Why You Get Migraines and What to Do About Them

If you’ve ever experienced the throbbing pain of a migraine, you know how difficult it can be to carry on with your normal routine — especially if you’re one of the 14 million people who experience chronic daily headaches.

More than 90 percent of sufferers are unable to work or function well during these headaches. That’s because migraines are not just really bad headaches. The World Health Organization classifies severe migraine attacks as among the most disabling illnesses, comparable to dementia, psychosis and even quadriplegia.

And it’s not only the headache sufferer who is impacted: American employers lose more than $13 billion each year as a result of the 113 million lost work days due to migraine, the Migraine Research Foundation reports.

Over 27 million women in the United States are affected by migraine. Women are three times more likely to have migraines than men, says Dr. Merle Diamond, managing director of The Diamond Headache Clinic in Chicago.

One determining factor might be estrogen. “It’s the drop in estrogen level that occurs just before, or at the time, of menstrual flow that sets off the migraine in predisposed women,” reports Dr. Ronald M. Andiman, director of The Headache Clinic at Cedars-Sinai Hospital in Los Angeles.

But there’s a silver lining: In two-thirds of women, the migraines will stop after menopause because those estrogen levels drop and no longer fluctuate, Andiman says. In fact, after age 50, both the frequency and severity of attacks in both men and women will drop off.

“We’re not sure why, but it’s most likely due to blood vessels being stiffer and less affected by the inflammatory peptides released near pain-causing fibers,” Diamond says.

Putting your finger on what causes a migraine can be difficult, since almost any factor can trigger an attack if you’re prone to migraines. To make things even more confusing, your threshold fluctuates and can change over time; what sets off a migraine one time may not set one off the next.

For some, it’s exposure to loud or excessive noise; for others, bright or fluorescent lights. Then there are lifestyle factors to consider, like an alteration of your sleep-wake cycle, missing or delaying a meal, underlying depression, stress or medications or foods.

“Popular consensus includes additives such as MSG, sugar substitutes, nitrates and nitrites used to preserve meats, chocolate, aged or hard cheeses and alcoholic beverages,” Andiman says.

Some people can sense that a migraine is imminent. One or two days prior to an attack, there may be subtle changes like constipation, depression, food cravings, irritability, neck stiffness, uncontrollable yawning and even hyperactivity, according to the Mayo Clinic.

Although no one test can definitively diagnose a migraine, there are generally accepted guidelines that define it. Andiman says: “These criteria were developed by world experts based on their experience and that of many clinicians and scientists.”

Migraines are diagnosed by the symptoms you describe, most commonly pulsating or throbbing pain on one side (or both sides) of your head, sensitivity to light, sounds and sometimes odors, blurred vision, nausea and vomiting, lightheadedness, pale facial color, and sweating or cold hands, according to the Mayo Clinic. The pain is not always limited to the head: It can also cause aching in the sinus, jaw or neck, according to the National Headache Foundation.

There’s another, less common form of migraine, known as migraine with aura, which occurs in approximately one-fifth of migraine sufferers and has a genetic link (although migraines in general tend to run in families). “First-degree relatives have a fourfold risk over the general population of developing migraine with aura,” Andiman says.

A migraine of this type can make you feel like you’re witnessing a wild light show: It’s preceded or accompanied by sensory warning symptoms like bright spots or flashes of light and may sometimes result in a temporary, partial loss of vision. (The symptoms will resolve completely in 10 to 30 minutes).

Although this aura will precede the migraine, it is possible for the aura to occur without a headache. Many people report feeling washed out or drained after it’s over.

Don’t ignore a sudden — or different — headache. Although headaches can be caused by many reasons, anyone who develops migraines starting later in life, especially after 50, should be thoroughly evaluated by their physician, cautions Diamond, who says it’s vital to rule out other conditions, such as a brain tumor, aneurism, or infection. That can typically be done with a CT scan and MRI.

Treating a migraine can be challenging, and the approach and number of treatments has changed dramatically over the years. There are well over 100 drugs, surgical treatments and devices available.

Once thought to be caused by the dilation and constriction of blood vessels in the head, migraines are now believed by some researchers to be a disorder involving nerve pathways and brain chemicals and genetics as well. As a result, many times the treatment changes and involves much trial and error — and may even prove ineffective over time.

Some of the medications commonly used to treat or reduce the symptoms of migraines include Imitrex, Floricet, Relpax, Maxalt, Aleve, Zomig and Cafergot, as well as some antidepressants. Medication may be taken during migraine attacks or preventatively, to reduce severity or frequency.

In 2010, the Food and Drug Administration (FDA )approved Botox as a preventative treatment option for chronic migraines, which is typically injected along the bridge of the nose, the temples, forehead, back of the head, neck and upper back once every three months over a 15-month period.

Non-drug treatments that may be helpful include acupuncture, biofeedback, massage, tai chi, feverfew, butterbur, magnesium, riboflavin and coenzyme Q10.

A fast-acting topical gel, still being tested, has shown promise by reducing inflammation, which is thought to be a key factor in the development of migraine attacks. Its formula, based on the nonsteroidal anti-inflammatory drug (NSAID) ketoprofen, is absorbed quickly through the skin.

In addition, researchers are feeling especially encouraged with two new preventative drugs currently being tested.

“This is really important since there are no preventative medications that were invented specifically for migraines,” Diamond notes. (Botox and antidepressants, for instance, were originally developed for other conditions and “found to help migraines almost by accident.”)

Called CGRP antagonists, both drugs work by blocking the protein responsible for the attack. The drug testing is moving into its final trial, says Diamond, who adds, “We’ll know more soon.”