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Understanding Migraines and Their Triggers


Believe it or not, 38 million Americans suffer from regular migraines, and many don’t even know it. Yes, the debilitating side effects of a migraine can knock sufferers off their feet and leave them pleading for relief, as the pulsing and throbbing continues from several hours up to several days in some of the most severe cases. But for others, the headache pain associated with their migraine is more moderate and may be mistaken for a sinus headache or tension headache.

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.