Dealing with Migraines: It’s More Than Just a Headache

As more than 36 million Americans know, the process of preventing, treating, and managing migraine headaches is one of the most onerous health problems anyone can face. Calculated annually, migraines cost an estimated $20 billion dollars last year in medical expenses and lost productivity, making it clear that they have an extensive impact on daily life, both professional and personal. 

While there are no guaranteed short, quick-fix answers to migraines, there are ways to get rid of a migraine fast. There are several keys to speedy relief: (1) understanding what migraine headaches are and how they work (2) knowing the specific individual symptoms and the best ways to deal with them (3) employing an array of effective treatment options.

So what exactly is a migraine? Simply put, migraine headaches are episodes of intense throbbing or pulsing sensations in one area of the head or body, with that basic symptom commonly accompanied by nausea, vomiting and extreme sensitivity to light, sound or both. Left untreated, they usually last anywhere from 4-72 hours, with a severity level ranging from mild to extremely debilitating.

Migraines can be divided into several categories, some very broad and others quite specific, and knowing which kind of migraine you’re experiencing is one of the keys to quick relief. The two most basic categories of migraines are common migraines and classic migraines.

Common migraines, which are sometimes also known as probable migraines, are often more severe versions of normal headaches, with some migraine symptoms. Classic migraines, meanwhile, always include some level of the key migraine symptom, which is known as an aura symptom.

In lay terms, aura symptoms can be described as a series of sensations and feelings that normally start anywhere from 10-30 minutes before the migraine itself. They include seeing flashing lights, jagged lines or blind spots, along with having a disturbed sense of smell, taste or touch. A lack of mental acuity may also occur, which victims often describe as feeling “fuzzy.”

These aura issues affect 1 in 5 migraine sufferers, and they are sometimes accompanied by a variety of other pre-migraine symptoms, such as constipation, food cravings, hyperactivity, irritability, neck stiffness, or uncontrollable yawning.

Why are aura symptoms important? If they are severe, they can also indicate the presence of more serious problems, such as brain stem bleeding, that obviously require immediate medical treatment. And if aura symptoms aren’t as serious, they provide a warning that a migraine sufferer has encountered a so-called trigger and should seek some kind of immediate relief.

With regard to the more specific types of migraines, those that last for 15 days or more are referred to as chronic, and people who suffer from this type of migraine frequently have aura symptoms that can last for a week after the attack itself. (Postdrome symptoms are the other type of symptom that can occur after a migraine, producing a feeling of being drained or “washed out.”)

To get even more specific, retinal migraines include visual symptoms along with the usual aural issues. Perhaps the most controversial diagnosis is abdominal migraines, which tend to affect children and often begin with a stomachache that is frequently cured by a nap. Many of those who experience abdominal migraines as children go on to have either classic or common migraines as adults, but the diagnosis of abdominal migraines has yet to be backed up by a conclusive body of research.

The first actual step in finding quick relief is to know your triggers. There are three basic groups of migraine triggers:

o Food triggers. These typically include aged cheese, soy products, hot dogs and lunch meats, caffeine, and alcohol, most frequently red wine. Skipped meals can also be a trigger, along with certain food additives such as monosodium glutamate (MSG) and artificial sweeteners like aspartame.

o Environmental triggers. These include sudden weather changes, the presence of bright lights, different pollutants, and certain odors. Obviously, there are a lot of individual variations in this category.

o Physical triggers. Fatigue is the most commonly cited physical trigger. Many migraine sufferers experience a feeling of being run down before a migraine, and too much sleep can sometimes be just as much of a problem as too little. Menstrual-related hormonal changes frequently trigger migraines for many women as well.

When it comes to getting quick relief, triggers serve two important functions. They provide warning that a migraine is about to happen, often helping the victim to get to a less stressful environment and start implementing whatever treatment options work best.

Treatment is more complicated, and is based to some extent on knowing more about the causes of the migraine itself. Genetic and environmental factors obviously play a significant role, and intense physical activity can cause migraines as well.

Migraines can also  be caused by a neurovascular disorder in which blood vessels become enlarged, particularly the temporal artery, which is one of the largest blood vessels in the brain area. When this happens, chemicals are released from nerve fibers that are coiled around the blood vessels, causing pain, inflammation and further enlargement.

Chemical changes in the brain itself can also cause migraines. One of the most frequent causes is overproduction of serotonin, a key brain chemical. This can occur naturally for some individuals, but it can also be caused by overuse of drugs used to treat migraines. Anti-depressants such as Zoloft, Prozac, Paxil, etc. are the most frequently cited examples of drugs that can cause serotonin buildup.

Finally, another purely medical cause involves chemical or physiological changes in the brain stem itself, which can affect the operation of the trigeminal nerve, a major pain pathway in the brain.

The path from diagnosis to treatment usually starts with a blood test. Blood tests are used to determine whether there are problems in the blood vessels themselves. They also help doctors detect or rule out the presence of infections in the spinal cord, or the presence of toxins in the body or the brain.

CT scans are often the next step in the diagnostic process if more specific information is required. These scans can also be used to rule out or detect the presence of tumors, infection, brain damage or bleeding in the brain. The final tools in the diagnostic kit is  are the MRI or a spinal tap, both of which can also be used to further analyze these possibilities.

Treatment itself can be divided into three fairly broad categories — drugs, alternative medicine and home remedies, with drugs usually bringing the quickest relief from severe migraines. Drug types can be further divided into two categories: (1) acute or abortive drugs that are taken during attacks and are designed to stop symptoms that have already started (2) preventive medications taken before an attack, often on a daily basis, to reduce severity or frequency.

The most common drug treatment is over the counter medications, which are especially effective in providing fast relief for milder migraines where the symptoms are less severe. These include aspirin, ibuprofen and acetaminophen, which are often combined by different manufacturers in proprietary products and formulas (e.g., Excedrin Migraine). While they are generally effective, the one major drawback of these kinds of drugs is that they can cause complications when overused on a consistent basis.

In the world of prescription drugs for migraines, the most commonly recommended drugs are called triptans, which work by constricting blood vessels and blocking pain pathways in brain. They are more effective than over the counter meds when it comes to providing quick relief, but the side effects, which include nausea, dizziness, drowsiness and muscle weakness, can be more severe as well. The most frequently prescribed triptan is Sumatriptin.

Ergots are the second most commonly prescribed drug for migraines, and they are often combined with caffeine. They are considered generally less effective than triptans, and they may worsen nausea or vomiting symptoms and lead to the same kind of overuse headaches associated with over the counter meds. 

Other prescription treatments include butalbital, a barbiturate that is sometimes combined with acetominophen, caffeine, aspirin or codeine. Narcotics such as oyxcodone are occasionally prescribed, as are narcotic nasal sprays such as  or tramadol. Naprosyn is another oft-used prescription drugs that has proven effective for some migraine victims.

One of the bright spots on the drug horizon is a new subcutaneous, needle-free treatment called Sumavel DosePro. In initial studies, freedom from pain occurred in less than two hours for 61 percent of the patients who took it, with 33 percent of those in clinical trials experiencing relief within 15 minutes.

Preventive medications represent the other side of the prescription drug approach. They are normally used or recommended for those experiencing four or more attacks a month, with the attacks lasting longer than 12 hours. They are also used frequently if pain relief medications aren’t helping, or if symptoms include prolonged aura issues with numbness or weakness.

The most commonly prescribed preventives are beta blockers, which include cardiovascular drugs, antidepressants, anti-seizure drugs and Botox.

If drugs don’t work, the medical treatment of last resort is migraine surgery, which involves the decompression of certain nerves around the head and neck to alleviate symptoms.

The final refuge for migraine sufferers who wish to avoid drug or medical treatments is home remedies and alternative medicine. These approaches vary widely on an individual basis in the level and amount of relief they provide. Some migraine victims report instant relief from certain types of alternative medicine or home remedies, while others experience no positive effects at all. They can also be preventive or provide immediate relief, depending on the reaction and approach of the individual.

The most common forms of alternative medicine used to treat migraines are acupuncture, biofeedback, massage therapy, and cognitive behavior therapy. Supplements containing herbs, vitamins and minerals also fall under the alternative medicine umbrella, with the best options being butterbur and feverfew on the herbal side and the most often used nutritional supplements containing riboflavin and magnesium.

Home remedies vary even more widely. Some people find salt consumption provides relief from a migraine, either before or after symptoms develop. Others find relief from ice wraps, and scalp massage has also been cited as being effective, with some people preferring temple massage and others choosing to avoid that particular area of the skull completely. There are dozens of other home remedies, some of which are based on folklore, cultural wisdom or both.