counter (OTC) medication may be quite effective at treating your migraine headaches, but if you take OTC medication regularly (3 times a week or more), you are setting yourself up for rebound headaches that are actually caused by too much medication. Taking too much acetaminophen can damage your liver, while ibuprofen, naproxen, and aspirin can irritate your stomach.
- Excedrin, Ibuprofen (Motrin, Advil), acetaminophen (Tylenol), naproxen (Aleve), aspirin, Goody’s
Your neurologist or primary care physician may prescribe medication that is stronger than over-the-counter medication for your migraine headaches. These may include pills, nasal sprays, injections, or suppositories. As with any prescription medication, there may be unwanted side effects that make taking the medication unpleasant. Examples of prescription medication include abortive therapy (taking medication each time you have a migraine) and prophylactic therapy (taking medication daily to try to prevent your migraines).
Abortive Therapy (to treat each individual migraine)
- Triptans, such as Imitrex, Maxalt, Zomig, Amerge, Axert, Relpax, Frova
- Ergots containing ergotamine, such as cafergot and dihydroergotamine (DHE)
- Isometheptene (Midrin) prevents blood vessels in your head from expanding and causing headaches
- Narcotics (pain medication) and anti-emetics (anti-nausea) can be given in combination
- Barbiturates such as butalbital (in Esgic, Fioricet, Fiorinal)
Prophylactic Therapy (to take daily for preventing migraines)
- Beta blockers such as atenolol (Tenormin), metoprolol (Lopressor or Toprol), nadolol (Corgard), propranolol (Inderal), timolol
- Calcium channel blockers such as diltiazem (Cardizem), nifedipine (Procardia), nimodipine (Nimotop), verapamil
- Anti-epileptic drugs (e.g., gabapentin (Neurontin), topiramate (Topamax), valproic acid (Depakene or Stavzor)
- Anti-depressants such as amitriptyline (Elavil), clomipramine (Anafranil), doxepin (Silenor), mirtazapine (Remeron), nortriptyline (Pamelor) , protriptyline (Vivactil)
- Angiotensin-converting enzyme inhibitors (ACE inhibitors) such as losartan (Cozaar), valsartan (Diovan), lisinopril (Prinivil or Zestril)
Will Muscle or Nerve Release Surgery Help Relieve My Migraines?
Several surgical approaches are also available to treat migraine headaches. Nerve decompression surgery and muscle release surgery are both options, depending on the nature of the migraine.