Migraines are a significant public health issue resulting in not only immense personal suffering but also substantial economic costs due to lost productivity and healthcare expenses. They can be debilitating, leading to missed workdays and reduced quality of life. They can also be misunderstood and officials believe in the importance of destigmatizing the condition, fostering understanding and promoting empathy for those who suffer.
“Migraines are a common medical problem and lead to significant disability. Migraines are estimated to affect 15% of the global population, approximately one billion people,” said physician Patrick Asselin, assistant professor at the University of Rochester Medical Center department of neurology. “They are the second leading cause of years lost due to disability, missed school and workdays.”
Asselin talks about five aspects of migraines.
1. Yes, you can treat migraines
Experts continue to be divided on treatment because much depends on offering acute care which is immediate relief during an attack or preventive options that can reduce the severity. Over-the-counter pain relievers like ibuprofen or acetaminophen help during an attack, while prescription medications, such as triptans or ergotamines, may be more effective for severe cases. Preventive treatments might include medications such as beta-blockers, antidepressants or anticonvulsants.
In addition, lifestyle modifications are also crucial such as maintaining a regular sleep schedule, managing stress through techniques like yoga or meditation, staying hydrated and avoiding known dietary triggers. Others have alternative therapies like acupuncture, biofeedback or cognitive behavioral therapy that may aid in relief for some individuals.
“Migraine treatment is often multi-modal and involves two different treatment approaches: prevention to reduce frequency along with acute, which treats a migraine as needed. Both treatment approaches can utilize medications, neuromodulation devices and lifestyle interventions,” said Asselin. “The best initial step is to try to optimize healthy migraine habits including adequate hydration, sleep, eating regularly and moderate caffeine use.”
2. Avoid bright lights, loud sounds, strong smells
During a migraine, certain stimuli can exacerbate symptoms. Bright lights, loud sounds and strong smells can make the experience more uncomfortable. Additionally, certain foods and beverages can trigger migraines; these can include aged cheeses, processed meats, alcoholic drinks and excessive caffeine. It’s also advisable to avoid dehydration and irregular eating patterns, as missing meals can trigger headaches. Stress and anxiety can heighten migraine severity, so finding effective stress management techniques is beneficial.
“There are no activities that need to be avoided during a migraine in terms of safety. Most people find that bright lights, loud sounds and physical activity worsen their migraine and so will generally try to rest when having one,” said Asselin.
3. Aura effects precede (or accompany) a migraine
An aura is a set of neurological symptoms that can precede or accompany a migraine. Auras typically manifest 20 to 60 minutes before the headache begins and can last from a few minutes to an hour. The most common type of aura involves visual disturbances, such as seeing flashing lights, zigzag lines or temporary blind spots. Other symptoms might include sensory changes, such as tingling or numbness in the face or extremities and speech difficulties. While not everyone who experiences migraines has auras, they can be a significant indicator that a migraine is imminent.
“Common examples are bright spots in vision, kaleidoscope in vision, numbness on one side of the body. The symptoms of an aura are typically consistent for an individual, but over long periods of time the aura can change or stop,” he added.
4. Hormones play a role
Hormones play a crucial role in the onset and frequency of migraines, particularly in women. Fluctuations in estrogen levels, which can occur during menstrual cycles, pregnancy or menopause, are linked to migraines. Many women report an increase in migraine frequency and intensity in the days leading up to their menstrual period, during ovulation or when beginning or stopping hormonal contraceptives. Consequently, understanding this link may help in developing targeted treatment strategies, such as hormonal therapies or preventive medications.
“Migraines are thought to be associated with hormones, specifically changes in estrogen. This is based on the phenomenon that some women have migraines specifically around their menstrual period, thought to be related to the changes in estrogen levels. We do not start hormone therapy for patients with migraine as that has not been proven to be helpful,” said Asselin.
5. Migraines are not intense headaches
One prevalent misconception is that migraines are simply intense headaches. In reality, migraines encompass a range of symptoms, including nausea, vomiting and sensitivity to light and sound. Another misconception remains that only women experience migraines; while they are more common in women, men also suffer from them. Some people mistakenly believe that migraines can be cured with one treatment. However, managing migraines often requires a combination of preventive measures and treatments tailored to the individual.
“Too often I hear people say only severe headaches are migraines and that migraines only affect women and both statements are wrong,” Asselin said. “It is true over the lifespan, migraines are more common in women. However the rate of migraines in men and women is similar until about puberty, 11 or 12 years old. After puberty, the rate of migraines in women is 3:1 compared to men.”