Migraine Triggers and Treatments

Migraine headaches are considered the third most prevalent illness in the world, with a staggering 39 million Americans suffering from migraines. Perhaps more startling is that more than half of migraine sufferers are never diagnosed.

Migraine is not just a bad headache; it’s a chronic, debilitating neurological disease. Migraines are frequently misdiagnosed as sinus or menstrual headache because symptoms can be similar. During a migraine attack, changes in brain activity (often triggered by environmental influences) can cause blood vessels and nerves around the brain to become inflamed. The associated pain can be excruciating, causing the sufferer the inability to function normally during daily activities, including work.

While everyone is different, a common symptom of migraine is severe, throbbing or pounding pains on one side of your head or in the neck area. People with migraines often experience symptoms like nausea and vomiting, and sensitivity to light and sound. Other potential symptoms include a stuffy or runny nose, watery eyes, dizziness and mood changes.

Common triggers for migraine include:

• Diet—food or food additives, dieting, hunger, caffeine or alcohol.
• Dehydration.
• Sleep—too much or too little.
• Environmental factors—bright lights, glare, smells or odor, loud noises, changes in altitude or weather.
• Stress.
• Hormonal changes.

Migraine can also be hereditary. If a parent suffers from it, there is a 50 percent chance you will, too. The chance increases to 80 percent if both parents have migraines. Children can have migraine headaches as well. In fact, according to the Migraine Research Foundation, half of all migraine sufferers have their first migraine before the age of 12.

Lifestyle changes can go a long way toward preventing migraine headaches. Eat at regular intervals, don’t skip meals, gradually taper off your caffeine intake and exercise regularly. Since dehydration can be a trigger, drinking plenty of water is a good preventive measure. Someone who suffers from migraines should aim to drink half their body weight in ounces daily; e.g., a 100-pound person should aim for 50 ounces of water each day.

Headache experts agree that treating a migraine early, when the pain is in the mildest phase, can limit the disability, shorten its duration and lessen the recurrence of headache.

For patients suffering acute migraine headaches during the course of a month, your physician may prescribe a class of drugs called tryptans that block serotonin receptors to offer headache relief. People experiencing recurring and frequent severe migraine attacks might be prescribed preventive medications. These can include tricyclic antidepressants like amitriptyline, anticonvulsant medications (seizure drugs that can also prevent migraine) or high blood pressure medications. Migraine treatments can also include taking supplements like vitamin B2 and magnesium.

In 2018, the FDA approved a new class of medications for migraine—calcitonin gene-related peptide (CGRP) monoclonal antibodies—that blocks one of multiple chemicals in our bodies responsible for setting off migraine. “There are currently three CGRP monoclonal antibodies approved by the FDA,” says Kate Kennedy, a nurse practitioner at Overlake Neuroscience Institute who holds a certification of added qualification in headache medicine. “They are all injectable medications taken once a month, and are generally very well tolerated and quite effective in reducing migraine days in many patients.”

Multiple other medications are being researched currently that look at blocking other chemicals and pathways involved in migraine. A fourth drug—an infusion given every three months—will likely be approved in late 2019.

Device therapy is another type of treatment for migraines for people who want to avoid medications or cannot tolerate medications. There are three FDA-approved, noninvasive neuromodulation devices currently available. Although they are called stimulators, they actually turn down brain activity. They include:

• The Cefaly, a nerve stimulator placed on the forehead for 20 minutes daily for prevention of migraine or 60 minutes to stop a migraine.
• The Spring TMS, a transcranial magnetic stimulator that can be used to stop a migraine (two pulses to the back of the head, which can be repeated after 15 minutes) or four pulses to the back of the head twice a day to prevent migraine.
• The Gammacore, a portable vagal nerve stimulator that is approved for both cluster headaches and migraine. For migraine treatment, it is a two-minute stimulation on the neck over the vagal nerve and can be repeated after 15 to 20 minutes.

Biofeedback (a technique using monitoring devices) or relaxation therapy are other alternative treatments that can ease or prevent migraine pain for patients who prefer not to use medications.

Although there is no cure, migraines are treatable with your help and proper medical care. If you suspect you suffer from migraines, start tracking your symptoms and headache frequency and severity on a headache calendar.

A headache history is the easiest way for a doctor to diagnose and treat your condition. Record possible triggers, the medication you took to try to ease the pain and the response. You might also make connections with lifestyle issues that could help prevent your next big headache.