Approximately 90% of individuals in the United States experience headache during their lifetime. There are several types of headaches, such as tension-type headache, migraine, cluster headache and others.
Headaches are common: The World Health Organization (WHO) estimates that half of the world’s adult population has some form of headache disorder. Among these people, 30% experience migraines.
Migraines are a type of headache, but it has symptoms that differ from other headache types, such as sensitivity to light and sound, as well as associated nausea and vomiting.
“Most people with migraine are not able to function during the headache, which is different from tension-type headaches, in which people can function,” says Dr. Natalia Murinova, director of the UW Medicine Headache Clinic.
Whether you get migraines and are looking for better treatment options or aren’t sure if the headaches you experience are migraines, experts from the Headache Clinic have advice you can use.
What are migraines?
Your headaches are likely migraines if you have intense, throbbing pain on one side of your head along with other symptoms like sensitivity to light, sound and smell; nausea or vomiting; or seeing spots or lines of light.
Migraine pain is usually worse than the pain of other headache types.
During a migraine, the brain is essentially in overdrive. Brain cells called neurons go into hyperexcitability, there is increased inflammation, an increased release of peptides such as CGRP (calcitonin-gene related peptide) and changes in the way the brain modulates serotonin, a neurotransmitter.
“We have a lot of evidence from functional imaging studies that show migraines are generated in the hypothalamus, part of brain that makes sure the brain is in equilibrium and regulates basic functions such as sleep, hunger and emotions,” Murinova explains.
What causes the brain to enter this hyperactive state? Genetics along with environmental changes that can trigger internal changes — though what those are varies from person to person.
Migraines can last up to several days, and in some people they become chronic and occur daily. Migraines start with a prodrome phase before the pain sets in and a postdrome stage as the pain fades. Prodrome can occur a few hours to days before pain sets in and involves symptoms such as fatigue, frequent yawning, food cravings, irritability, difficulty concentrating and insomnia. Postdrome may happen after a migraine, can last a day or two, and involves brain fog, fatigue and depressed or euphoric mood.
What are common migraine triggers?
From stress and lack of sleep to not eating or drinking enough to hormonal changes, there are many different migraine triggers. Individually they may not cause a migraine, but together they can.
Foods — everything from cheese and chocolate to substances like coffee or alcohol — can also trigger a migraine. For someone who is prone to migraines, just smelling something potent or being in bright light can be a trigger.
There is a big debate if these are true triggers that activate migraines or if a migraine would have occurred regardless, Cuneo and Murinova say.
“For most people it’s cumulative: We stay up late watching Netflix, we don’t exercise because we don’t have time for ourselves, we skip meals, we’re stressed from the pandemic,” says Dr. Ami Cuneo, a neurologist at the UW Medicine Headache Clinic.
When the trigger happens, the brain overreacts, kind of like how your immune system overreacts to pollen and gives you spring allergies.
What is aura?
Another unique aspect of migraines that doesn’t occur with other types of headaches? Aura.
Up to 30% of people who get migraines also get aura before or during migraine, and most of them get visual aura. It’s a visual disturbance that can look like flashing lights, zig zags, blurry spots or even temporary loss of vision lasting from five minutes to one hour.
There are other types of aura such as sensory aura, which involves a tingling sensation in one side of the body; and language disturbance, which makes it hard for someone to speak.
Aura usually starts before migraine pain and lasts anywhere from a few minutes to an hour.
While aura can happen on its own, without being followed by a migraine, you may want to see a doctor if this happens to you or if you’ve never had aura with migraines before and suddenly do. The visual disturbances of aura need to be differentiated from other neurological disorders such as stroke or transient ischemic attack (TIA).
“The way to differentiate migraine aura from TIA or stroke is that usually aura won’t last longer than an hour, it is gradually progressive, your vision doesn’t go completely dark and there are vision changes like flashing lights,” Murinova says. However, if this is your first attack, she recommends being evaluated in urgent care or going to the emergency room.
What treatments work best for migraines?
Treating migraines isn’t just about treating pain or other symptoms — it’s about giving people back the loss of time and activity that migraines take away.
According to 2019 data from the Institute for Health Metrics and Evaluation’s Global Burden of Disease study, headache disorders, including migraines, were one of the top causes of health loss among people under age 50 worldwide.
While migraines can cause disability, there are more options than ever to treat them.
“There’s never a good time to have migraine, but in the history of time we have more targeted therapies now than there ever were, and we also have neuromodulating devices that help address nerve function in the moment,” Cuneo says.
Experts don’t know exactly how neuromodulation works to treat migraines. They think that the electromagnetic stimulation can normalize brain function, Cuneo and Murinova say. The goal is to normalize brain activity and prevent migraines. Using neuromodulation to treat migraines is most commonly done using at-home devices you buy on your own. They can be expensive, but some of the devices are covered by insurance.
Medication, exercise and sufficient sleep are all important parts of migraine treatment, too. Finding the right balance of all these things is often key to successfully treating someone’s migraines.
“People come to us and say they’ve tried everything, but they’ve tried it separately, not together,” Murinova says. “Many people will try many medications, however not long enough, or they have side effects. They often do not incorporate neuromodulation, supplements and lifestyle changes.”
It’s important for people who get migraines to avoid over-the-counter painkillers, such as Tylenol and Advil. Taking these medications can result in medication overuse headaches (yes, the medications end up worsening headache pain). If someone has medication overuse headaches, treating their migraines can be more difficult unless the medication overuse is addressed.
Can migraines be prevented?
Medications designed to help prevent migraines — such as CGRP (calcitonin gene-related peptide) inhibitors — can give someone relief and give them more headache-free days than they had without medication.
Other types of medications that can be helpful include antidepressants, Botox, beta blockers and anti-seizure medications.
There is a type of therapy called cognitive behavioral therapy (CBT) that can be helpful for people with migraines. CBT for migraines helps people learn how to cope with symptoms and change their behavior to help them avoid migraine triggers.
Of course, lifestyle changes such as getting more sleep, being more physically active, drinking more water and eating regular meals can help prevent migraines as well as reduce stress.
If you have or think you may have migraines and are looking for treatment options, it’s important to talk with your medical provider and consider a referral to a headache specialist.
“There is always hope, now more than ever. We have new treatment options. You can start steps toward healing yourself before you see an expert with exercise and lifestyle changes, and we are here to help you in your healing journey using multimodal therapy,” Murinova says.