Everything You Need to Know about Migraines

chronic migraines

There is nothing like lying in the emergency room getting pumped with shot after shot of morphine while your husband and child look on in concern. I’ve found myself in this situation 3 times in the past 5 years due to a migraine so powerful I couldn’t stand, see or speak. In between each event, I was suffering up to 20 head-throbbing headaches a month. Fortunately, thanks to an excellent doctor and a proactive approach, my headaches are now largely under control.

See our comprehensive Treatment Chart

An estimated 38 million Americans, including 8 million children and adolescents, suffer from migraines. About 1 in 5 women and 1 in 20 men in the U.S. experience migraines. Unfortunately, many sufferers find the medications used to prevent and treat migraines so troublesome they opt not to take them, according to a recent study cited in WebMd.

Anyone who has ever had a migraine knows it is far more than just a bad headache. In The Migraine Solution — a book I co-authored with with Elizabeth Loder, MD and Paul Rizzoli, MD — Dr. Rizzoli refers to a migraine as a “headache plus,” meaning a headache plus a lot of other symptoms.

“It’s really a whole body experience that can make it really hard to get through your day and contribute something useful,” says Dr. Rizzoli, who is also an assistant professor of neurology at Harvard Medical School. “It’s such a complex, textured experience, it’s not even entirely about the pain.” Dr. Rizzoli says in many cases it is possible to get your migraines under control, though there may not be a quick or simple solution. Education is the first step, he says.

Here are some helpful answers from Dr. Rizzoli regarding important questions you may have about migraines. Be sure to review the comprehensive Treatment Chart to learn all you can about common migraine treatments, including possible side effects. And, click on the resources guide for some useful websites compiled by Dr. Rizzoli.

How can I tell if I’m having a severe headache?

Everyone experiences a migraine a little differently. About 20 percent of migraines begin with a neurological symptom known as an aura. Visual auras are the most common and may include seeing halos, sparkles, flashing lights, wavy lines, and even temporary loss of vision. An aura may also produce numbness or tingling on one side of the body, especially in the face or hand.

Whether you experience an aura or not, your headache will probably feature a severe, throbbing pain on one side of the head, often beginning around the eye and temple before spreading to the back of the head. You might also experience nausea or vomiting, or perhaps watering eyes or a runny nose. Symptoms usually last for 24 hours but can also last for days at a time. And while some people may only get a migraine once or twice a year, others may experience them once or twice a week.

One way to remember the features of a migraine is to use the acronym POUND: P is for pulsating pain; O for one-day duration of severe untreated attacks; U for unilateral (one-sided) pain; N for nausea and vomiting; D for disabling intensity.

What causes migraine?

That’s the million dollar question. There are lots of theories, but the prevailing thought is that migraine originate in the brain rather than the surrounding blood vessels. Some experts believe they are the result of orderly waves of brain cell activity crossing the cortex, the thin outer layer of brain tissue, followed by periods of no activity, a phenomenon known as cortical spreading depression. Other research suggests migraines begin in the brainstem, a “primitive” region of the brain that controls basic functions, such as respiration and responses to pain, and modulates many others, including incoming sensory information. If the brainstem malfunctions in some way, it may start a cascade of neurological events, including cortical spreading depression, that account for the migraine’s multiple symptoms.

What triggers a migraine?

Dr. Rizzoli says to think of your migraine triggers as your kryptonite. What is it that you do, eat or experience that could be setting off a migraine? The most commonly cited triggers are alcohol (particularly certain red wines and beer), lack of sleep, hormones, weather, stress, caffeine and specific foods including those that contain tyramine, such as aged cheeses, yogurt, soy products and smoked fish, foods with MSG, citrus fruits and items with Aspartame (NutraSweet and Equal).

Unfortunately, there isn’t conclusive research to prove triggers are true culprits and not just imaginary catalysts in your head. For example, chocolate is one food in particular where the evidence is confusing. Many people believe that eating chocolate sets off a migraine but research is contradictory. In fact, it is possible that a craving for chocolate is an early sign of the beginning of a migraine, rather than a cause.

Regardless of what the science says, Dr. Rizzoli says the first step to managing migraine — even before seeing a doctor — is observing and recording your headache patterns. By keeping a detailed headache diary for a few weeks you might be able to spot your own personal triggers.

In this diary, it is helpful to note: the time of day your headache started; where you were and what you were doing when the migraine began; what you ate or drank 24 hours before the migraine started; and for women, the date their menstrual cycle began and ended. It is also helpful to tell your medical team about any family history of migraines and about any medicines you are taking or have taken recently and any side effects you may have experienced from them. All of this information can help you and your medical team take control of your migraine.

What should I do about migraine?

If you’ve been enduring more than a few headaches a month and lifestyle adjustments such as getting better sleep and limiting caffeine aren’t working, go see a headache specialist. Together you can determine the cause and best remedies for your severe headaches. There are no reliable diagnostic tests for migraines so your doctor is most likely to diagnose you based on your history and symptoms. Once it’s determined that you are indeed suffering from migraines, your doctor may prescribe a preventative medication to stop headaches from occurring, abortive or acute medication to halt a headache in progress, or both.

Go to our comprehensive Treatment Chart to learn about the most commonly prescribed treatments plus common side effects.

According to womenshealth.gov — a project of the U.S. Department of Health and Human Services Office on Women’s Health — acupuncture, biofeedback, massage and other relaxation techniques can sometimes help alleviate migraine symptoms. The website also suggests drinking fluids when you get a migraine and lying down in a dark, quiet room, if possible.

Migraine Resources on the Web

Alliance for Headache Disorders Advocacy

American Council for Headache Education (ACHE)

The American Headache Society

Help For Headaches

National Headache Foundation

National Institute of Neurological Disorders and Stroke

American Academy of Sleep Medicine

National Sleep Foundation

National Center for Complementary and Alternative Medicine (NCCAM)

U. S. Department of Health and Human Services Office on Women’s Health

Migraine and Diet

• For more information about migraines, order your copy of The Migraine Solution


Treating migraine headaches: Some drugs should rarely be used (Choosing Wisely)

What Not to Do for Migraines (WebMD)

Migraine treatment innovations still have ways to go (SFGate)

Long-Term Side Effects of Topiramate for Migraines (Livestrong.com)

Migraine Headache Relief Comes at a Cost

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