Migraine isn’t just any headache. It’s a severe, throbbing pain that can keep you home from work, disrupt your family life and leave you with significant disability. Migraines are very common. In fact, they affect 18% of women and 6% of men in the US. Without treatment, they can recur year after year.
A typical migraine…
- Occurs on one side of the head.
- Is of moderate to severe intensity
- Interferes with daily activity.
- Is exacerbated by physical activity like coughing, walking or climbing stairs.
- Is accompanied by nausea, vomiting or sensitivity to light and sound.
Most migraine sufferers (migraineurs) can recognize what’s called a prodrome in the 24 hours leading up to a migraine sudden depression or exhilaration, increased or decreased appetite, disruptions in sleep, etc.
About 15% of migraine sufferers “see” flashing lights or strange shapes just before the headache hits. Such hallucinations are known collectively as an aura.
There’s no easy way to tame migraines. But when migraineurs get good medical care and take an active role in their treatment, nine out of 10 can reduce a once debilitating problem to a minor inconvenience.
What triggers migraines
A migraine starts with abnormal electrical activity in the cerebral cortex, the thinking part of the brain. It spreads quickly to the hypothalamus and the midbrain.
Levels of the brain chemical serotonin rise and then drop sharply, making blood vessels swollen and inflamed.
Though the migraine predisposition is inherited, most individual attacks are triggered by either dietary or environmental factors
- Alcohol (especially beer and red wine).
- Erratic meal and/or sleep schedules.
- The artificial sweetener aspartame (NutraSweet).
- The flavor enhancer monosodium glutamate (MSG).
- Processed meats and other foods containing the preservatives nitrates or nitrites.
- Aged cheeses, freshly baked bread, and chopped liver and other foods that contain the amino acid tyramine and chocolate, which contains phenylethylamine.
- Perfume or cigarette smoke.
- Caffeine withdrawal. To avoid trouble, it’s best to have no more than one five-ounce cup of coffee a day.
- Psychological stress. Most migraines occur when the period of stress is over. That’s why migraines are common after exams or holidays.
How to prevent attacks
The first step in controlling migraines is to keep a “headache diary.” Record the frequency and severity of your attacks as well as the foods you consumed during the 24 hours prior to each attack. Other key strategies…
- Maintain a regular schedule. Eat at the same times each day. Keep consistent sleep hours seven days a week. Don’t “sleep in” on weekends.
- Take vitamin supplements—vitamin E, consult your doctor for appropriate dosage vitamin B-2, 400 milligrams (mg) a day vitamin B-6, 50 mg a day. Vitamin supplements help stabilize levels of estrogen and serotonin.
- Schedule “nurturing” time during which you listen to music, read, play with your dog or cat, etc. anything you find enjoyable and relaxing.
- Practice a relaxation technique like yoga, meditation, deep breathing or bio feedback once or twice a day for 15 minutes.
Deep breathing: Loosen your clothing and sit in a quiet place. Breathe in as you count to five, then out to the count of five. Silently repeat to yourself, “Breath in relaxation, breath out tension.”
Biofeedback: With this high-tech relaxation aid, you’re hooked up to a mechanical unit that measures skin temperature or muscular tension. With practice, you will learn how to raise the temperature or loosen the muscle. Either way, your body relaxes.
When traveling: Give yourself plenty of time to pack. Don’t carry heavy bags using a neck or shoulder strap. Avoid alcohol during airplane flights.
- Exercise regularly. Physical activity relieves stress and boosts levels of endorphins, the body’s pain-relieving chemicals. At least three times a week, have a moderate, noncompetitive workout. Competitive exercise boosts your stress level.
Most effective medication
If migraines persist despite these lifestyle changes, taking daily medication may prove to be helpful.
Over-the-counter (OTC) painkillers like acetaminophen, aspirin, ibuprofen and naproxen are often effective in treating an attack.
If you do not respond to one of these medications, “combination” analgesics like Excedrin or Anacin may help. These products combine aspirin or acetaminophen with caffeine, which constricts swollen blood vessels and enhances pain relief.
If OTC remedies don’t work, ask your doctor about Tylenol with codeine Fiorinal (aspirin plus a mild sedative) and Midrin (acetaminophen plus a muscle relaxant and a drug to shrink swollen blood vessels).
For preventing attacks, daily use of the beta blockers propranolol (Inderal) and nadolol (Corgard) is often effective.
The calcium channel blocker verapamil (Calan, Verelan) and antidepressants such as amitriptyline (Elavil), nortriptyline (Pamelor) and fluoxetine (Prozac) are also effective.
Although methysergide (Sansert) is often effective, it can scar the lungs, kidneys and heart. If it must be used for more than five months, periodic chest X rays, MRI scans of the kidneys and other tests should be performed to make sure no harm is taking place.
What about alternative remedies? Some migraineurs get relief from a daily dose of the anti-inflammatory herb feverfew, which is available at health-food stores. Others get relief from fish oil supplements.
To the rescue
It may offer relief to some migraineurs. At the first sign of a headache, press the web between your thumb and index finger, on the same side as your headache, for five minutes.
• Sumatriptan (Imitrex)
It is the biggest advance in migraine care in more than a century. One self-injection relieves most migraines within 60 minutes. The pill form is also effective, but it takes longer.
Beware: Don’t use sumatriptan if you have heart disease it narrows blood vessels. If you’re at risk for heart disease (men over 40, family history of heart attack, smoking, blood pressure over 140/90, cholesterol over 220), the doctor may want to administer the first dose in the office, and check your electrocardiogram.
A sensation of pressure in the chest after a dose of sumatriptan is common. But if the drug causes chest pain, discontinue it.
• Dihydroergotamine (Migranal)
It is as effective as sumatriptan but takes longer to work. Inhaled and injectable versions of dihydroergotamine (DHE) and sumatriptan are very helpful when vomiting makes it impossible to keep pills down.