Migraine is much more than a bad headache.
- Migraine is a neurological disease with extremely incapacitating neurological symptoms.
- It’s typically a severe throbbing recurring pain, usually on one side of the head. But in about 1/3 of attacks, both sides are affected.
- In some cases, other disabling symptoms are present without head pain.
- Attacks are often accompanied by one or more of the following disabling symptoms: visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound, light, touch and smell, and tingling or numbness in the extremities or face.
- About 25% of migraine sufferers also have a visual disturbance called an aura, which usually lasts less than an hour.
- In 15-20% of attacks, other neurological symptoms occur before the actual head pain.
- Attacks usually last between 4 and 72 hours.
For many sufferers, migraine is a chronic disease that significantly diminishes their quality of life.
- More than 4 million adults experience chronic daily migraine – with at least 15 migraine days per month.
- Medication overuse is the most common reason why episodic migraine turns chronic.
- Depression, anxiety, and sleep disturbances are common for those with chronic migraine.
- Over 20% of chronic migraine sufferers are disabled, and the likelihood of disability increases sharply with the number of co morbid conditions.
There are 3 main types of non-drug treatments for migraine.
- See a doctor for a proper diagnosis. Migraine is a diagnosis of exclusion, which means doctors must eliminate other reasons for your symptoms before arriving at a migraine diagnosis. If your symptoms are bad enough for you to be evaluating treatments, you should make sure you actually have migraine and not something else.
- Keep a detailed headache diary so that you can analyze patterns to try to learn your common headache triggers.
- Stick to the same eating and sleeping schedule every day – even on the weekends. Don’t skip meals or change sleep patterns.
- Drink lots of water to stay hydrated. Dehydration is a very common migraine trigger.
- Exercise regularly.
- Keep your weight down. An increase in BMI (body mass index) may result in an increase in the frequency of migraines.
These therapies promote general good health and well-being. They can improve your quality of life. Their success in treating migraine is difficult to measure and may depend on many things, like the therapist, the length of treatment, and your commitment to regular practice.
These therapies can be tried alone or in combination:
- Physical therapy
- Tai Chi
- Stress management: relaxation techniques, breathing, visualization, meditation
- Cognitive Behavioral Therapy
Exercise programs are frequently recommended to promote health, control weight, and prevent disease. Migraine sufferers typically are less physically active than those who don’t suffer. They often avoid exercise, worrying that the exercise itself will aggravate or trigger a migraine.
Sufferers who follow certain common-sense guidelines can improve their quality of life and increase their aerobic endurance and flexibility without aggravating or triggering their migraines. Here are some tips:
- Keep your exercise low-impact. Use equipment like stationary bikes or ellipticals that minimize pounding movements. Try Tai Chi, Yoga, isometric or band exercises.
- When using a treadmill, increase the incline rather than the speed to minimize pounding movements.
- Stretching and weight-bearing exercises are important, but be careful of the neck area. This is a very tender and vulnerable spot that can directly affect migraines.
- Drink water and stay hydrated. Dehydration is a very common migraine trigger.
- Take it slow. Work up to longer and more intense exercise as your body gets stronger.
- Listen to your body – if an exercise aggravates your migraines, don’t do it! But don’t abandon exercise. Consult a trainer or physical therapist for alternatives.
Hormones have an impact on migraine in women. Many women find their migraine symptoms are affected by menstruation, hormonal contraception, pregnancy, and menopause.
Menstrual Migraine: Menstrual migraine is an attack that occurs up to 2 days before and up to 3 days after your period begins. It’s usually more severe and more difficult to treat than other types of migraine. 7-19% of women get menstrual migraine. About 60% of these women also have migraine at other times of the month, too.
In the same woman, attacks of menstrual migraine may differ from their other attacks in duration, severity, symptoms, and response to treatment. Estrogen itself is not the culprit. Hormonal fluctuations, and especially estrogen withdrawal, are thought to trigger the attack.
Menstrual migraine is generally treated with the same medications that are used for other types of migraine. If a woman’s menstrual migraine is so severe that it doesn’t respond to these medications, hormonal contraceptives might be considered as a treatment.
While birth control pills remain the most popular form of hormonal contraception, hormones can also be administered vaginally, by patch, or injection. The impact of hormonal contraception on migraine varies from woman to woman. Some find they have fewer headaches, while others experience more pain, and some find there’s no effect at all.
Oral contraceptives can trigger a woman’s first migraine attack, especially if she has a family history of migraine. Contraceptives which reduce or eliminate periods are sometimes used to treat severe menstrual migraine. Women with migraine should be careful when choosing a hormonal contraceptive, and weigh the risks and benefits of a particular contraceptive with their doctor.
Pregnancy and Nursing
Migraine sufferers should discuss their pregnancy plans with their doctors. Some migraine medications may impact the ability to conceive and may harm the fetus.
60% of pregnant sufferers find their migraines improve significantly in their first trimester, and more than 75% find they improve or even disappear during the rest of their pregnancy. Unfortunately, this is not the case for everyone. 15% report their migraines worsen during the first trimester, and about 25% notice no change. Usually, sufferers return to their pre-pregnancy migraine patterns after they give birth. Regular nursing may delay the return of migraines.
Migraines often worsen during per menopause, the years before menopause, with intense hormonal fluctuations. But the prevalence of migraine decreases significantly during menopause, when menstruation ends and hormones cease fluctuating. Migraines improve or go away entirely in 67% of sufferers. Women who go through natural menopause often find their migraine symptoms improve dramatically, while women who experience a surgical menopause often suffer more. The effect of estrogen replacement therapy on migraine varies.
The prevalence of migraine drops markedly after age 60 to 7.5% in older women. Few sufferers have their first migraine after age 65. It’s important to consult a doctor to explore the causes of headaches in later life to rule out other medical problems.
Migraine often goes undiagnosed in kids and teens.
In childhood migraine, head pain may be less severe than other symptoms, like unexplained nausea or vomiting, abdominal pain, or dizziness. These non-headache symptoms are referred to as migraine equivalents. Like adults, children may experience migraine with or without aura, a visual disturbance which can occur about an hour prior to the headache. But migraine without aura is more common.
Before a migraine begins, parents may observe changes in their child’s behavior, including loss of appetite, irritability, yawning, food cravings, lethargy, withdrawal, and mood swings. Sensitivity to light, touch, smell, and/or sound is also common. Other indicators may include sleep walking, sleep talking and night terrors. Infant colic and motion sickness may be warning signs of a predisposition to childhood migraine or an early form of it.
The most common migraine triggers in children are inadequate or changed sleep, skipped meals, stress, weather changes, bright lights, loud noises, strong odors, and hormonal fluctuations. Contrary to popular belief, there is little evidence linking specific foods to migraine.
Diagnosing Migraine in Kids and Teens
Diagnosis is made through a patient history, physical exam, and by ruling out other explanations for the symptoms. Sometimes diagnostic tests, such as blood tests, EEG, lumbar puncture, and neuroimaging are also used to assist in the diagnosis. Migraine tends to run in families, so family history of migraine is a risk factor.
A history, preferably conducted with both the child and the parent, should include:
- description of the pain (including location, nature, and timing)
- frequency and duration of episodes
- identifiable triggers
- symptoms at the onset, such as aura, lethargy, or nausea
- impact on quality of life (disability)
- previous treatments
- thorough family history
It’s important to explore whether there’s a pattern to the attacks. For example, attacks may occur after a car ride or when the weather changes. Girls may have attacks associated with their menstrual cycle. Parents and kids should keep a joint headache diary to assist the doctor in diagnosis and treatment.