If you’re struggling with migraine and don’t know the cause, you’re not alone. According to the American Migraine Foundation, nearly 40 million men, women and children in the U.S. are affected by migraine. More than a headache, a migraine can be debilitating and painful, and for some, impact every part of their lives. Despite how common migraine is, it’s a poorly understood condition that is often misdiagnosed and undertreated.
One of the challenges with the disease, says Stacy Younger, MD, a neurologist at Johnson County Neurology and Menorah Medical Center, is that migraine triggers can be different for everyone. That’s why an accurate diagnosis and migraine treatment plan based on your specific triggers are so important. If you’re suffering from chronic headaches, you may want to consider seeing a headache specialist who can not only diagnose migraine and rule out other causes of your headaches, but create a personalized treatment plan to help you better manage the condition.
Do I have a migraine or just a bad headache?
A migraine is typically a painful, throbbing and recurring headache that can last anywhere from four hours to three days. It usually begins on one side of the head, but can spread to both sides, and is often accompanied by nausea, vomiting and extreme sensitivity to light or sound. About 20 percent of people with migraine have warning signs, known as an “aura,” usually visual changes such as flashes of light, or “wavy” vision. Sometimes other senses are affected as well. For example, you may smell something strange or feel as though someone is touching your skin. The symptoms of a migraine are sometimes confused with those of other conditions, including stroke.
If you have recurrent headaches or symptoms of migraine, it’s important to see a physician for an accurate diagnosis. A headache expert can rule out other potential causes and provide expert advice on managing and treating your symptoms. Because there is no actual test to diagnose a migraine, says Dr. Kaplan, a physical examination and detailed history are the physician’s best tools for diagnosis.
What is causing my migraine?
The exact causes of migraine aren’t clearly understood, although they may be linked to environmental factors, imbalances in brain chemicals and genetics (or family tendency). About 90 percent of migraine sufferers have a family history of the condition. The triggers – those factors that bring on a migraine – vary from person-to-person. What may trigger an attack in one person may not have the same effect on another migraine sufferer, says Dr. Kaplan. Triggers and/or risk factors include:
- Age – Migraines can start at any age, but are slightly more common to begin in the teens or early 20s.
- Gender – Women are three times more likely to get migraines than men.
- Hormonal changes – For some women, hormone replacements such as birth control pills or others makes migraines worse, while for other women, it makes their headaches better.
- Stress – Anxiety, worry, and fear can trigger a headache and/or make an existing one worse.
- Foods – Salty and processed food, aged cheeses and foods containing MSG are known triggers.
- Poor eating habits – Skipping meals can trigger an attack for some.
- Alcohol and caffeine
- Sensory overload – Bright lights, loud noises act as triggers for many migraine sufferers.
- Intense physical exertion – Exercising at too-high a level can bring on a headache.
- Weather and environment changes – Changes in the barometric pressure can trigger a headache or worsen an existing one.
- Change or disruption in sleep – Either too much or too little sleep can trigger a migraine.
Help your doctor to help you
Your doctor will be depending on you to provide the information and history that he or she needs to diagnose your migraine and build the most effective treatment plan. Start keeping a headache diary that charts your headache frequency, duration, other symptoms and what you were doing when it started in advance of your appointment. Your doctor will ask about:
- Your headaches – how they feel, how often they occur, other symptoms you have with the headaches, the severity of the pain.
- Family health history – because there may be a family or genetic component to migraines, your doctor will want to know if anyone else in your family has had them.
- Your activity level and how the headaches impact your lifestyle.
- Potential triggers such as diet/eating habits, allergies or other conditions you may have.
- What, if anything, improves your symptoms or makes them worse.
The doctor will also perform a thorough physical examination, including a check of your neurologic function to rule out other conditions. Remember your conversation should be two-way, so write down your questions in advance so you remember them and walk out with the information you need.
Will the doctor do a head scan?
There is no imaging procedure or blood test to diagnose migraines. That said, depending on your symptoms and what your doctor finds during the physical exam and history, he or she may order imaging such as a CAT or MRI scans or blood tests to rule out other conditions.
How are migraines treated?
Migraine treatments are designed to either prevent attacks or stop the symptoms of a migraine.
A migraine prevention plan includes more than medicines. Once you understand the triggers for your migraine, you may make some lifestyle changes such as eating healthier, avoiding certain foods and stress or establishing better sleep habits. If you suffer from chronic migraines, your doctor may prescribe “prevention” medicines that can help reduce the severity or frequency of migraines if taken on a regular basis.
There are many abortive medications used to treat migraine symptoms, including some, like Toradol, that were actually intended for something else, but are effective in treating migraine symptoms. Most of the treatments are triptans, anti-inflammatory medications or those that reduce nerve pain.