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Is This a Migraine, or Just a Whopper Headache?

How to tell the difference.

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A young woman with dark curly hair is using mobile phone. Female is smiling while holding smart phone. She is lying on sofa at home.

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Dear Doctor,

I’ve always been prone to headaches. I’ve had a couple of really bad ones in the last few months, and I’m starting to wonder if they could be migraines. What makes a headache a migraine, and what can I do about it?

Sincerely,

“Make it Stop”

Dear Make it Stop:

Everyone gets headaches from time to time, but migraines are different from your everyday headache. The World Health Organization has classified severe migraine attacks as among the most disabling illnesses there are, affecting about one in seven people worldwide. Although they are more common in women, they can affect any gender as well as people of all ages. Some signs that you might have migraines include a throbbing pain on one or both sides of your head that is severe enough to interfere with everyday activities. Additional symptoms often include nausea and vomiting, as well as sensitivity to the lights and sounds around you. You may find yourself lying down in a dark and quiet room for relief. In addition, some people experience an “aura”—visual disturbances that can include dark spots, bright spots, squiggly lines, or colors in your visual field.

If this sounds like your symptoms, see your doctor or go directly to a neurologist. Treating severe and chronic migraines effectively requires expertise.

The good news is there are now lots of treatments that can help manage your migraines. To break an occasional mild to moderate migraine headache, we often recommend non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, or triptans—prescription drugs that target the serotonin system. These agents are most effective when taken within two hours of headache onset. However, be careful not to overuse them (maximum three days per week), as frequent use can result in “medication overuse headaches.”

If your migraines happen frequently or if each one lasts for a long time, your doctor may want to put you on “prophylactic” medications, which are daily medications to prevent the migraines from starting in the first place. There are multiple categories of medications used for prevention, including ones that treat seizures, depression, anxiety, and high blood pressure. Although these drugs were developed for other disorders, they are effective in preventing migraines as well. In addition, an exciting new category of medications, known as calcitonin gene-related peptide (CGRP) inhibitors, was approved. These drugs target proteins that play an important role in the pathophysiology of migraine pain. 

If you have “chronic migraines,” which means that you have more than 15 headache days every month, and you are not responding to prophylactic drugs, you could be a candidate for botulinum toxin (Botox) injections, which have also been found to significantly reduce migraine frequency.

And new options are coming along all the time. In the meantime, pay attention to the lifestyle factors that can play a role in migraines. Dehydration, lack of sleep, skipping meals, or eating certain foods (such as processed meats, cheeses, or red wine) can trigger pain in many people. Keep a log and play detective. And then let your doctor know what you’ve discovered.

That’s a key take-home message about treating migraine: Although there are many options, there’s no magic formula that works for everyone. If you are diagnosed with migraines, you and your doctor have to work closely together to find the regimen that’s right for you.

“The good news is there are now lots of treatments that can help manage your migraines.”
Svetlana Faktorovich, MD

Next Steps and Useful Resources

  • Are you stuck in a vicious migraine medication overuse cycle? Here’s what you can do to help yourself.
  • Read what one woman wants you to know about her terrible migraines. 

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Published September 16th, 2019
A young woman with dark curly hair is using mobile phone. Female is smiling while holding smart phone. She is lying on sofa at home.

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