Migraines Suck!

Migraines are a neurological disorder characterized by severe and recurring headaches.  The American Migraine Foundation estimates that at least 39 million Americans live with migraines, but because many people do not get a diagnosis or the treatment they need, the actual number is probably higher.  A single migraine attack can last anywhere from a few hours to several days.  While migraine can affect people of any gender, sex, age, race, ethnicity, or background, it's especially common in women.  In fact, three times more women live with migraines than men.  While some people may think that a migraine is "just a headache," it is actually very different.  

Most people with migraine will have spontaneous attacks, meaning there is nothing they did or did not do to trigger the attack.  Although migraine causes are not fully understood, genetics and environmental factors can play a role.  While everyone has different triggers, there are a few common culprits that affect a large number of people.  Some of these common triggers include stress, certain foods, skipping meals, alcohol, not getting enough sleep, changes in barometric pressure, hormonal changes in women, concussions, and traumatic brain injuries.

There are often four distinct phases to a migraine: prodrome, aura, headache, and postdrome.  Each phase has its own set of symptoms.  One thing that makes migraines especially hard to diagnose and treat is that not every patient will experience all four phases.  For example, only about 20% of migraine sufferers experience an aura.

Prodrome symptoms can include severe mood changes, food cravings, neck stiffness, and excessive yawning.  These typically occur a few hours before the onset of a migraine.  Aura symptoms can include visual sensations, such as seeing light spots or having blind spots, difficulty speaking, and vertigo.  Headache attack symptoms can last from between 4 and 72 hours, if left untreated.  The pain can be just on one side of the patient's head (but sometimes on both), the pain throbs or pulses, and the patient can also experience nausea or vomiting.  Another common symptom is sensitivity to light, sound, smells, or touch.  It is possible to have a migraine without any pain.  The last phase, postdrome, is sometimes described as a "migraine hangover," leaving patients feeling drained and confused, sometimes for up to two days after the headache phase has passed.

There are two primary types of treatments for migraine: acute and preventative.  Preventative treatments aim to reduce the frequency, severity, and length of migraine attack.  Some examples of preventative treatments are lifestyle changes, trigger avoidance, behavioral therapy, and physical therapy.  Acute treatments are taken when a patient experiences an attack and are designed to stop the migraine from progressing.  Some medications, such as triptans, have been on the market for a while.  They include sumatriptan (Imitrex) and rizatriptan (Maxalt), and can be taken as a pill, injection, or nasal spray.  

A newer class of migraine drugs, called calcitonin gene-related peptide (CGRP) inhibitors or antagonists, has recently become available for patients.  Medical researchers noticed that CGRP levels were elevated during migraine attacks and were lower between attacks.  This was the first class of drugs developed to prevent migraines both with or without visual auras.  Some medications, like Ubrelvy and Nurtec ODT, are given as an oral pill.  Monoclonal antibody medications that target CGRP, such as Aimovig and Emgality, are given by injection or IV.  These treatments are usually given to patients if oral medications are ineffective for treating migraine.  

Migraines of any type can be debilitating and isolating.  When they occur frequently, they can interfere with a patient's professional and personal life. If you are getting migraines consistently, please consider seeing a neurologist who specializes in migraines and headaches.