around the usa 37 million men, women and children suffer from migraines, but less than 5% of those affected are diagnosed and receive appropriate care. According to World Health OrganizationHead disorders affected 3.1 billion people in 2021 – almost 40% of the world’s population.
Headache, often used interchangeably with migraine, is merely a symptom of a migraine episode that is likely to include a headache. However, migraine sufferers may also experience fatigue, dizziness, nausea, extreme sensitivity, and more.
Dr. Maxwell Levy, assistant professor of neurology and director of the Neurology Residency Program at Tulane School of Medicine, said most headache sufferers have tension headaches, which are different from migraines.
“Migraine headaches are more disabling than your standard headaches,” Levy said. “Often people are unable to work or unable to function well when they have a migraine.”
Migraines, or migraine episodes, can last anywhere from two hours to three days, according to Levy.
Dr. Mara Carmen Wilson, medical director of the Headache and Facial Pain Program at Ochsner Health Center in Covington, has studied the impact of migraines and headaches and has suffered from migraines all her life.
Dr. Mara Carmen Wilson
“I’m a migraineur,” Wilson said. “We’re in a very good place right now for people who have migraines.” We have effective and safe medicines that can help.”
According to Wilson, a migraine is a perfect storm. It’s a combination of triggers that change the brain to create a big event—and pain is a part of it.
A perfect storm
These “brain events” can cause sensitivity to light, noise, movement, light or smell. Migraine sufferers can feel foggy and suffer from an inability to think clearly.
“Think of a migraine as a big, complex neurological event,” Levy said.
For a headache to be classified as a migraine, patients without an “aura phase” – when people experience sensory disturbances – need to have at least two episodes, and patients with an “aura phase” need to have at least five episodes.
“If your headaches are preventing you from doing what you want to do, living the life you want to live,” Levy said, “you should talk to your doctor about it. There are some treatable conditions.”
There are 13 subtypes of migraines, according to International classification of headacheand they all come with their own set of symptoms and causes. The most important division is primary headaches and secondary headaches.
A primary headache is a condition where the headache itself is a condition and not a resulting symptom of external or internal triggers. Secondary headaches occur when one or more of these triggers affect the brain, such as illness or exposure to too much light.
Both primary and secondary headaches use the same brain pathway to transmit pain, Wilson noted.
“It affects the quality of life,” Wilson said. “It’s important to differentiate between primary and secondary because when there’s a cause, we go after it. With primary migraine, the goal is to manage the condition.”
Know the triggers
Wilson added that it’s important to know what triggers a headache or migraine.
Triggers come in several forms. Internal triggers that come from within the body include hormonal changes (such as the menstrual cycle), changes in sleep patterns or sleep disturbances, illness (such as fever or allergies), or hunger. External triggers are more related to the environment. For example, excessive light, weather and stress.
Premenstrual and menstrual times are a time of vulnerability, Wilson said. He recommends avoiding too much activity and intense exposure to the senses – such as a very bright concert, excessive alcohol consumption or fasting.
“If it’s a ‘go, go, go’ weekend,” Wilson said, “there’s a strong possibility of an ‘attack’ of a headache or migraine.”
Extreme weather changes, as is common in Louisiana, are a common cause of headaches. Higher temperatures and “hidden humidity” can often lead to dehydration and subsequent secondary headaches.
In the sweltering heat, Wilson recommends staying away from saltier foods and pumping up electrolytes. Eating foods high in water content, such as watermelon, grapes, and spinach, and magnesium-rich vegetables such as kale, broccoli, and cucumbers can help the body retain water. Using cold compresses on the head, doing activities closer to the start and end of the day when it’s cooler, and breaking up yard work into segments are all effective ways to let the body rehydrate and cool down to prevent heat headaches.
Thunderstorms, hot desert winds and changes in atmospheric pressure also affect the brain and become external triggers for headaches. In the atmosphere, during major weather events, the ratio of positive and negative ions changes. The body reacts to these changes as the blood vessels react and the level of serotonin in the brain changes.
“Those are the things that can’t be seen,” Wilson said. “But it’s an ideal time to avoid as many triggers as possible and be prepared to take medication.”
Can migraines be prevented?
If a patient has frequent migraines, Wilson advises them to be aware of the triggers that often cause an attack—and treat it preemptively.
A migraine goes through four stages:
- The prodromal phase occurs before the pain becomes apparent, often manifesting as fatigue, soreness, or feeling tired.
- During the aura phase, migraineurs experience sensory disturbances such as blurred vision, flashing lights, or tingling in the arms or legs.
- The pain appears in the headache phase, often manifesting as a pounding in the head.
- The postdromal phase is when the pain subsides, sometimes leaving the person weak or confused.
Not all migraine episodes go through all four stages, and not all migraine episodes involve a headache. Wilson found that a migraine sufferer was 70% successful in identifying whether they were going to have an episode in the first stage of migraine. Wilson says that if a patient takes medication between one and six hours after the prodromal phase of a migraine, then the attack will either not occur or will be relatively mild.
The caveat to this preventative treatment is that doctors like Wilson don’t want migraine sufferers with chronic migraines — patients with more than 15 headache days a month — to take medication for every migraine they have.
Levy also recommends patients using Botox as a preventative treatment. Botox, originally developed for use in the treatment of muscle tension in patients who have had a stroke, can be used to reduce pain-transmitting signals in migraines.
According to Levy, half of patients who receive Botox migraine treatment experience a 50% reduction in migraine frequency.
While medications are effective in reducing the burden of headaches, Wilson emphasizes the importance of lifestyle changes and avoiding both internal and external triggers.
“We want to make sure we don’t let our patients get into a chronic condition,” Wilson said. “The best way to prevent this is to teach them to change their lifestyle.”
Lifestyle changes
If you have a routine, try to stick to it as much as possible, Wilson advises — including weekends.
Wilson said the migraine brain “likes to be bored.” During the summer months, daily schedules often change – sleeping in later and engaging in all-day summer activities, often under the hot sun. Now that students have returned to school, those routines are changing again.
A very busy week followed by a relaxing weekend often leads to migraine headaches because there are too many fluctuations in the routine.
“The brain responds to routine much like when you’re a heavy caffeine drinker and then you suddenly stop, cold turkey,” Wilson said. “Your brain will react to it.
This is also why it is common to experience headaches and migraines when changing time zones or traveling.
Stress is also a common cause of headaches in migraineurs, Wilson said. Maintaining a calm routine and preventing stress will go a long way in preventing migraine episodes.
Other, smaller ways to prevent headaches are to listen to your body and pay attention to external triggers. If the light is too bright, look away or wear sunglasses. If the music is too loud, leave the area or turn it down a few notches.
“We really need to maximize and optimize the treatment of acute seizures so that when it happens, you’re not miserable,” Wilson said. “We migraine sufferers have to live life. We cannot be hermits. We want all tools to be able to enjoy life like everyone else.”