How to Cope with Chronic Migraines

Having a headache is an unpleasant experience for anyone but imagine if that headache involved pain so severe that it was incapacitating and it went on for hours or days at a time.  That is what a migraine is like. For many migraine sufferers, an episode may also involve nausea, vomiting, sensitivity to light or sound, visual disturbances and numbness in the face or extremities.

Migraines are the third most prevalent health condition in the world and the sixth most common cause of disability.  In the United States, 18 percent of women suffer from migraines, as do 6 percent of men and 10 percent of children. More than 4 million adults experience migraines at least 15 days a month, the standard for chronic migraines. Almost one in five chronic migraine sufferers is disabled by their condition.

What Causes Migraines?

Despite migraines being a serious health concern that affects a large fraction of the world population, there is still no clear understanding of the physiological causes of migraines.  Current research suggests that there could be multiple mechanisms at work.  Many researchers believe that migraines are related to a dysfunction in the trigeminal nerve, a key component of the pain pathway.

However, there is also evidence that neurotransmitters like serotonin also play a significant role. It appears that changing serotonin levels can cause blood vessels to dilate or constrict, which can, in turn, produce pain or other migraine symptoms.

At a more personal level, there are many things which might trigger a migraine, including

  • Diet—many foods or drinks like alcohol, caffeine, or pickled foods might be triggers.  In some cases, even hunger or thirst may be a trigger.
  • Stress—although emotional stress or anxiety may initiate an episode, physical stress like too much physical exertion or lack of sleep may also serve as triggers.
  • Sensations—for many people, certain stimuli like loud sounds, flashing lights or strong smells may bring on an episode.
  • Medicines—some migraine sufferers respond poorly to certain drugs. If you are reacting poorly to a prescribed medication, ask your physician for a substitute.
  • Illness—the cold or flu may produce migraine attacks in some people, especially children.
  • Hormonal changes—many women find themselves having more migraines during monthly menstrual cycles and menopause, as well as while on hormonal birth control.

When You Should See a Specialist

Migraine headaches vary in severity with some sufferers experiencing only moderate pain.  That may be why less than half of people with migraines seek medical attention.  However, if you find your life being disrupted by migraines, it may be time to book an appointment with a headache specialist.

It is appropriate to see a physician if

  • You miss work, school, social activities or daily tasks
  • You schedule around your migraines
  • You have a migraine weekly or more often
  • You are self-medicating twice a week or more
  • Your headache pain is severe

Drugs for Migraines

Although there is no cure for migraines, there are several over-the-counter (OTC) and prescription medications that may help manage symptoms. Many OTC drugs like aspirin, ibuprofen, naproxen and acetaminophen do carry some risks like liver damage or higher risk of stroke and heart attack, so you should discuss their usage with your doctor first.

There are some prescription medications that may help limit the number of episodes. These may include non-steroidal anti-inflammatory drugs (NSAID) like Cataflam as well as antidepressants like Elavil or Cymbalta.  Other prescription medications include Atenolol, Topamax, Stavzor, or Aimovig.

A relatively new prescription medication for migraines is Botox. The botulinum toxin is injected into various head and neck locations every three months. Primarily for chronic migraine sufferers with 15 or more headache days a month, Botox can cut the number of episodes by up to 50 percent.

Coping Strategies

Managing your migraines so that you minimize the number of episodes and severity of symptoms usually involves a multi-level approach.  You should consider adopting one or more of the following techniques and then discuss it in detail with your doctor prior to implementation to see if it appropriate for you.

  • Minimize stress—because stress is often a trigger for migraines, you should do your best to eliminate sources of anxiety in your life.  If you can’t remove stress triggers, you may want to learn some stress coping techniques like yoga, Tai Chi, or biofeedback.
  • Regular exercise—exercise can lower the frequency of migraines as well as their intensity. This is largely due to the stress relief from endorphin production and improved sleep. The optimal exercise program should include three 40-minute sessions a week.
  • Sleep well—it is critically important that you get a good night’s rest to prevent migraines. It should be noted that too much sleep may be as harmful as too little. You should determine the optimal amount for you to feel fully rested and make it a habit. If you have difficulty falling or remaining asleep, discuss your options with your physician.
  • Keep a diary—you may not recognize all of your migraine triggers, so if you detail the circumstances prior to an attack, you may learn what to avoid in the future.
  • Maintain a proper diet—if there are certain foods or drinks that induce a migraine, maintain a strict diet that excludes those items.
  • Avoid bad habits—smoking is a well-known trigger for migraines, so do your best to avoid it. If you smoke habitually, talk to your doctor about ways to stop. Similarly, alcohol and excess caffeine may trigger migraines in some people; if you are a habitual drinker, seek treatment to stop as soon as possible.
  • Substitute contraceptives—if you are on a birth control pill, then you should strongly consider switching to a substitute if you experience migraines.  Your doctor can recommend a pill that has a different combination of hormones that may be less problematic.
  • Acupuncture—this alternative therapy is gaining popularity due to its efficacy and minimal side effects.  Major studies show that acupuncture may lower the frequency and severity of migraines.

Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care

M.D. Disclaimer: The views expressed in this article are the personal views of Robert Moghim, M.D. and do not necessarily represent and are not intended to represent the views of the company or its employees.  The information contained in this article does not constitute medical advice, nor does reading or accessing this information create a patient-provider relationship.  Comments that you post will be shared with all visitors to this page. The comment feature is not governed by HIPAA and you should not post any of your private health information. 

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