Breaking down your migraine

Having a migraine isn’t the same for everyone, but for most people, these headaches all have one very unpleasant common denominator: pain. The types of pain and other symptoms can vary though, and Stephanie Vertrees, MD, headache specialist and assistant professor with the Texas A&M College of Medicine, breaks down migraines.

What is a migraine?

According to the Migraine Research Foundation, migraines are the third-most prevalent illness in the world and affect roughly 37 million Americans. However, although many people think a migraine is just an intense headache, that’s not necessarily the case.

“A migraine headache is a headache plus other symptoms,” Vertrees said. “Common symptoms can be sensitivity to light and noise or nausea, but other symptoms can also present themselves.”

However, Vertrees noted that it is possible to have a migraine with only these other symptoms and without having a headache. These are called complicated migraines. Other types of migraines are ocular migraines and hemiplegic migraines. Ocular migraines are temporary visual disturbances that can affect one or both eyes, and hemiplegic migraines are rare and can mimic symptoms of a stroke—such as weakness on one side of your body, a symptom that doctors call hemiplegia.

For most people, a migraine headache is much more painful than a tension or sinus headache, but the pain isn’t the same across the board.

“With migraines, the type of pain is usually pressure or throbbing, but not always,” Vertrees said. “Some people have burning or shooting pain, and their hair hurts. That can be due to involvement of nerves on the head.”

What are migraine triggers?

Most people who have migraines have a list of things that they avoid like the plague because they are their “migraine triggers.” Often the usual suspects will be chocolate, red wine, other alcohol or a bad night(s) of sleep. Other times people may say it’s a certain smell, such as paint thinner or a perfume. However, Vertrees notes that it’s rarely one specific trigger and there is usually more at play.

“It’s usually a cumulative effect of triggers that then pushes someone over the edge and causes a migraine,” Vertrees said. “I tell my patients about the ‘trigger burden’ versus one specific trigger. A lot of the burden can be lessened with lifestyle management—such as reducing stress, managing your blood sugar and having healthy sleep patterns.”

Certain foods can add to your trigger burden, such as aged cheese or foods with preservatives, and Vertrees recommended removing them from your diet if they lead to frequent migraines.

Sometimes, a condition called occipital neuralgia can lead to migraine. This occurs when the occipital nerve is pressured due to injury or tight muscles that entrap the nerves at the base of the skull or top of the neck.  Physical therapy or injections can help this issue.

Talking with your provider

Migraines can vary widely: some people may just power through them if it lasts an hour or two, while others may deal with them for days on end. Regardless, if you begin having frequent migraines, you should bring it up at your next health care visit.

“If a headache or a migraine is debilitating, then you should see a health care provider,” Vertrees said. “If there’s been a change in a way a headache presents itself or an increased frequency or severity of the headaches, then we’d want to rule out secondary causes for migraines.”

Vertrees stressed the importance of bringing your symptoms up with your provider and not just constantly taking acetaminophen or ibuprofen to treat the headache.

“If a person is repeatedly taking over-the-counter medications for their frequent migraines, then they should be seen by a provider,” Vertrees said. “Otherwise, they risk medication-overuse headaches—previously known as rebound headaches.”

Symptoms of medication overuse headaches may differ from the original headache and begin to feel better when they’re treated by medication but return when the medication wears off.

‘Frequent migraines and headaches aren’t normal,” Vertrees said. “If they start interfering with your life, then you should bring it up with your healthcare provider and ask about getting on some headache treatment.”