Unlocking the Mysteries of Migraine Headaches

If you’ve ever experienced a migraine, you know just how debilitating these headaches can be. They can ruin your plans for the day, making it impossible to work, exercise or have fun with family and friends. The good news is that effective treatments are available. And the first step toward relief is an accurate diagnosis.

What is a migraine?

Doctors define a migraine as a type of headache that has occurred at least five times with the following description:

  • Moderate to severe head pain, usually worse on one side of the head.
  • Pain that pulsates.
  • May have nausea, vomiting and sensitivity to light or sound.
  • A duration that lasts from 4 to 72 hours.
  • No identifiable underlying cause.

“Common triggers for migraines include stress, weather changes, dehydration, strong odors, and bright or flashing lights. Menses can be a trigger in some women,” says Selena Nicholas-Bublick, MD, MHS, a neurologist with ProMedica Physicians. “Women are 3 times more likely to be affected with migraine compared to men and 85% of patients with chronic migraine are women.”

The Five Phases of a Migraine

When people think about migraines, they tend to focus on pain. However, Dr. Nicholas-Bublick outlines that a single migraine can actually be thought of as having five different phases:

  1. Prodromal/Premonitory phase: Hours to days before the headache pain begins, patients may experience food cravings, neck discomfort, yawning, gastrointestinal issues, mood changes and irritability. About 80% of migraine sufferers have a prodromal migraine phase.
  2. Aura: About one-third of people with migraines experience an “aura” five to 60 minutes before other symptoms begin. Auras often disappear when migraine pain starts (but not always) and can include visual disturbances such as flashes of light, blind spots, tunnel vision and tingling in the hands or face.
  3. Headache: Sometimes called the pain phase, this can last 4 to 72 hours. Pain is on only one side of the head, pulsating with moderate to severe intensity that worsens with routine physical activity. There can be nausea, vomiting, light and sound sensitivity.
  4. Postdrome: After the headache pain goes away, patients can still experience symptoms that can last anywhere from 24-48 hours. Symptoms can include poor concentration, sensitivity to touch (especially on the head), depressed mood and fatigue.
  5. Interictal: During this phase a person may be relatively symptom-free. Some individuals are sensitive to light, sound and certain odors, such as cigarette smoke.

Tracking Your Migraines

Dr. Nicholas-Bublick recommends talking to your primary care provider about your headaches if you find that they are beginning to interfere with daily life or are requiring more and more over-the-counter medications to be controlled. “Your primary care provider knows your health and can begin investigations into possible underlying causes. They can also assist with referrals to headache specialists if needed,” she says.

It’s a good idea to keep a headache journal for a month or two before seeing a provider and many apps available on Android and iOS phones can help you track this information. When you get a headache, record the following information:

  • How long it lasts.
  • Over-the-counter medications you take and how effective they are.
  • Symptoms you experience.
  • What may have triggered the headache.

This will help your provider determine whether your headaches are migraines and if they are “episodic” or chronic; information that’s critical to treatment planning. Episodic migraines occur 14 days or fewer a month, and chronic migraines occur 15 or more days a month with headaches lasting 4 hours or longer (for over three months).

Finding a Treatment Strategy

Treatment strategies for migraines are quite varied and depend on the individual. It is thus important to have a conversation with your provider about which medications or therapy may be best suited to your needs.

Successful preventive treatment of migraines reduces the burden of headaches and improves overall quality of life.  “Everyone is different, and it may take time to find the right combination of medication and lifestyle changes you need to experience relief,” notes Dr. Nicholas-Bublick.

Preventive therapies include oral and injectable medications, including botulinum toxin injections or BOTOX®.

Other considerations when discussing migraines are potential comorbidities such as insomnia, sleep apnea, depression, anxiety and lack of physical activity. It is a good idea to have a full clinical evaluation if migraines are suspected.

Learn more about the diagnosis and treatment of migraine headaches on ProMedica’s website.

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