Migraine is not just head pain: it is an inheritable neurologic disorder that disrupts the processing of pain, light, sound, and smell. It causes normal input like sunlight or music to cause discomfort. It is characterized by headache attacks that usually last hours to days but, for some, it can be continuous. Migraine headaches are usually accompanied by nausea and can also be associated with other neurologic symptoms such as visual changes, dizziness or vertigo, numbness, weakness or difficulty speaking. For some, those associated symptoms can be even more disabling than the headache.
There is no known cause, though it is clear that there is a genetic predisposition. (There are triggers which can bring on headache attacks in migraine but those are not the cause of the condition.)
There are an estimated 36 million American men, women and children with migraine.
Migraine occurs across all ages, in both sexes and across the socio-economic scale. It is more common in women (about 18% of women have migraine headaches) than in men (about 6%). It is estimated that 4% of the population have some form of a daily headache with migraine accounting for the largest part of that.
Migraine is the 9th leading cause of disability in women world wide, according to the World Health Organization.
There is no “test” to confirm migraine. A doctor can usually tell if the headaches you are having are migraine by asking about your symptoms, family history and by examining you. If the doctor thinks that there could be any other cause of the symptoms then they may order tests to rule out other conditions that could be the cause of headaches.
If you are having frequent or disabling headaches or are diagnosed with migraine, there are many options of seeking care.
>> Diagnosis is usually made and and initial care given by your primary care physician or internist.
>> You may be referred to a neurologist (specialist in neurological disorders) if the headaches are difficult for the primary care physician to manage, if there are other neurologic conditions or symptoms or if the headaches are frequent or atypical.
>> Headache specialists (usually neurologists who specialize further with training in treating complex headache disorders) can be consulted when there are other health concerns (cardiac conditions, pituitary disorders or other endocrine disorders, high blood pressure, etc) or if the frequency and severity are increasing, are disabling and not responsive to routine care.
If headaches are a problem and you are seeking care, you should be using a headache diary. (here are good examples that you can use). You should be able to answer:
1. When did you get your very first headache ?
2. Are there any family members with any headache (does not need to be to the degree that you are having)
3. What is the frequency of headaches, the duration and intensity ?
4. What is the location and the nature of the pain (sharp, dull, ache, throbbing, pounding, searing etc) ?
5. Are there things that fairly reliably can bring on a headache ? (bright lights, loud sounds, alcohol, weather, lack of sleep etc.)
6. What do you do when you get a bad headache ? are there things that you do or avoid doing ?
7. What you are taking for the headaches, what dose and how many days per week are you taking it
8. What medications have you tried in the past ?
For some with migraine, avoiding triggers, using over the counter pain medication, and complimentary medicine or behavioral treatments (ie meditation, stress reduction, biofeedback, guided imagery) will be enough.
For more severe or frequent migraines there are prescription medications available.
Acute medication is for treating the headache you have at the moment. It can treat the pain and the other symptoms associated with migraine. Examples include prescription tripans (sumatriptan, rizatriptan, naratriptan, frovatriptan, zolmitriptan, almotriptan, eletriptan) and prescription and over the counter non-steroidal anti-inflammatory medications (naproxen, ibuprofen, diclofenac). Acute treatments should be limited to 2 days per week in order to avoid headache worsening over time.
Preventive medication is medication that you take on a daily basis with the goal of reducing frequency (and intensity) of headache over time. If you have headaches that are increasing in frequency, are more often than 8 days a month or if they are fewer but severely disabling, then your provider will consider a preventive medication for you. There are several classes medications studied and used to prevent migraine. A full “trial” of a preventive medication requires getting to an adequate dose (which varies depending on the medication) and being on the medication for an adequate duration (achieving the maximum benefit can take a few months).
While there are dozens of preventive medications, due to a lack of research funding, there have been no new migraine specific acute medication developed since the triptan class in the late 1980s, and no new migraine specific preventive in decades.
Read more detailed information on migraine medications.
Visit our Migraine Resources page to learn more about health care facilities specializing in Migraine treatment, and groups organizations involved with migraine.