Coping with Migraine Pain: Part 2

by Food and Drug Administration (FDA)

(Page 2 of 2)

Individual Triggers

Many scientists think migraine is a vascular disorder caused by a tightening (constriction) and sudden opening (dilation) of the blood vessels in the head, neck or scalp.

Others believe that the throbbing pain of migraine is caused by an abnormal release of neurochemicals in the brain, such as serotonin or noradrenaline.

Migraine sufferers may be born with a hypersensitive nervous system that makes them prone to the headaches. Then, a lifestyle or environmental "trigger," such as a hormonal change or a certain food or chemical, can provoke an attack.

A simple change in lifestyle to avoid personal triggers may minimize the frequency of migraines in some patients.

Potential dietary triggers include:

• alcoholic drinks (especially red wine)
• foods containing a chemical called "tyramine" (for example, aged cheeses, sour cream, and yogurt)
• chocolate
• dairy products
• foods with additives such as nitrites, MSG, or aspartame.

A change in caffeine intake, either up or down, can also trigger migraine.

Other lifestyle factors, such as change in sleep habits and even overuse of headache medicines, may sometimes provoke migraines, as can environmental factors, such as:

• change in weather (often the approach of a low-pressure weather front) or temperature
• high altitudes
• bright or fluorescent lights or sunlight
• loud noises
• strong odors.

The role of hormones in provoking migraine helps explain why three times as many women as men suffer from this type of headache. "Hormones seem to play the most important role in this women-men differential," Sheftell says. Because of the impact of hormones, women who are pregnant, using birth control pills, or going through menopause often experience an increase or decrease in the frequency of headaches.

Migraines can also be triggered by emotional factors, including not only negative feelings like frustration, anxiety or depression, but also by relaxation and positive feelings such as excitement. "Someone can go through a very stressful time — no headache — and then the weekend or holiday comes and they can finally relax, and the headache comes on," Levin says.

For Coleman, weather is a key trigger. But things that trigger migraine in one person might not affect another, even someone else in the same family. For this reason, experts say that keeping a personal "headache diary" may help in determining the best treatment approach. The diary should include characteristics of each attack, including triggers as well as the date and length of the attack, preheadache symptoms, level of pain (on a scale of 1 to 4, for example), sensitivities during the headache, medicine taken within 48 hours before the attack started, and other observations.

Stress as Aggravator

The fact that stress can play a role in migraine, experts say, doesn't mean that migraine is a psychological disorder. "Does stress or worry ever provoke a headache? Of course," says Neil Raskin, M.D., a neurologist at the University of California at San Francisco. "But it's simplistic to think that someone is having a headache solely because of stress. That would be extraordinarily unusual."

The role of psychological stress on migraines, Sheftell explains, is like the role of psychological factors on epilepsy, asthma, hypertension, and heart disease. "Stress is not the cause of migraines, but psychological issues can worsen migraines as they can these other medical conditions."

Like someone with high blood pressure or heart disease, people with migraines should maintain a healthy lifestyle, including regular sleep patterns, a healthy diet, and exercise. Beyond those traditional healthy habits, some people report benefiting from behavioral treatments even though these have not been scientifically proven effective. These treatments include relaxation therapy, yoga, or biofeedback, which teaches people to reduce their muscle tension.

Despite the biological cause of migraine, Coleman says the myth persists that the pain is imagined or rooted in a psychological problem. "My in-laws used to say, 'Michael, are you still pretending to have those little headaches to get attention?'"

Many doctors, too, lack knowledge about migraines, which Sheftell says may account at least in part for the high rate of undiagnosed migraine cases — an estimated 60 percent of women sufferers and 70 percent of men.

Sheftell recommends forming a partnership with your health-care professional to ensure the most effective treatment. Seek a knowledgeable and interested doctor who will work with you, he says, and get information yourself from headache organizations.

"There's a great deal more that can be done for migraine today than 20 years ago," Sheftell says. "Don't accept 'You have to live with it.'"

Is It a Migraine?

Migraines are "primary headaches," meaning they are not caused by an underlying medical condition such as a tumor. Two other forms of primary headaches are tension-type and cluster headaches.

Tension headaches are the most common type and are usually characterized by a steady ache rather than the throbbing pain that is typical of migraines.

Cluster headaches affect only about 1 percent of the population, mostly males. The headaches come in groups over weeks or months. The pain is very severe, usually centering around one eye, but rarely lasts more than an hour or two.

Should You Call a Doctor?

Some headaches, called "secondary" headaches, result from another medical condition, ranging from a relatively harmless condition like the flu to a serious condition such as a tumor. Headaches very rarely result from a condition as serious as a tumor, but to be safe, the American Council for Headache Education recommends that you contact a health professional if your attacks start after age 50 or your headache:

• appears suddenly and is more severe and different from past headaches, or worsens over time
• is triggered by exertion, coughing, or bending
• is linked with a stiff neck and fever
• is accompanied by disturbed vision or speech or numbness, tingling or weakness in a part of the body
• makes it difficult for you to think and remember
• causes severe vomiting
• follows a head injury.

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.