“Oh no, not another Migraine! What can I do?”
Migraines are a common, recurrent, incapacitating headache, which chiefly afflicts women. Migraines can cause significant pain for hours or even days with awful symptoms such as nausea, vomiting, and extreme sensitivity to light and sound. They may be accompanied by sensory warning symptoms or signs (auras), such as flashes of light, blind spots or tingling in your arm or leg.
When a migraine hits, all you want to do is to find a dark, quiet place to lie down and pull the covers over your head.
You are not alone. More than 18 million women, as compared to 5 million men in the United States are migraineurs. It is interesting to know that migraines often occur in women who suffer depression and the reverse is also true: those who suffer migraines are more likely to experience depression. Women with migraine headaches have a worse prognosis (outcome) than men. It appears that the onset of migraines has some gender specific pattern; for example, in girls the onset of migraine headaches is often closely linked to menarche (the start of your period). Also, just like we discussed in the link on Premenstrual Dysphoric Disorder (PMDD) earlier in this blog, often these headaches are worse just prior to the onset of your period. This may be one reason that women suffer migraines more often than men…our sex steroids (estrogen and testosterone) fluctuate dramatically each month. Some women are vulnerable to these changes in sex steroids each month, which may precipitate a migraine or mood symptoms. Men just don’t have these same monthly changes.
“Help!! I am missing school and work!! What is the cause of these headaches??”
Although much about the cause of migraines isn’t understood, both genetics and environmental factors are likely to play a role.
It is believed that migraines are caused by changes in the trigeminal nerve, a major pain pathway. Imbalances in brain chemicals, including serotonin — which helps regulate pain in your nervous system — also may be involved. Again, remember the importance of serotonin when we were talking about PMDD or depression. As you know, many of the antidepressants try to increase serotonin to treat depression or PMDD, just as some of the most important medications in treating migraines attempt to do as well.
When the serotonin levels drop during migraines, this change may trigger your trigeminal system to release substances called neuropeptides, which travel to your brain’s outer covering (meninges). The result is headache pain.
“What are the risk factors?? What should I avoid?”
One of the major risk factors is family history. If your mother, for example, had migraines, then you are more likely to get them. As mentioned before, women are at increased risk. Premenopausal women are more likely to suffer with migraines, especially between the ages of 30 to 39. Fluctuating hormones may precipitate migraines in women who are sensitive to these changes. So you are more likely to have a migraine just before or during your period when the hormone levels changes the most. Migraines may also change during pregnancy or menopause. Some women report that their migraines got worse during the first trimester of a pregnancy; others report the onset of migraines after the birth of a child. Fortunately, the migraines are likely to improve during later stages in the pregnancy. After menopause, when the sex steroids no longer fluctuate to a significant degree, the headaches may decrease as well.
You cannot do much about these family and gender risk factors.
But thankfully, there are some migraine triggers that you can control. The goal is to learn to manage the following potential unique factors that may leave you vulnerable.
Food Triggers:
Food triggers may vary based on the individual. During susceptible times, like right before your period or when you’re really stressed out, you may want to avoid common food triggers. Common offenders include alcohol, aged cheeses, chocolate, aspartame (a sugar substitute often used in diet cola and other products), overuse of caffeine, monosodium glutamate, salty foods, and processed foods. Keeping a food diary may help you to identify your personal food triggers. It is also important not to skip meals. Generally, safe foods include rice, fresh cooked vegetables, water, and cooked or dried non-citrus fruits like cherries, cranberries, pears or prunes.
Stress Triggers:
Folks need to be careful and observant in order to figure out their stress triggers. For some, a change in sleep pattern may leave them more vulnerable. It is important to maintain a regular sleep schedule. For others, feelings of being stressed out at work or home cause changes in the body that precipitate a migraine. Try to take time to practice stress management techniques such as relaxation therapy or breathing exercises on a regular basis to manage stress of daily life.
Medications and Illicit Drugs:
Be an observer of yourself. Do any prescribed, over the counter or illicit drugs exacerbate the frequency of your headaches?
Environmental Triggers:
You may need to avoid sun glare, bright lights, loud sounds, and strong smells (such as perfume, smoke, paint fumes). Try to figure out if a sudden physical exertion causes a trigger for you. Sometimes even a change in the weather can increase the chances of a migraine.
“So, I know what causes migraines and what my triggers are. What can I do to prevent these headaches?”
Prevention
Many individuals benefit greatly from medications. Standard acute medical treatment of migraine may include the administration of any of the triptans (can be administered by pill, injection or inhaled) that are serotonin (5-HT) receptor agonists. The administration of the triptans results in an increase in 5-HT receptor stimulation with an increased inhibition of the headache pathway. There are other medications that may be very helpful to you in the management of your symptoms. Various other medical treatments should be discussed with your physician.
In addition to the acute and preventive medications, patients often benefit from lifestyle changes that can be incorporated into your daily activities.
Watch out for your triggers: Be proactive. Avoid foods that you notice which precipitate headaches in you. Avoid places where the scents give you a problem. Daily predicable routines are often key…with regular sleep and eating patterns. Watch carefully when you experience an increase in stress and incorporate stress management techniques such as meditation, deep breathing exercises, visual imagery or whatever skills work for you.
Start a regular exercise program: If I were to prescribe a magic bullet …it would be exercise. Regular aerobic exercise reduces stress and tension which can precipitate migraines. Talk with your physician about how to best begin. Pick any activity that you enjoy: walking, biking, swimming, hiking. It may be helpful to recruit a partner to help keep the exercise regime on track.
Observe your menstrual cycle: if you notice that your headaches are associated which changes in your menstrual cycle then you may be one of the women sensitive the hormonal declines. If so you may benefit from some medications such as birth control pills or hormone replacement therapy. Talk with your doctor about the best alternatives or dosages for you.
Natural remedies: Some research suggests that foods rich in magnesium or magnesium 
supplements may be helpful in preventing migraines (Sun-Edelstein, 2009). Talk with your doctor before deciding to take any nutritional supplements.
It is an awesome accomplishment to learn to manage migraine headaches. You may not be able to stop them completely, but how wonderful if you manage to decrease the frequency. Then you have that much more time to make a difference in yourself and in your world!
References:
Sun-Edelstein C, Mauskop A. Foods and supplements in the management of migraine headaches. Clin J Pain. 2009 Jun;25(5):446-52.
Warnock JK, Clayton AH. Chronic Episodic Disorders in Women In Psychiatric Clinics of North America. Kornstein S and Clayton A, editors. WB Saunders Company 2003 26(3):725-40.
http://www.mayoclinic.com/health/migraine-headache/DS00120/DSECTION=causes
