When I was a neurology resident in Baltimore during the 90s, I worked as
a researcher doing
population-based studies on
migraine patients. We’d use random digit dialing to call homes in a particular area,
ask questions about headache, then invite individuals into our clinic
to confirm their headache type with a medical evaluation and offer them
the opportunity to take part in further research. We’d routinely
speak with individuals by phone who stated, “I get headaches, but
they’re sinus headaches.” Or, “My sister gets migraines,
but I only get tension headaches.” Very often, those same individuals
would come into our research clinic and, after history and examination
with a physician, meet all criteria for the diagnosis of migraine. They just
thought they had sinus or tension headaches. The distinction is critical because
there are specific medications and treatment strategies that are very
effective for migraine. And migraine is known to significantly affect
function and productivity. Although our unsolicited call may have initially
been a nuisance (I hate being interrupted at dinner by these kinds of
disruptions as well), most of these research subjects were happy to have
been accurately diagnosed. Not only did appropriate treatment improve
their headaches, it also improved their productivity at work and allowed
them to take care of responsibilities at home that they had previously
been unable to complete while they suffered from their “sinus”
or “tension” headache.
Migraine headaches differ from regular headaches in that they come with a variety of accompanying symptoms. In addition
to the pulsating pain felt on one or both sides of the head, nausea and
vomiting, as well as sensitivity to light and sound, are among the most
common symptoms. Needless to say, they can put quite a damper on the sufferer’s
ability to function at optimal levels during and even after the headache
has subsided.
Other key features that differentiate a migraine from other kinds of headache
in some individuals are something called the
Prodrome stage and a migraine aura. Some migraine sufferers notice subtle changes in
their daily routine up to a day or two before a migraine sets in –
a sort of warning period alerting the troops that the enemy is on its
way. Everyone may experience these differently, but a few of the most
common of these prodromal signs are excessive yawning, depression, irritability,
and a stiff neck. Migraine aura is a neurological symptom that immediately
precedes the headache. It may consist of visual disturbances (like seeing
flashing lights or experiencing partial loss of vision that gradually
spreads across the visual field), or other sensory phenomena (like numbness
or tingling gradually spreading across the face or down the arm). Though
experiencing these symptoms is an unfortunate realization that migraine
pain is likely coming, there's also an upside. These warning signs
provide an opportunity to initiate treatment very early in the course
of the migraine episode, which significantly improves the likelihood that
the treatment will be successful. Many individuals reduce the efficacy
of a treatment by waiting “to see if it will get better on its own”
or feel that they should only take medication if they “really need
it.” Again, keep in mind that early treatment is more effective.
Triggers for migraine are simply any factor that is felt to contribute
to developing the headache. They may lower the threshold or risk of developing
the migraine or “trigger” the migraine attack. Every person
has a different set of triggers, so if you suffer from migraines, one
of the best things you can do for yourself is to figure out what your
triggers are. Of course, there are some rather common triggers that many
people do experience including fatigue, inadequate sleep, stress, certain
foods or alcohol, or altitude changes. It’s important to mention
however that these triggers may not always remain the same, so something
that caused a migraine episode on one occasion may not do so in another
situation, and vice versa. However, doing the detective work to discover
what any of your personal triggers are can hopefully help you avoid the
ensuing migraine that may have followed.
One of the best ways to identify recurring migraine triggers is to develop
a headache diary. This may sound odd at first, but it is one of the surefire
ways to recognize what exactly is making your brain “ticked,”
literally. On days when a migraine creeps in, write down all of the surrounding
evidence. What did you eat that day and the couple days before? How well
have you slept lately? Were you participating in any unusual activities?
This list of what you did and how you behaved for a few days before the
migraine sets in becomes your possible list of triggers. For example,
perhaps you begin to see a pattern that you often develop a migraine when
you only sleep for 5 hours, or every time you eat too much chocolate before
bed. Once you can pinpoint some of what
triggers your migraines, you’ll want to avoid those things as much as possible.
Unfortunately, there are certain circumstances where a migraine will be
unavoidable despite all efforts at avoiding triggers, and that's simply
a product of a person’s disposition to these types of headaches,
but avoiding the triggers can help reduce the number of episodes.
The most important thing anyone can do to help avoid migraine triggers
is regulate their lifestyle with healthy choices. Getting at least 8 hours of
sleep per night, drinking 8 glasses of water per day, feeding your body with healthy nutrition
and eliminating as many sources of extra stress as possible will put your
body on the express path to raising the threshold of migraines –
meaning your risk of developing a migraine is decreased, even when exposed
to a known trigger. Another plus? Having the discipline to treat your
body with the TLC it needs and avoiding known causes may even eventually
eliminate the need for taking prescription headache medications. Some
of these medications, though helpful at curbing the pain of a migraine,
can come with unwanted and bothersome side effects.
Remember, there are lots of options for
prescription medications that are very effective at reducing migraine frequency (so-called prophylactic
medications) and others that can stop a migraine in its tracks. If you
suspect (or know) that you suffer from migraine headaches, it’s
worth seeing a physician who can confirm the diagnosis and work with you
to develop a treatment plan. In mild to moderate cases, lifestyle and
behavioral changes, mindfulness meditation and supplements or over-the-counter
medications may be sufficient. For severe cases, there are even interventional
procedures and
electrical stimulation therapies that can be very helpful.
Limiting the number of migraine episodes you develop can also help keep
them more treatable. Paying attention to the warning signs and knowing
your triggers can make all the difference. Play detective and figure out
what works for you to reduce the severity and frequency of migraines,
and eventually prevent them from taking over your life.
Vernon Williams, MD, sports neurologist and founding director of the Center
for Sports Neurology and Pain Medicine at Kerlan-Jobe Orthopaedic Clinic
in Los Angeles, California. Dr. Williams is a neurological medical consultant
to local professional sports organizations, such as the Los Angeles Rams,
Los Angeles Dodgers, Los Angeles Lakers, Los Angeles Kings and Los Angeles
Sparks. He also assists local college and numerous high school and youth
sports/club athletic teams in this capacity. He is Commissioner for the
California State Athletic Commission and Chair of the American Academy
of Neurology Sports Neurology Section. Follow him on
Twitter or
Facebook.