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As many as 28 million Americans, including 25 percent of all adult women, have migraine headaches. Migraine headaches are often misdiagnosed as sinus headaches because the pain is felt across the forehead and the bridge of the nose, just like sinus headaches.
The latest genetic and biological research shows that migraine headaches are a neurological, not a vascular, disorder. Treatment methods for migraine headaches are being developed to target peripheral and central nervous systems.
Migraine headaches involve recurring episodes (two or more a month) of head pain, plus sensitivity to light and sound. Nausea, vomiting, and neck pain can accompany the pain. Ten to 20 percent of the time, the person who is about to experience a migraine gets a warning, called an aura. An aura may be a tingling sensation or visual distortion (seeing zigzag lines) that lasts from 10 to 30 minutes.
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Migraine headaches are triggered by hormonal changes (caused by menstrual periods or estrogen), diet (particularly alcohol, chocolate, monosodium glutamate, caffeine, or marinated foods), bright lights, strong odors, stress, fatigue, or poor sleep patterns. Researchers believe they are triggered when nerves and blood vessels at the base of the brain stem interact to cause pain. However, biochemical processes in the brain and vascular disease, respectively, also are potential migraine causes.
It is nearly impossible for patients to determine the cause of their migraine episodes without undergoing clinical experiments. Daily fluctuations of variables, such as weather, diet, hormone levels, sleep, and stress, appear to prevent the conditions necessary to determine triggering factors.
Migraine Headaches Associated with Too Much, Too Little Weight
A review of studies conducted at Johns Hopkins University School of Medicine found both obesity and being underweight are associated with an increased risk of migraine headaches. Migraines affected 12 percent of adults in the U.S. Dr. B. Lee Peterlin and his colleagues completed a meta-analysis of 12 studies with approximately 300,000 participants to reach their conclusions. Patients and their doctors need to be aware that excessive weight and extreme weight loss are not good, and that maintaining a healthy weight can decrease the risk of migraine headaches. Obese people were 27 percent more likely to have migraine headaches than those at a normal weight, and those who were underweight were 13 percent more likely to suffer from the condition. Previous studies had shown that the link between migraines and obesity is greater for women and for those under the age of 55.
Treatment for Migraine Headaches
A physician might suggest changes in sleep or eating habits and will probably prescribe medicines to block the pain. Medications called triptans can prevent or treat migraine headaches. These drugs include sumatriptan (Imitrex), eletriptan (Relpax), and rizatriptan (Maxalt). Injectable triptans have an 80 percent success rate, and triptan tablets are thought to be 60 to 70 percent effective in treating migraine headaches. Antidepressants and drugs used to treat high blood pressure (including beta-blockers) also can help prevent migraines.
Injecting an anesthetic directly into trigger points in muscles of the neck may eliminate symptoms. The treatment also may reduce patients’ dependence on drugs, which can sometimes trigger additional headaches.
Over-the-counter drugs such aspirin, ibuprofen (Advil), and naproxen (Aleve), also may play a role in prevention of migraine headaches. The drug or combination of drugs that works best depends on the individual.
A class of drugs called CGRP monoclonal antibodies appears to significantly reduce the frequency of migraine headaches in clinical trials. Levels of CGRP are elevated during migraine attacks and decrease when the attacks subside. The new drugs reduce CGRP levels either by inactivating CGRP or disabling the receptor it seeks. The goal is to disrupt the chain of events that causes the pain. If proven to be effective, they will be the first new class of anti-migraine drugs in more than 20 years.
Occipital Nerve Stimulation
Occipital nerve stimulation is effective in controlling intractable migraines. Randomized trials conducted at the Cleveland Clinic Department of Pain Management showed significant improvement of the daily pain scores, as well as significant decreases in the number of headache days in those who received occipital nerve stimulation to treat migraine. In 2014, the FDA approved a battery-powered device called the Cefaly headband to prevent or reduce the number of migraine episodes by limiting pain signals.
Sensitivity to Light
Sensitivity to light is associated with more than 80 percent of migraine headaches. Harvard researchers found that exposing migraine headache patients to narrow-band wavelength green light significantly reduced their sensitivity to light and reduced their pain.
For related reading, please visit these posts:
- How to Overcome Migraines Naturally
- Migraine Symptoms: Treatment (and Prevention) Tips
- Ocular Migraine: Headache or Not, It Can Be Disturbing
- Migraine Triggers: 6 Food Additives to Avoid
- A Look at the Causes of Migraines and the Latest Migraine Treatments
This article was originally published in 2017. It is regularly updated.