If you suffer from migraine headaches, you're not alone. About 12 percent of the U.S. population experience migraines, according to the National Institute of Neurological Disorders and Stroke (NINDS) at NIH.
Migraines involve recurrent attacks of moderate to severe pain that is throbbing or pulsing and often strikes one side of the head. Untreated attacks last from 4 to 72 hours. Other common symptoms are increased sensitivity to light, noise, and odors; and nausea and vomiting. Routine physical activity, movement, or even coughing or sneezing can worsen the headache pain.
Migraines occur most frequently in the morning, especially upon waking. Some people have migraines at predictable times, such as before menstruation or on weekends following a stressful week of work or a change in sleep schedule. Many people feel exhausted or weak following a migraine.
Who Gets Migraines?
Migraines occur in both children and adults, but affect adult women three times more often than men. There is evidence that migraines are genetic, with most migraine sufferers having a family history of the disorder. They also frequently occur in people who have other medical conditions.
Depression, anxiety, bipolar disorder, sleep disorders, and epilepsy are more common in individuals with migraine than in the general population. Migraine sufferers who have pre-migraine symptoms referred to as an aura have a slightly increased risk of having a stroke.
Migraine in women may be related to changes in hormones. The headaches may begin at the start of the first menstrual cycle or during pregnancy. Most women see improvement after menopause, although surgical removal of the ovaries usually worsens migraines.
Women with migraine who take oral contraceptives may experience changes in the frequency and severity of attacks, while women who do not suffer from headaches may develop migraines as a side effect of oral contraceptives.
A number of environmental influences can trigger a migraine, and their effects vary from person to person. Triggers include sudden changes in weather or environment, too much or not enough sleep, strong odors or fumes, emotion, stress, overexertion, loud or sudden noises, motion sickness, low blood sugar, skipped meals, missed medications, tobacco smoke, depression, anxiety, head trauma, alcohol, some medications, hormonal changes, and bright or flashing lights.
In some 50 percent of migraine sufferers, foods or ingredients can trigger headaches. These include aspartame, caffeine (or caffeine withdrawal), wine and other types of alcohol, chocolate, aged cheeses, monosodium glutamate, some fruits and nuts, fermented or pickled goods, yeast, and cured or processed meats. Keeping a diet and lifestyle journal will help identify triggers.
Types of Migraine
The two major types of migraine are:
Migraine without aura, or common migraine, is the more prevalent form of migraine. Symptoms include headache pain that occurs without warning and is usually felt on one side of the head, along with nausea, confusion, blurred vision, mood changes, fatigue, and increased sensitivity to light, sound, or noise.
Migraine with aura, previously called classic migraine, includes visual disturbances and other neurological symptoms that appear about 10 to 60 minutes before the onset of the headache and usually last no more than an hour. Individuals may temporarily lose part or all of their vision. The aura may occur without headache pain, which can strike at any time. Other classic symptoms include trouble speaking; an abnormal sensation, numbness, or muscle weakness on one side of the body; a tingling sensation in the hands or face, and confusion. Nausea, loss of appetite, and increased sensitivity to light, sound, or noise may precede the headache.
There are other forms of reoccurring headaches that are less common than the two major types. Discuss your headaches thoroughly with your healthcare provider
Phases of Migraine
Migraine is divided into four phases, all of which may be present during the attack:
- Premonitory symptoms occur up to 48 hours prior to developing a migraine. These include food cravings, unexplained mood changes (depression or euphoria), uncontrollable yawning, fluid retention, or increased urination.
- Aura. Some people will see flashing or bright lights or what looks like heat waves immediately prior to or during the migraine, while others may experience muscle weakness or the sensation of being touched or grabbed.
- Headache. A migraine usually starts gradually and builds in intensity. It is possible to have migraine without head pain.
- Postdrome (following the headache). Individuals are often exhausted or confused following a migraine. The postdrome period may last up to a day before people feel back to normal.
"I get an aura prior to my migraine"
Comfort measures help Pamela Duvick manage migraines
Since she was in her early 30s, Pamela Duvick, 53, of Charlotte, N.C., has had migraines.
"I get an aura prior to my migraines," she says. "Typically, my vision is affected. I will get blind spots in my field of vision and it will last for approximately 15 or 20 minutes."
Her speech can be affected as well. "Sometimes it is difficult to speak during this time; difficult to find the words to say," she says.
"Shortly after the aura dissipates," says Duvick, "I will feel a headache begin."
If it's a particularly bad migraine, she adds, it will be accompanied by nausea and sensitivity to light.
When her migraines first started, Duvick says it seemed they were more related to changes in barometric pressure, since she had been diagnosed with vasomotor rhinitis. "Another trigger in my 30s was tension and stress," she says. "As I have entered perimenopause/menopause, I feel like the migraines are more often triggered by hormonal shifts in addition to stress and weather changes."
Duvick says diet is also a factor, as she sometimes gets a migraine after consuming red wine or aged cheeses.
"Besides being very frightening, due to the auras, it can really disrupt your life," she says. "The discomfort is severe and you have to take measures immediately to try and relieve the symptoms, which are simply miserable—it isn't the type of headache that you can 'work through.'"
Duvick manages her migraines with comfort measures and over-the-counter pain relievers, such as Aleve and Motrin.
"In addition to massage, I have a head wrap that has gel packs, which you can refrigerate or heat in the microwave," she says. "It is very soothing and tends to help tremendously."
She adds, "Closing my eyes and making sure I'm in a calm, low-light environment is another comfort measure that helps."
Managing the condition day-to-day can be a challenge for Duvick. "Unfortunately, since [my symptoms] are weather-, stress-, and hormone-related, those aspects are hard to manage," she says. "I recently visited my ENT doctor and he prescribed a nasal spray called Olopatadine, which makes my sinuses less reactive to barometric changes. That has been quite helpful."
Duvick says she has also stopped using artificial sweeteners, and has cut back on her consumption of aged cheeses and red wine.
"Cutting back on my caffeine intake and [practicing] meditation has been helpful in managing the stress of daily living and menopause," she adds.