6 Facts You Need to Know About Migraine - Lauren Natbony, MD
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6 Facts You Need to Know About Migraine

Treatment, Prevention, and Triggers

A version of this article first appeared Nov. 22, 2021 on TheHealthy.com.

1.     What is migraine? Do we know why it happens? 

Migraine is a chronic neurologic disease characterized by attacks lasting from 4 to 72 hours, usually located on one side of the head, associated with moderate to severe pain intensity, throbbing in quality, made worse with activity and associated with nausea, vomiting, and sensitivity to light and/or sound.  We think that migraine is hereditary and one inherits a vulnerability /lowered threshold to migraine. Whether one actually gets migraine headaches is based on internal (stress, anxiety, illness) or environmental triggers (food, alcohol, dehydration etc). These triggers produce a migraine by overcoming an already lowered threshold. 

Migraine is a very complex disorder and the cascade of events that causes migraine pain is not completely understood.  It is thought that migraine occurs due to inappropriate activation of nerve fibers in the central pain modulatory system.  Simply stated, the migraine brain gets over-excited and produces pain signals when it’s not supposed to.

2.     What are the four common stages of migraines, and what do they entail? Does everyone experience the four stages? 

The four stages of a migraine attack include prodrome, aura, headache and postdrome. Not everyone experiences all 4 phases of migraine. Prodrome and aura are the earliest stages of a migraine attack with prodrome sometimes occurring hours to days before headache onset. Prodromal symptoms can include changes in mood, yawning, food cravings, frequent urination, fatigue, among others. During the prodrome phase, taking medication, avoiding known triggers and engaging in mindfulness or relaxation techniques, can help prevent headache. The second phase, aura, occurs in about 1/3 of people with migraine, though it may not happen with every migraine attack. The aura phase typically lasts from 5 to 60 minutes and is followed by headache in most people. Aura is most commonly visual and patients report seeing spots, stars, flashing lights, zigzag lines etc.  Other common auras include sensory loss (numbness, tingling on one side of the body) and slurred speech.

The headache phase presents with pounding/pulsating head pain on one or both sides of the head that lasts from 4 to 72 hours. In addition to pain, other symptoms are present and can include nausea, vomiting, sensitivity to light, sound and smell, neck pain, blurry vision, dizziness etc. Postdrome is the last phase and occurs in about 80% of those with migraine. Symptoms can mimic those of prodrome and may last up to 48 hours.

3.     What is migraine hangover? Is there any way to treat it, either with medications or at-home remedies? 

A migraine hangover is also known as a postdrome. It is the after effects of a migraine headache and can include fatigue, trouble concentrating, mood changes etc. Postdrome can be extremely debilitating, and can last for 24-48 hours after head pain has resolved. The best way to treat postdrome is to prevent a migraine attack from happening and/or to treat it aggressively at the onset. Treating early in a migraine attack can prevent it from progressing to later phases. During the postdrome, it is best to avoid known migraine triggers and to load up on water, engage in relaxing activities and minimize stress.

4.     How is migraine treated? Is there anything you can do at-home to treat them? 

A migraine attack can be treated acutely with medications (over the counter and/or prescription) and behavioral interventions. Acetaminophen, Ibuprofen and Naproxen are all first-line over the counter pain relievers for headache.

There are many non-pharmaceutical interventions that can be done at home to ease migraine symptoms. A simple one is to turn off the lights and minimize sounds.  Migraine often increases sensitivity to light and sound and thus diminishing these external stimuli can help decrease pain. A nap, even a short one, can be helpful as sleep is a natural pain reliever. Using a hot or cold compress on your head or neck can ease pain.  Ice packs can have a numbing effect, which may decrease the sensation of pain and hot packs can relax muscle tension. Drinking a caffeinated beverage may also help as caffeine, in small amounts, can be a potent pain reliever at the beginning of a migraine attack.

5. Is there anything you can do to prevent migraine? 

When migraine attacks occur on 6 or more days per month or are debilitating, preventative treatment is indicated. The goal of preventative treatment is to reduce the frequency and severity of migraine attacks. Preventative therapies include lifestyle modifications, vitamin supplements, prescription medications, medical devices, and complementary treatments such as acupuncture and biofeedback.

The first step in migraine prevention is to make lifestyle changes. These include getting regular sleep, hydrating with at least 64oz of water per day, eating a protein filled meal/snack every 3-4 hours and participating in cardiovascular exercise for 30-45 minutes 4-5 days per week. 

6. What are some common migraine triggers? 

Stress is one of the most common triggers for migraine, reported in about 70% of people with migraine. Other common triggers include an irregular sleep schedule, dehydration, skipping meals, weather changes, and alcohol. For women, attacks can be triggered around the time of the menstrual period when hormones fluctuate. Food is often blamed as being a migraine trigger however it is not as common as we think. The most common food triggers are: caffeine, MSG, nitrites, artificial sweeteners, citrus fruits and aged cheese.