According to the American Migraine Foundation, “migraine headaches are a “disabling neurologic disease that affects at least 39 million Americans.” The Centers for Disease Control (CDC) reports that 3 percent of emergency department visits are due to migraine attacks. Women are 3 times more likely than men to experience migraines. There is also a strong familial component; if one parent has migraines, children have a 50 percent chance of developing migraines and if both parents have migraines their offspring have a 75 percent chance of developing migraines.
While symptoms vary, migraines typically cause:
Moderate-to-severe and often intense pain,
Pain often on just one side of the head,
Throbbing or pounding pain,
Pain worsened by physical activity,
Sensitivity to light, noise and odor,
Nausea and vomiting.
Migraine attacks can include four distinct phases. The prodromal phase precedes the headache by hours or days; symptoms include fatigue, moodiness, difficulty concentrating and food cravings. The aura phase, beginning just before the headache, may be associated with vision changes, numbness, tingling and trouble speaking. The actual migraine attack usually causes pain on one or both sides of the head that lasts for several hours but which can continue for days. The migraine postdrome, also known as the “migraine hangover,” extends beyond migraine-related pain and can last several days. This postdrome, affecting up to 80 per cent of migraine patients, typically produces fatigue, body aches, light sensitivity and poor concentration.
While doctors are not sure what causes migraines, recent evidence suggests a connection with the body chemical serotonin (Serotonin also seems to be related to depression and anxiety.).When serotonin levels are high, blood vessels are more likely to constrict, while when serotonin levels are low blood vessels tend to dilate. Swollen blood vessels within the skull and associated with the brain increase the pressure within the skull, and this increased pressure has been associated with headaches.
Common migraine triggers include: •
Food and drink, notably aged cheese, alcohol, peanuts pickled foods, most beans, chocolate and potato chips,
Hormone changes in women, associated with menstrual cycles, menopause, hormonal birth control and hormone replacement therapy,
Stress, when overwhelmed at work or home, when exercising too much and not getting enough sleep,
Strong sensory input, such as loud sounds, bright lights and strong smells,
Medicines, which can differ from person to person, and • Infections, such as the cold or flu, and Covid-19.
A variety of medicines can help migraines. Over-the-counter choices include:
Aspirin,
Acetaminophen,
Excedrin Migraine,
Ibuprofen,
Naproxen, and
Ketoprofen
The best prescription choices for migraine treatment include:
Triptans, such as Imitrex and Maxalt, that reverse artery dilation and therefore reduce swelling within the skull. These are short -acting drugs that help to reverse existing headaches. (Patients experiencing acute migraines may also benefit from lying down in a cold, dark room, applying cold compresses on the forehead and neck, massaging the scalp, applying pressure to the temples and consuming small amounts of caffeine.)
Calcitonin gene-related peptide (CGRP) inhibitors, which also reduce artery swelling, are recent additions to the treatment options for migraines. The short-acting CGRP inhibitors Ubrelvy and Nurtec are effective for the episodic relief of acute migraines, while the long-acting CGRP inhibitors Aimovig, Emgality and Vyepti are indicated for routine use for headache prevention in patients who experience 4 or more migraine attacks per month.
Click the links to learn more about each highlighted medication. Recent evidence also supports the regular practice of yoga as a way to reduce the frequency and severity of migraines.
There have been many recent advances in migraine therapy. Consult your physician for more information about migraines and how to treat them.