Understanding Your Migraine

Introduction
For a disease that affects over 36 million people in the US, migraine is still a poorly recognized and under-diagnosed disease. By 2018, the number of migraine-specific treatments available in the US will be almost double what was available 2 decades ago. Studies show that most people are rarely offered these treatments. We will discuss what you need to know about a migraine to make sure you are getting the best treatment to reduce disability related to this disease.

What is a migraine?
Migraine is brain disorders that causes time periods of changes in the brain that give you moderate to severe head pain, stomach upset, vomiting, and make lights and sounds more difficult for you to handle. The pain can be one sided, can get worse with movement, and can cause you to be stuck in bed instead of getting to work. These episodes can last anywhere from 4 to 72 hours and can occur numerous times a month. Sometimes you can get symptoms, such as seeing flashing lights, or losing part of your vision, or having difficulty with your speech, that can occur prior to the head pain. This is called an aura. While less common, aura can be a symptom of a type of migraine called migraine with aura. For up to 3.2 million people in the US, headaches can occur more than half the month, with about half of these headaches being migraine like. When this happens at least 3 months in a year, it is called chronic migraine.

You are not alone
Migraine is a common brain disorder. It affects over 36 million people in the US. Migraine is more likely to occur in women compared to men. Migraine can occur in any age group, from children to people in the later part in life. It is most common in your 20’s and 40’s and tends to improve for many women after menopause.

What triggers a migraine?
Migraine is a genetic disease. Most people with migraine have a family member who had migraines. You inherit a brain that is more likely to go into cycles of attacks that cause pain, upset stomach, and light and sound sensitivity. These attacks can be triggered by things in your environment. There are many things that can trigger migraine, but often, triggers will layer on each other before they cause an attack. Stress, weather changes, sleep irregularities, skipped meals, dehydration, hormone changes (prior to your period, or prior to menopause) are the most common triggers. For some people, certain foods can trigger migraine as well, such as MSG, processed foods containing high amounts of nitrates, alcohol, and excessive caffeine are a few common food triggers.

Keeping a calendar of your headaches and any changes in your life around the time they occurred may help you track your triggers. Certain applications you can download to your phone can help you track your headaches and triggers as well .
If you can identify a few consistent triggers, avoiding them can help reduce your risk of getting a migraine. Triggers can layer on each other, so avoiding multiple triggers together may give you better results (no alcohol when you have your period, or no fast food if you are stressed).

How do I treat a migraine?
Migraines are treatable, though there currently is no cure. When treating migraine, consider treating the current attack, but also ways to reduce future attacks.

When treating a current attack, you can use some lifestyle modifications along with medications called “abortive” treatments to improve the symptoms of a migraine. Combining both will be more helpful than just doing one alone.

When looking at ways to reduce future attacks, you can also use some lifestyle modifications along with medications called “preventive” treatment to help reduce the frequency of attacks (Table 2). Preventive medications should be discussed and prescribed by your healthcare provider. If you have made lifestyle modifications and are still having frequent headaches, consider seeing a health care provider to discuss options to help improve your migraines.

When should I see a healthcare professional?
If you are having frequent headaches (more than 1 day a week), or you have tried over the counter and lifestyle modifications and find them ineffective to treat your symptoms, consider speaking to your healthcare provider about a migraine. There are many options available to treat migraines and many new options on the way. Start the conversation with your primary care provider. This can put you on your way to better days with fewer migraines.

If you feel you have discussed symptoms with your provider and are still not improving, consider seeing a headache specialist. A headache specialist is a health care provider who has dedicated their career to taking care of people with headaches. They often have extra training in headache management and are usually up to date with the latest treatment options. Headache specialist can be nurse practitioners, physician assistants, primary care providers, dentist, pain specialist, or neurologists, who have received extra training in a headache.

Conclusions
A migraine is a common lifelong disease for which there is currently no cure, but there are a number of treatment options to manage and reduce attacks and symptoms. If you are having more days in bed due to a migraine than out living life, consider seeing a headache specialist to discuss your treatment options.