Understanding and Mitigating the Pain of Migraines

A migraine is more than a bad headache. It’s a strong, throbbing, persistent headache with neurologic complications that can be temporarily debilitating. A migraine can take you out of your daily routine and limit your ability to attend to anything other than the pain. The severity ranges from uncomfortable to unbearable. Experts estimate that at least 10 percent of the world’s population experiences migraines.  

Most people who experience migraines get them on a recurring basis. Migraines can occur on one or both sides of the head. They are typically accompanied by flashes or waves of light, or extreme sensitivity to light, sound, and even smells. Other abnormal visual symptoms may also occur. Many people who get migraines experience nausea or vomiting during an episode. Migraines can last for a few hours or a few days.  

Analysis of a migraine 

A migraine typically follows this pattern: 

One or two days before a migraine begins, a person might feel mood shifts. They might suddenly crave specific foods, feel excessively thirsty, or need to urinate more frequently. They might start yawning more often or experience tightness in the neck area. Any or all of these symptoms can accompany the onset of “prodrome,” which is the medical term for the immediate period before a migraine strikes. 

Also in the days leading up to a migraine, or in the middle of a migraine attack, a person might experience “aura.” This typically involves visual abnormalities, particularly the wavy or jagged flashes of light mentioned above, or other phenomena like black dots. Other neurological symptoms accompanying aura can include difficulty moving one side of the body or face, or complete inability to control sudden movements. People in this phase of a migraine may also hear sounds or music that aren’t objectively present.  

The attack phase of a migraine is when the pain in the head becomes full-blown. Insomnia and heightened anxiety can accompany the throbbing pain. Loss of consciousness is not typical, though. At this stage, many people simply need to lie down in a dark, quiet room until the episode passes. Cold or warm compresses may help, and over-the-counter pain medications can also take some of the edge off the pain.  

The concluding phase of a migraine is known as “postdrome,” but more commonly as a “migraine hangover.” In this phase, a person is likely feeling tired to exhausted, and still sensitive to light, nauseated, or with the sensation of a dull, receding ache. 

An elusive diagnosis 

The precise etiology of migraines isn’t currently known. What we do know is that they are characterized by abnormal neurological activity that temporarily plays havoc with brain chemistry and neuro-signaling.  

There is no one specific diagnostic test for a migraine; instead, healthcare providers gather information on symptoms, lifestyle, environment, and other factors to make the most likely determination. The condition does show a strong correlation with heredity, so doctors often look to family history to confirm a migraine diagnosis. Magnetic resonance imaging (MRI) and similar tests can help rule out other neurological conditions. 

Most people who get migraines are between 20 and 50 years old, and women get them at more than three times the rate of men. In fact, more than 17 percent of women responding to a recent survey reported having migraine symptoms. 

There is help for migraines 

While it’s likely that few people with migraines will ever be able to prevent them completely, there are specific lifestyle changes and medical treatments that can often make them less frequent and severe.  

Here are a few of those changes that might be beneficial: 

Be proactive about recording when and under what circumstances you experience migraines. Note their duration, and any possible behavioral or environmental triggers, including the foods you eat. Also keep track of anything that alleviates the symptoms. This data can help you know what kinds of activity to avoid. Biofeedback, under a doctor’s supervision, can be helpful in determining your particular migraine triggers, and may also help you to better internalize useful relaxation techniques.  

Learn to manage your stress levels. Various types of therapy, as well as the practice of meditation, have proven helpful in reducing the incidence of migraines for many people. Establish a routine for unwinding after each day, and avoid too much stimulation from caffeine or other substances too close to bedtime.  

Regular exercise, particularly aerobic fitness routines like walking and cycling, correlates with a lower incidence of migraines. Keeping to a regular schedule, with routine times for working out, sleeping, and meals, can also be helpful in this regard.  

Check with your doctor to see if preventive medication could help you. There are a variety of migraine-preventive therapeutics out there, including anti-depressants, anti-convulsants, nerve blocks, and even Botox. There are also specific medications to help women whose susceptibility to migraines coincides with their menstrual cycle. Most experienced physicians do not recommend opioids to prevent or treat migraines.  

Signals transmitted along the trigeminal nerve can influence the intensity of migraines. Some physicians have found that their migraine patients benefit from FDA-approved portable, headband-like electrical devices that deliver t-SNS—transcutaneous supraorbital nerve stimulation—to the trigeminal nerve.  

The American Migraine Foundation (AmericanMigraineFoundation.org) offers a “Migraine 101” and other self-education pages, as well as connections for support, public advocacy, and other resources.