Why We Get Migraines and How to Prevent Them

November 14, 2019

"If this is your first headache ever, or your worst headache ever, go see your doctor."

People who suffer from migraines (and there are a lot of us!) know that they can be pretty debilitating. That's why Dr. Keller Wortham, MD, is going to take a look at why some of us get these extremely painful headaches and what triggers them, review the symptoms associated with them, and discuss we can do to treat them and even prevent them. Plus, we'll talk about when it's important to see the doctor to determine if there's a serious condition that causes similar symptoms.

Video Highlights

  • 02:19: What is a Migraine?
  • 03:04: What Causes a Migraine?
  • 04:27: Migraine Aura
  • 05:36: Migraine Triggers
  • 07:25: Diagnosing Migraines
  • 09:20: The 5-4-3-2-1 Rule
  • 10:23: Treating Migraines
  • 15:29: A Final Word on Headaches
  • 16:41: Wrap-Up

What is a Migraine?

If you’ve ever had a migraine, you are probably familiar with some of the following symptoms. It involves an extremely severe headache, sensitivity to light and sound, and nausea. It’s believed that the closest thing to migraine pain might be brain freeze. So, if you've ever sucked down a Slurpee or ice cream too quickly, and gotten that brain freeze, that is perhaps similar to a migraine. 

So, what exactly are migraines? Well, migraines are headaches that have been around for a long time. In fact, way back in ancient Greece, they documented them with the term hemicrania, which means half the head (or mid-cranium). Hemicrania is actually where the term "migraine," comes from. 

That's because migraines are typically experienced on one side of the head. That’s not always the case, but the typical migraine occurs on one side of the head, with symptoms like sensitivity to light, sensitivity to sound, and nausea. 

What Causes a Migraine? 

Why do we get those symptoms that are so debilitating for so many people? Unfortunately, not much is known about what causes a migraine, but there are various theories. 

It’s thought that perhaps migraines were caused by changes in the brain stem that then send signals to other parts of the brain that can cause misfiring of the trigeminal nerve, which is a nerve plexus that handles a lot of pain sensation from half of the head. It may also be changes in certain neurotransmitters like serotonin that are influencing the pain pathways. Another possibility is that vascular changes to the arteries in your brain, dilate so they are pumping a lot of blood, and that gives it that throbbing painful sensation. But, in the end, we're not exactly sure what’s causing migraines and researchers are still trying to determine which theory is correct. Basically, it's either a vascular issue, a neurotransmitter issue, or a nerve issue, that leads to this very severe pain. 

A lot of people don't get all of the symptoms listed above. They might get one or two of them, and some people do get pain on both sides of their head. So, just because you have pain on both sides of your head doesn't mean it's not a migraine — it may still be. 

Migraine Aura

There's also a very interesting thing about migraines, called an aura, which is the sensation you might feel coming on before a migraine. They're typically temporary neuro-sensations, and they can include things like vision changes — maybe you see floating lights or twinkling lights, or you experience some temporary vision loss. You may also experience tingling sensations (like pins and needles) in one part of your body, or you may have difficulty speaking, or hear noises. Of course this list of symptoms sounds pretty scary, and it is true that these symptoms may signify something more serious going on. 

There are other health problems, like a stroke, that can cause those very worrisome symptoms. So, it's very important to have your migraine properly diagnosed. 

Migraine Triggers

Many people who suffer from migraines might already know that certain things can trigger a migraine. Understanding these triggers is important, as it can help you avoid them. Here are some of the most common migraine triggers: 

  • Sleep disturbances. Poor sleep, or sleep deprivation can certainly lead to migraines. 
  • Hormone changes. This can happen because of a woman's menstrual cycle, menopause, or due to birth control pills. It can happen in andropause with men, as their hormone levels go down. 
  • Certain beverages. Certainly, caffeinated beverages and alcoholic beverages — especially, certain alcoholic beverages like red wine — can be big triggers for migraines.
  • Stress. Life stress, work stress, money stress, and family stress can all lead to migraines.
  • Intense stimuli. This could be really loud noise, or really bright light. 
  • Certain foods. Foods that trigger migraines might include aged cheeses, and things that have food additives like the preservative monosodium glutamate (MSG). Many people to to avoid MSG altogether, but this is especially important if you’re a migraine-prone person. 

Diagnosing Migraines

So, how do you know if what you’re experiencing is a migraine? A lot of people who've dealt with migraines for a long time, are familiar with the symptoms and know when they have one. They know what the aura feels like, and know when one is coming on. But, if it's new for you, then you really should see a doctor just to make that first initial diagnosis. 

There are some things that a doctor can do to evaluate you and rule out other conditions. A good rule of thumb for when to go to the doctor is the "first and worst" rule. If this is your first headache ever, go see a doctor about it. If this is your worst headache ever, go see a doctor about it. Your doctor can help you determine if you have a migraine or are experiencing symptoms of a more serious condition.

Serious conditions with similar symptoms might include: 

  • A stroke 
  • An aneurysm, which is a blood vessel bursting in the brain. 
  • Tumors that cause swelling in the brain. 
  • Infections of the brain like meningitis. 

Any of these could cause really bad headaches. So, again, if this is your first or worst headache, go talk to your doctor and make sure you get the right diagnosis. 

The 5-4-3-2-1 Rule

The International Headache Society has come up with a little rule called the 5-4-3-2-1 rule, which can help you give a little guidance for understanding whether you’re experiencing a migraine. 5-4-3-2-1 stands for: 

Five headaches, with a duration of 4 hours to 3 days, with two of the following qualities: 

  • Pain on one side of your head
  • A throbbing quality
  • Moderate to severe intensity
  • Aggravated by physical motion 

As well as one of the following other qualities: 

  • Nausea and vomiting
  • Photophobia, which is our medical term for sensitivity to light or sound 

If your headaches fit the qualifications listed here, chances are good that you get migraines. 

Treating Migraines

So, what are you going to do if you have a tendency to get migraines or if you feel like one is coming on? 

Over the Counter Medications

Try to take a medication to control that migraine as soon as possible. There are some over-the-counter choices like Advil, Excedrin Migraine that can really help reduce migraine pain. 

Caffeine Products 

Caffeine is great for treating migraines. Of course there is also such a thing as a caffeine headache, which is a headache triggered by caffeine, or by suddenly abstaining from caffeine. You have to kind of know what your caffeine intake is. But, often, caffeine as a substance is really good at reducing migraine pain. 

Prescription Medication

Your physician can write you a prescription to treat your migraine. And again, these are most effective if you start right away. Some of them are a class of drugs called Triptans, which include things like Imitrex or Maxalt. These work by blocking pain pathways in the brain, primarily those that are mediated by serotonin. So, those medications can help reduce pain transmission through the brain. Triptans come in pill form, or as nasal sprays, or dissolving tablets.

Another class of medications is called Dihydroergotamines. Migranal is one of these. They work by a different method than Triptans, but also help reduce migraine pain. 

A caution with both of these medications: if you're at risk for heart disease, heart attack, stroke, or high blood pressure, they might not be the right category for you. Make sure you talk to your doctor about this if they are prescribing you a medication. 

Anti-Nausea Medications

One of the main complaints with migraines is nausea, so sometimes an anti-nausea medication can help with migraines. 

Preventing Migraines

As we always say, prevention is best. So, avoiding those triggers that you have is your first step — whether that’s poor sleep, caffeine and alcohol, or managing stress, try to avoid your triggers. Try to avoid medications that could lead to them, like birth control pills. 

If you avoid your triggers and you're still getting migraines, you might want to look at some other things that you can do: 

  • Blood pressure medications can help, if you suffer from high blood pressure (and sometimes even if you don’t). 
  • Antidepressants work for some people, as they help modulate serotonin in the brain. Since one of the theorized pathways for migraines is about serotonin, that could be a solution. 
  • There are certain seizure medications, that have an effect on the brain. So, if there's a nerve firing incorrectly in the brain, anti-seizure meds might work for reducing your migraine pain. 
  • A lot of people get relief from their migraines by using Botox. 

There are also some more natural things you can do like:

  • Employ some techniques to get better sleep
  • Exercise regularly
  • Proper hydration
  • Supplementation. There are some supplements that may help as well. Some people CoQ10 (or Ubiquinol), Feverfew, magnesium citrate, and B12 for migraines. 

So, you can start there and see if some lifestyle modifications and natural products are able to help you get your migraines under enough control. 

A Final Word on Headaches

There are lots of things that can cause headaches, some of them quite serious. If you have a really severe headache come on all at once, really think about seeing your doctor right away. You could be sitting on a very serious problem like an aneurysm or a brain bleed, or even a tumor. Again, if this is your first headache or your worst headache, see a doctor. 

Remember that a fever is not a symptom of a migraine. So, if you have a fever, go see your doctor. You could have meningitis or some other kind of infection. 

If you get headaches that wake you up in the middle of the night, that also is a worrisome sign. And, if you've had a recent injury or head trauma, and you start getting headaches, you need to be aware of the possibility of brain bleeds and other conditions that could damage the skull, which could lead to headaches that are not migraines. 

Wrap-Up

So, there’s a little bit of info there on migraines. Remember to try some natural lifestyle changes, like paying attention to your triggers and learning to avoid them, getting good sleep, staying hydrated, supplementing, and exercising. 

You might also consider keeping a headache journal. This can help you track your headaches and understand your triggers better: when they happen most, what you ate before getting one, whether it’s related to your hormone cycle, and whether you’re particularly stressed. 

And then, talk to your physician. They are there to help you, to give you prescriptions if you need them, and to rule out more serious headaches.

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