Recognizing and Managing a Migraine Headache

MIGRAINE HEADACHES

According to the American Headache Society, migraines are the most common headaches for which people seek help in the United States. Little is known about why some people get migraines while others do not. In some cases, there is one common thread that links many migraines: That is, in some cases, it appears to be genetic. If you believe you have migraines or have been diagnosed with them, look at your family history, and it may give you a clue. Moreover, they might be associated with underlying stress, anxiety, or depression. They may be due to abnormal nerve transmission or inflammation of the brain, or they may be caused by environmental factors or hormones. If you are interested in exploring other causes of headaches, read more here.

Suffering From a Severe Headache

Many of the trigger factors commonly associated with headaches—such as stress, hormonal changes, and environmental stimuli—can also provoke migraines. Interestingly, migraines may, in turn, heighten sensitivity to these very triggers, leading to symptoms like photosensitivity (light sensitivity) and osmophobia (aversion to smells).

Unlike typical headaches, migraines often present with a combination of symptoms, including nausea, visual disturbances, and intense throbbing pain. Severity can range from mild to completely debilitating, interrupting daily routines and requiring extended recovery periods.

Recognizing and managing a migraine headache will help you understand your symptoms and help you get a handle on them. Read on.

Stages if a Migraine

Mayo Clinic recognizes four typical stages of a migraine: Prodrome, aura, attack, and postdrome (lasts from a few hours to a couple of days). These stages occasionally overlap.

1. Prodrome

This phase can last for hours to a few days. It tends to involve behavioral changes from depression to anxiety, excitability, and Irritability. Or, it may be manifested by greater thirst and food cravings. Sometimes, there is increased urination or fluid retention, constipation, muscle stiffness (especially of the neck), and even yawning.

2. Aura

Auras usually begin a few minutes before a migraine; they can sometimes continue into the migraine, or they can start during the migraine.

These involve a distorted response by one of our senses. For example, during a photophobic reaction, the eyes may become extremely sensitive to regular light, flashing lights, or even visualize bright spots or wavy lines. Hyperacusis, a distorted reaction to sound, can also occur. And osmophobia, a distorted response to smells, sometimes precedes a migraine. Occasionally, a migraine is accompanied by blurred vision or vision loss, difficulty speaking, confusion, and tingling of an extremity. Rarely does a person's migraine become so severe that unusual movements occur that are similar to a seizure.

3. Attack

This phase is the actual onset of the headache and can last anywhere from four hours to up to 72 hours if left untreated. This is typically characterized by a throbbing, usually felt on one side of the head, but can occur on both sides. In addition to having a headache, the migraine may be accompanied by nausea and vomiting.

At this point, physical activity tends to make the migraine worse.

4. Postdrome

This stage can last from a few hours to several days (the average is about two days). During this period, the migraine sufferer is recovering, feeling tired, dazed, confused, and sometimes achy feeling. Sometimes, this feeling is described as similar to a "hangover."

Migraines can be chronic and debilitating, occurring more than 15 times per month. Others get them rarely.

Recognizing and Managing a Migraine Headache -

General Recommendations for Treatment

• If you do not know the precipitants of your headaches, try to identify them by using a headache diary to find a connection - what you were doing when it came on, what you ate, and so on.

• Alter your surroundings or attempt to avoid the cause.

• Rest in a dark, quiet, and comfortable place when you feel a headache coming on. Sleep.

• Use relaxation and deep breathing techniques.

  -Try Progressive Muscle Relaxation Exercises: This is done by tightening muscle groups for eight seconds then relaxing them for several seconds: Begin with facial muscles, with the face, moving to the scalp - tighten muscles eight seconds, then relax; then the neck, doing with each muscle group of the chest, back, pelvis, extremities and so on. This releases some tension and stress. If you do not have time to move through all of your muscle groups, do this with those muscles you believe have the most tension.

• Pressure Points: One approach sometimes used to relieve these headaches is that of using a pressure point. Pressure point LI-4 is also called Hegu (her-goo). It is found on the back of your hand. It is between the base of your thumb and index (pointer) finger. Doing acupressure on this point can help with pain and headaches. Other pressure points can be found here.

• Acupuncture

• Cold compresses (to the head or neck) for15-20 minutes at a time.

• Hydrate well

• Massage

  
  

Over-the-Counter

NSAIDS: Ibuprofen (common: Advil, Motrin), naproxen sodium (common: Aleve, Naprosyn), and the combination of caffeine, acetaminophen, and Aspirin (common: Excedrin Migraine, Goody’s Powder). These are probably the best choices for headaches. Try to take NSAIDS with a little bit of food (as simple as a cracker) to avoid stomach irritation. If your headache is minor, take the lowest dose. If it is moderate, take the higher recommended dose.

Acetaminophen (common: Tylenol). 

Take as directed over-the-counter if there are no contraindications.

Try to treat early on in the headache: It is easier to stop pain if you attack it early rather than waiting until it is full-blown.

Natural Remedies and Approaches

• Peppermint

• Rosemary

• Lavender

• Eucalyptus

• Butterbur

• Caffeine

• Chamomile

• Magnesium

Prescriptions

Fast-acting, well-known triptans such as sumatriptan (Imitrex) or Zomig (zolmitriptan), taken early in the migraine attack, in combination with a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen or naproxen, are often sufficient for managing a migraine. In addition to oral forms, Sumatriptan (Imitrex) and zolmitriptan (Zomig) are available in injectable, oral, and nasal forms, which tend to work faster than oral medications. These are some of the more commonly used.

​There is an advantage of having a prodrome or aura phase - You can use these medications preventively during those times before the migraine fully attacks - thereby often averting the worst of the actual attack.

Often, an anti-nausea medication may be prescribed as well.

Prevention

Preventive medications can be very helpful. These include such prescription medications as metoprolol (Lopressor), propranolol (InnoPran, Inderal, others), amitriptyline (Elavil), Divalproex (Depakote), topiramate (common: Topamax), or erenumab-aooe (Amovig)-used once monthly$$$$. These can be taken regularly to help stave off dreaded migraines. If you are interested in these, discuss them with your healthcare provider.

When to See a Doctor for Headaches or Migraines

If you’ve never talked to a primary care provider or neurologist about your headaches, it’s worth having that conversation, especially if your symptoms are:

• Recurring or increasing in frequency

• Severe or disabling

• Associated with nausea, aura, or sensory sensitivity

A thorough evaluation can help rule out other causes and confirm a migraine diagnosis, ensuring you get proper treatment and avoid misdiagnosis.