FAQs on Migraines
Migraine headaches occur from certain brain changes. These headaches are debilitating and contribute to lost time from work, school, and recreation activities.
How common are migraine headaches?
According to the Migraine Foundation, migraine headaches affect 38 million people in the United States—approximately 12% of the population. In addition, 18% of American women report having a migraine headache at some time during their lives. Migraines are more common during the productive years (25 to 55).
What are the symptoms of migraine headaches?
Symptoms associated with migraine are:
- Severe pounding and throbbing head pain
- Eye pain
- Sensitivity to noise and light
- Nausea and vomiting
What causes a migraine headache?
Migraine headaches occur due to certain brain chemicals and changes within the brain. Neurotransmitter levels are altered in patients with migraines. A number of factors tend to trigger (bring on) migraines. These include:
- Hormonal changes
- Oral contraceptives
- Strong loud noises
- Bright lights
- Certain foods (aged cheese, red wine, smoked meats)
- Artificial sweeteners
What are the risk factors for migraine headaches?
- Family history – Approximately 90% of people who have migraines have a family history of these.
- Age – Migraines can occur at any age, but they usually start in the late teens/early 20s.
- Sex – Women are three times more likely to develop migraine headaches. During childhood, migraines affect boys slightly more than girls, but this changes after puberty.
- Hormonal changes – Hormone replacement and oral contraceptives are associated with migraine headaches.
How are migraine headaches diagnosed?
The doctor will follow the criteria set by the International Classification of Headache Disorders. The patient must meet five of the following criteria:
- Headache that lasts 4-72 hours
- Headaches that are unilateral
- Headache of pulsating quality
- Headache that is moderate-severe
- Headache that is aggravated by routine activities
- Associated symptoms of nausea, vomiting, and/or noise/light sensitivity
How are headaches treated?
Treatment options for migraines include:
- Botox injections – Botulinum toxin A is used to treat migraine headaches. The doctor injects the forehead with this paralyzing agent. In a clinical study involving over 250 headache patients, those who received Botox reported pain to be significantly reduced, including a reduction in the duration of pain and the number of headache days.
- Occipital nerve block – Some patients respond to a nerve block. The doctor injects the back of the head with an anesthetic, which is placed near the occipital nerves. In a large review, these blocks were effective for many forms of head pain.
- Pain relievers – These include aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen.
- Triptans – To abort the headache, triptans are used. Examples include Axert, Amerge, and Frova.
- Ergots – These drugs contain caffeine and ergotamine, which work to abort the headache. Examples are Cafergot and Migergot.
- Anti-nausea medicines – For nausea, the patient may be prescribed Phenergan, Regland, or Compro.
- Opioids – These drugs are rarely prescribed because they have addiction potential.
- Beta blockers – Inderal LA and Betimol are used to prevent migraine onset.
- Calcium channel blockers – Verelan and Calan are used for prevention also.
- Antidepressants – Tricyclic antidepressants (amitriptyline and nortriptyline) reduce the frequency of migraine headaches.
- Anticonvulsants – Depacon and Topamax reduce the frequency of migraines.
- Acupuncture – This includes insertion of tiny needles into the back of the neck. Clinical studies show that acupuncture is beneficial for headache pain.
- Biofeedback – To relieve migraine pain, this relaxation technique uses special equipment to teach the patient how to control certain physical responses that are caused by stress.
- Cognitive behavioral therapy – This teaches the patient how to control body responses and change cognitive perceptions related to headaches.
Khalil M, Zafar HW, Quarshie V, & Fayyaz A (2012). Prospective analysis of the use of OnabotulinumtoxinA (BOTOX) in the treatment of chronic migraine; real-life data in 254 patients from Hull, UK
Jurgens TP, Muller P, Seedorf H, et al. (2012). Occipital nerve block is effective in craniofacial neuralgias but not in idiopathic persistent facial pain. Journal of Headache Pain, 13(3), 199-213.