When A Headache Is Not Just a Headache: How To Treat Migraines

June is Migraine Awareness Month. Those who suffer from the debilitating headaches know that they can be difficult to treat. Dr. Sharisse Stephenson provides more information that could potentially help sufferers. Here is some info below:

 WHAT’S THE DIFFERENCE BETWEEN A HEADACHE & MIGRAINE? WHAT ARE THE MAIN SYMPTOMS?

There are many different types of headaches. There is actually an International Classification system which describes the different types of headaches.  Migraine is one of the most common types of headaches.  Migraines can often occur on one side of the head, the pain may be moderate or severe in intensity.  Nausea, vomiting, light and noise sensitivity are common associated symptoms.  Activity can aggravate the pain. 

 WHEN IS A HEADACHE NOT JUST A HEADACHE? HOW DO YOU KNOW WHEN TO SEEK CARE?

 An important distinction that we make as neurologists is the difference between primary versus secondary headaches. Primary headaches are headaches without an underlying bad cause such as migraines or tension headaches. The headaches can still be debilitating and lead to disability but there is not an underlying bad cause for the headache such as stroke or tumor.

Secondary headaches occur as a result of an underlying cause.  If you or someone has a severe, new headache or “the worst headache of your life”, that is an indication to call 911 and go to the nearest emergency department.  This can be a sign of a serious and potentially fatal problem called subarachnoid hemorrhage which occurs when an aneurysm ruptures in the brain.

If you do not have a history of headaches and develop a new headache especially accompanied with other symptoms such as fever, weakness, numbness, difficulty speaking, neck stiffness, you should go to the emergency department as this can be a sign of something more serious such as stroke or meningitis.  Even if you have a known history of headaches or migraines, you should seek care if you have frequent headaches, severe pain, or headaches that are difficult to stop as we have many treatment options to get headaches and migraines under better control.

DOES STRESS PLAY A ROLE IN HEADACHES OR MIGRAINES?

Stress plays a significant role in migraines. Stress can increase the frequency and severity of migraines.  Stress can contribute into the role of developing chronic migraines and increase migraine-related disability.

 DOES THE WEATHER AFFECT HEADACHES OR MIGRAINES?

Some people who have migraines appear to be more sensitive to changes in the weather. Weather-related triggers include:

• Bright sunlight
• Extreme heat or cold
• Sun glare
• High humidity
• Dry air
• Windy or stormy weather
• Barometric pressure changes

For some people, weather changes may cause imbalances in brain chemicals, including serotonin, which can prompt a migraine. Weather-related triggers also may worsen a headache caused by other triggers.

 WHAT TREATMENT OPTIONS ARE AVAILABLE TO GET RELIEF FOR A MIGRAINE OR HEADACHE?

There are many treatment options for migraines. Triptans are a common class of medication that can help stop a migraine in progress.  A common triptan that some people may be familiar with is imitrex or sumatriptan.  For patients with frequent migraines, we use different preventative options to reduce the frequency of migraines such as oral medications, botox injections and a new class of monthly injectable medications called CGRP antagonists.

 DOES HORMONAL IMBALANCE PLAY A ROLE IN MIGRAINES?

Hormones play an important role in migraines. Women are more affected from migraines compared to men.  Some women may experience more headaches associated with their menstrual cycles or even experience specific menstrual migraines.  Migraines can worsen in response to some hormonal medications.  Migraines can also worsen during the peri-menopausal stage as a result of a change in estrogen levels.

HOW CAN MIGRAINE HEADACHES AFFECT A PERSON’S LIFE AND WHAT CHANGES SHOULD THEY MAKE?

Migraine is the third most common disease on the planet, affecting more than 36 million Americans. One in every four households in the U.S. has at least one person living with migraine, and often more than one person since migraine is genetically linked. The evidence shows that migraine reduces family, social, and recreational activities.  Migraines can cost missed days of work or lead to chronic disability preventing full time work.  It is important to get treatment if migraines are impacting your life.  It is important to address any underlying medical issues such as high blood pressure, insomnia, sleep apnea, stress, obesity which can affect headaches.

ARE THERE SOME LIFESTYLE CHANGES THAT MIGHT HELP PREVENT HEADACHES, SUCH AS DIET, EXERCISE OR MEDITATION?

Lifestyle changes can greatly improve migraines. Studies have shown that a regular exercise routine can reduce migraine frequency.  Weight loss can also help migraines and treat underlying medical issues such has high blood pressure and sleep apnea which can cause headaches. Stress management techniques such as guided relaxation and meditation can help improve migraine control. I encourage all of my patients with migraines to do a guided relaxation or meditation program at least 10 minutes per day. Adequate sleep and a regular sleep schedule are also important for migraine control.

 HOW DO  DEPRESSION AND MENTAL HEALTH ISSUES INCREASE SEVERITY AND FREQUENCY OF MIGRAINES?

A: Depression is one of the most common psychiatric conditions in patients with migraine.  Depression can play a role in increasing severity and frequency of migraines and the development of chronic migraines which occurs when a person suffers from 15 or more days of headache per month. Controlling anxiety of patients with migraine is associated with improved quality of life, adherence to a migraine treatment plan, and effectiveness of migraine treatment.

ARE MIGRAINES CURABLE?

Migraines can resolve in some people.  There are many treatment options to help improve migraines.

WHAT ARE YOUR THOUGHTS ON THE FDA APPROVED WEARABLE DEVICE FOR MIGRAINE PAIN. HOW DOES IT WORK?

The Nerivio Migra is a neuromodulating device recently approved for migraines. It is worn on the arm and controlled by a smart phone device to send electrical impulses to help modulate migraines. This is just one of several neuromodulating devices that have been FDA approved for migraine. There is Gammacore which is a device that stimulates the vagus nerve. The Cefaly device looks like a headband and sends electrical stimulation to the supra orbital nerve.  There is now a model that stimulates the occipital nerve. The single pulse transcranial magnetic stimulator sends a magnetic pulse to the head to help with migraines. These neuromodulating devices have been shown to improve migraines.

 WHAT’S THE DIFFERENCE BETWEEN A SINUS HEADACHE AND A MIGRAINE?

Sinus headache is now considered an outdated term because a lot of headaches described as “sinus headaches” may really be related to a primary headache disorder such as migraine or tension headache. A true sinus headache is pain that results from disorder of the nasal or sinus passages. However, patients may state they have sinus headaches but the headaches are truly migraines.  A true sinus headache may have some pain but should not have any of the other symptoms associated with migraine and should resolve with treatment of the sinus issue.

 CAN CERTAIN FOODS OR BEVERAGES TRIGGER A MIGRAINE?

Yes, certain foods and beverages can trigger migraines.  Even moderate alcohol use can trigger headaches in patients with migraines. Excessive caffeine and caffeine withdrawal can trigger migraines. MSG can trigger migraines.  Some patients can try elimination diets to find their own personal diet triggers.

WILL A MIGRAINE INCREASE RISK OF A STROKE OR HEART ATTACK?

Migraine with aura can increase the risk of stroke especially in women on oral contraceptives.  Certain underlying medical issues can increase headaches such as high blood pressure and sleep apnea and also increase the risk of stroke and coronary artery disease.

Dr. Stephenson answers your ‘Text Tom’ questions on the next page:

Doc, have you heard of headaches with no pain? I just have flashes in my lower eye. The doctor called them silent migraines.
Yes. You can have migraine auras without pain. Migraine auras are neurological symptoms that can accompany a migraine. Visual changes such as flashing lights in the eyes are the most common auras. However, you should still be evaluated as disorders of the eye can also cause these types of changes as well as other neurological causes. Other ocular and medical issues should be ruled out before making a diagnosis of migraine aura without headache.

Can your kids be the cause of a migraine headache?
Having a family can be stressful. Trying to manage work, kids and social life can be difficult. Stress can definitely trigger headaches and exacerbate migraines. Poor sleep and irregular sleep can trigger migraines. Having babies or infants at home that are not sleeping through the night can affect sleep and aggravate migraines.

Is there a difference in a migraine headache and an allergy-induced headache?
A migraine headache is a specific headache disorder that consists of throbbing pain with associated light or noise sensitivity, nausea or vomiting and aggravated by physical activity. Allergy-induced headaches or sinus headaches are often misdiagnosed and are really truly migraines or tension headaches. However, you can have a true headache due to disorder of the sinuses. That headache should improve with treatment of the sinus issue.

I was told cluster headache is the worst pain a human can endure. What is the best treatment?
Cluster headaches are a very painful condition. Some treatments for cluster headaches are similar to migraines. Triptans such as Imitrex or sumatriptan can be helpful to treat a cluster headache. Steroids can shorten the duration of cluster headaches.

A blood pressure medication called Verapamil can help with the prevention of cluster headaches. Nerve blocks such as occipital nerve blocks and sphenopalantine ganglion blocks can help treat cluster headaches. A neuromodulation device called Gammacore is now indicated for treatment of cluster headaches and works by stimulating the vagus nerve. Oxygen can also be an effective treatment for cluster headaches.

Is it true that dehydration can cause headaches?
Headaches are a common symptom of dehydration and can aggravate headache conditions such as migraines.

I am 43 years old and suffered a slip and fall in 2017. I took a CT scan with negative results. Any suggestions why I’m having headaches? 
Head injury can be a cause of headaches. In cases of mild head injury or concussion, the headaches will often improve within several weeks or months of the injury. However, in some cases, the headaches may become a chronic problem.

There are other symptoms that can be related to head injury including cognitive difficulties (thinking or concentration difficulties), mood difficulty, and sleep difficulty. If you are still experiencing symptoms or difficulties after the injury, you should see a neurologist.

Is there a way to get disability if migraines come often and the person can’t work?
We have many treatment options to improve migraines today. Unfortunately, a small percentage of patients may suffer from long term disability due to migraines despite treatment. If you are disabled due to migraine despite treatment, you may use the usual methods to apply for disability such as going to your local Social Security office.

Is there some truth that when severe thunderstorms are forecast, they contribute to migraines? I have a 16-year-old who has migraines and they are often triggered when the weather is poor.

Yes, many patients doe report weather changes as a trigger for migraines.

I suffer from migraines…how come some are minor and others are full-blown to the point you have to go to the ER?
Migraines can simply vary in intensity and symptoms. Migraines can vary in different individuals as well. Certain triggers can aggravate migraines and increase severity. Sleep deprivation, stress, caffeine withdrawal and hormonal changes are just several things that can aggravate migraines.

Just going about daily activities I will have migraines. What could be causing them?
It is important to first make a distinction between primary headaches versus secondary headaches. Primary headaches are headaches without and underlying medical or bad cause. Secondary headaches occur as a result of another issue such as stroke, infection, head injury, just to name a few.

Many factors play a role in migraines. Genetics and hormonal changes can affect migraines. Sleep, diet, stress can all impact migraines. If you are having frequent migraines, you should see a neurologist to discuss preventive options and make sure there is not an underlying medical issue causing the headaches.

I have tried the Imitrex – didn’t work. Surprisingly OTC Excedrin Migraine helps me better than anything if I can take it as soon as I feel it coming on. As a sufferer, you know when you are getting one. Loud perfumes is another cause for me. Hadn’t had a bad one in about 5 years, but about a month ago, one took me down. They are horrible to have and my pain is always on my left temple.
Yes, odors are another common trigger for migraines. If you have more migraines, there are many more treatment options other than Imitrex. Most of these medications will work best if you take as soon as you feel the headache coming on. I encourage you to see a neurologist to learn more about treatment options for migraines.

Certain medications even over the counter medications such as Excedrin Migraine can cause medication overuse headache. This occurs when you take the medications frequently and can cause a “rebound headache” and actually lead to more frequent headaches.

Is there a correlation between chocolate and migraines?
There are certain foods that trigger migraines. This can vary from individual. Chocolate has been noted to be a trigger for some patients with migraines. Alcohol, caffeine withdrawal can also trigger migraines. Food triggers may vary between individuals.

After having brain surgery years ago, I still suffer with headaches.
Headaches may occur after any injury to the brain. Headaches may occur after a traumatic brain injury, stroke, meningitis just to name a few conditions. If you are still suffering from headaches, you should see a neurologist to discuss treatment options.

What causes ice pick headaches -sharp, stabbing pains in the temple area? They don’t last long, but are intense and very painful.
Ice pick headaches are a primary headache disorder. A primary headache disorder is a headache disorder that does not have a clear underlying cause such as stroke or tumor. A medication called indomethacin may help if someone has frequent ice pick headaches.

Dr. I suffer from hormonal migraines. I get one every month and they last anywhere from 3 days to 3 weeks. My question is will they continue past menopause?
Migraines can worsen during the peri-menopausal period due to hormonal changes. Many women will have improvement in their migraines after menopause. However, some women may continue to suffer from migraines.

I tend to get migraines during that time of the month. What can I do to eliminate these headaches? Also what kind of physician can diagnose the reason for these headaches? I have been prescribed Imitrex which I have been taking at increasing rates. Is there a physician that specializes in treating headaches that I can see besides my FP?
The hormonal changes with the menstrual cycle can trigger migraines. Menstrual migraines can be longer in duration. Longer acting triptans such as frovatriptan can be helpful for menstrual migraines.

Hormonal treatments can also be used to help with the change in estrogen levels that trigger the migraines. Migraine preventive medications may be indicated depending on the frequency of your migraines. A neurologist is the physician that specializes in treating migraines. There are headache specialists which are neurologists that specialize in the management of headaches and migraines.

How often is normal to have a headache in a week?
Ideally, you should have no headaches. If you are consistently having one or more headache per week, you may need preventive medications and evaluation to make sure there are no other underlying causes to your headache.

How common is migraine-induced fainting? 
Fainting or syncope can occur in patients with migraines at an increased frequency. There may be several causes of syncope that can occur more frequently in patients with migraines. A very common form of syncope is vasovagal syncope which can occur with migraines. Vasovagal syncope occurs when you faint because your body overreacts to certain triggers, such as the sight of blood or extreme emotional distress or pain. It may also be called neurocardiogenic syncope.

Postural tachycardia syndrome (POTS), a disorder that causes lightheadedness, fainting, and a rapid heart rate, is common among patients with migraine. Migraines with brainstem auras can present with syncope as well. Treatment would be aimed at reducing migraine frequency through preventive medications and treatments and lifestyle changes. Treatment should also address any underlying medical issues that can be contributing to the symptoms.

Dr. I had severe headaches 4 days in a row that sent me to the E.R. each day. Come to find out it was a sinus infection. I still get headaches in my right temple. Could this still be associated with my sinuses?

It is possible to have more than one type of headache disorder. You can have a headache related to a sinus infection and still have migraines. If the headache is truly related only to the sinus infection, it should improve with treatment of the underlying infection. Sinus infections may also aggravate underlying migraines. “Sinus headaches” are often misdiagnosed and still may be related to a headache disorder such as migraines or tension headaches.

Dr. Sharisse Stephenson is a board-certified headache specialist and brain injury medicine specialist.  She has special interest in the treatment of migraines, multiple sclerosis, and movement disorder such as Parkinson’s disease. She received her bachelor’s degree from Colombia university and her master’s degree from the University of Texas at Arlington. Dr. Stephenson obtained her medical degree from the University of Pittsburgh School of Medicine. She’s currently affiliated with City Hospital at White Rock.