Around the U.S., 37 million men, women and children suffer with migraines, but less than 5% of those affected have been diagnosed and receive appropriate care. According to the World Health Organization, headache disorders affected 3.1 billion people in 2021 — nearly 40% of the world population.
A headache, often used interchangeably with a migraine, is only a symptom of a migraine episode, which will likely include a headache. However, migraine patients could also experience fatigue, dizziness, nausea, extreme sensitivities and more.
Dr. Maxwell Levy, assistant professor of neurology and director of the Neurology Residency Program at Tulane School of Medicine, said most who suffer from headaches, have tension headaches, which are different than migraines.
“Migraine headaches are more disabling than your standard headaches,” Levy said. “Oftentimes, people are not able to work or are not able to function well when they have a migraine.”
Migraines, or migraine episodes, can last anywhere from two hours to three days, according to Levy.
Dr. Mara Carmen Wilson, the medical director of the Headache and Facial Pain Program at Ochsner Health Center in Covington, has studied the impact of migraines and headaches and has suffered migraines her whole life.
Dr. Mara Carmen Wilson
“I’m a migraineur,” Wilson said. “Right now, we’re in a very good place for people who have migraines. We have effective and safe medications that can help.”
A migraine is a perfect storm, according to Wilson. It’s a combination of triggers that alter the brain to create a big event — part of which includes pain.
The perfect storm
These “brain events” can cause sensitivity to light, noise, motion, light or smell. Migraineurs can experience fogginess and suffer from the inability to think clearly.
“Think about a migraine like a big, complex, neurologic event,” Levy said.
In order to classify a headache as a migraine, patients without the ‘aura phase’ — when people suffer from sensory disturbances — need to have a least two episodes, and patients with the ‘aura phase’ need to have had at least five episodes.
“If your headaches are stopping you from doing what you want to do, living the life you want to live,” Levy said, “you should talk to your doctor about that. There are treatable conditions to some extent.”
There are 13 subtypes of migraines, according to the International Classification of Headache Disorders, and they all come with their own set of symptoms and causes. The most important division is primary headaches and secondary headaches.
A primary headache is when the headache itself is the condition, and not a resulting symptom of external or internal triggers. Secondary headaches occur when one or more of these triggers affect the brain, like an illness or exposure to too much light.
Both primary and secondary headaches use the same brain pathway for pain transmission, Wilson noted.
“It affects the quality of life,” Wilson said. “It is important to distinguish between the primary and the secondary because when there is a cause, we go after treating the cause. With a primary migraine, the goal is to manage the condition.”
Knowing the triggers
Wilson added that it’s important to know what triggers the headaches or migraines.
Triggers come in multiple forms. Internal triggers, coming from the inside the body, include hormonal changes (like a menstrual cycle), changing sleep patterns or sleep disorders, an illness (like a fever or allergy) or hunger. External triggers are more related to the environment. For example, excessive light, weather and stress.
The pre-menstrual and menstrual time is a time of vulnerability, Wilson said. She advises avoiding too much activity and intense exposure for the senses — like a very bright concert, overindulging on alcohol or fasting.
“If a weekend is ‘go, go, go,’” Wilson said, “there is a large possibility for a headache or migraine ‘attack.’”
Extreme weather changes, as is common in Louisiana, are a common cause of headaches. Higher temperatures and “hidden humidity” can often result in dehydration and a resulting secondary headache.
In the sweltering heat, Wilson recommends staying away from saltier foods and pumping up the electrolytes. Eating foods high in water content like watermelon, grapes and spinach and magnesium-rich vegetables like kale, broccoli and cucumbers can help the body retain its water. Using cold packs on the head, doing activities nearer to the start and end of the day when it’s cooler and splitting up yard work into segments are all effective ways to let the body rehydrate and cool down to prevent heat-induced headaches.
Thunderstorms, hot desert winds and atmospheric pressure changes also affect the brain and become external triggers for headaches. In the atmosphere, the ratio of positive and negative ions changes in large weather events. The body reacts to these changes, as the blood vessels react and serotonin levels in the brain change.
“These are things that cannot be seen,” Wilson said. “But it’s the perfect time to avoid as many triggers as possible and to be ready to take medication.”
Can migraines be prevented?
If a patient often has migraines, Wilson advises them to become aware of the triggers that often cause the attack — and treat it preemptively.
Migraines go through four phases:
- The prodromal phase occurs before pain presents itself, often presenting as fatigue, an achy feeling or sense of tiredness.
- In the aura phase, migraineurs suffer from sensory disturbances like blurred vision, flashing lights or tingling in the arms or legs.
- The pain occurs in the headache phase, often presenting as a pounding sensation in the head.
- The postdromal phase is when the pain has subdued, sometimes leaving a person weak or confused.
Not all migraine episodes go through all four phases, and not all migraine episodes include a headache. Wilson has found that a migraineur will successfully identify if they are going to have an episode in the first phase of a migraine with 70% accuracy. Wilson says that if a patient takes medication between one and six hours from the prodromal phase of a migraine, then they will either not get the attack or it will be relatively moderate.
The caveat with this preemptive treatment is that doctors like Wilson do not want migraineurs with chronic migraines — patients with over 15 days of headaches per month — to take medication for each migraine they have.
Levy also recommends to patients using Botox as a preemptive treatment. Originally developed for use in treating muscle tightness in patients that had strokes, Botox can be used to reduce pain transmitter signals in migraines.
According to Levy, half of the patients who receive migraine treatment with Botox get a 50% reduction in migraine frequency.
While medication is effective in reducing the burden of headaches, Wilson stresses the importance of lifestyle changes and avoidance of both internal and external triggers.
“We want to make sure that we don’t let our patients get to the chronic state,” Wilson said. “The best way to prevent that is teaching them lifestyle changes.”
Lifestyle changes
If you have a routine, try to keep to it as much as possible, Wilson recommends — that includes weekends.
Wilson said the migraine brain “likes boredom.” Often in the summer months, everyday schedules change — sleeping in later and engaging in daylong summer activities, often under the hot sun. Now that students have returned to school, those routines are changing again.
A very busy week followed by a laid-back weekend will often result in headaches for the migraineur because there is too much fluctuation in the routine.
“The brain reacts to routine much like if you are a huge caffeine drinker and then you all of a sudden stop, cold turkey,” Wilson said. “Your brain is going to react to that.”
It’s also why it is common to get headaches and migraines when changing time zones or traveling.
Stress is also a common cause of headaches among migraineurs, Wilson said. Maintaining a peaceful routine and preventing stress will go a long way in preventing migraine episodes.
Other, smaller ways to preempt headaches are to listen to the body and look out for external triggers. If a light is too bright, look away or put on sunglasses. If music is too loud, leave the area or turn it down a few notches.
“We really have to maximize and optimize the treatment of acute attacks, so that when this happens, you’re not miserable,” Wilson said. “We people that have migraines have to live life. We cannot be hermits. We want all the tools to be able to enjoy life like everybody else.”
