En español | There are headaches — and there are migraines. These headaches from hell are, along with back pain, the most prevalent pain complaint in the U.S. Migraine’s blinding pain, along with nausea or vomiting, sensitivity to light and sound, and sensory disturbances like flashing lights — called aura — affect more than 38 million people in the U.S., most of them women.
“Headache and more specifically migraine has troubled individuals from the dawn of time,” says Brian Grosberg, M.D., director of the Hartford HealthCare Ayer Neuroscience Institute Headache Center. But now there’s much more you can do about it — including several promising new drugs released in the past two years (more on that below.)
Get trigger — and treatment — savvy
The trick is figuring out what triggers your migraines and then experimenting with the available treatments. “Migraine is not a homogeneous disorder,” says Alexander Mauskop, M.D., founder and director of the New York Headache Center in New York. “Every person has a slightly different version, and as a result, no single drug will be effective for every patient.” Finding a regimen that works requires a process of trial and error.
It also often requires finding a pain specialist. “Migraines are often diagnosed as sinus headaches or tension headaches,” Mauskop says. “Even if they are diagnosed correctly with migraines, they are often not offered the best treatments.” His advice: Seek out a headache specialist. “Well over 90 percent of people who do can be helped,” he says, but only a quarter of patients get the right treatment, according to surveys.
A specialist will likely have you start by keeping a migraine diary, considered the best way to zero in on your specific triggers and gauge the effectiveness of the treatments you try. Triggers can be anything from smells, bright lights, irregular sleep, stress, weather changes, hormonal changes (for women), mood disorders like depression and anxiety, medications, and certain foods. (Ripened cheeses, alcohol, fermented foods, chocolate, nuts, and meats preserved with nitrates are common offenders.)
Attacking triggers with lifestyle changes is the first step toward pain relief. But you likely will need medication to stop a migraine in progress.
While over-the-counter painkillers (aspirin, naproxen sodium, ibuprofen, acetaminophen) can be effective for mild and moderate headaches, prescription drugs known as “triptans,” such as sumatriptan, are specifically designed for a migraine. They constrict blood vessels and block pain signals to the brain. In addition, ergotamine-based drugs, sometimes combined with caffeine, work by preventing blood vessels in the brain from expanding.
Ask for preventive therapies
To prevent migraines, doctors may prescribe certain types of oral medications used to treat high blood pressure, depression or seizures. These are taken daily, not just when migraine strikes. “All of these medications may take weeks or longer for their benefits to be seen,” Grosberg says.
People with chronic migraine (headaches for 15 or more days a month) have several options, including Botox shots. Patients typically get a number of injections around the head and neck every three months. The latest data show that users have, on average, 1.6 fewer migraines a month, but may experience double vision, drooping eyelids, and pain and tightness in the neck.
New to the market is a new class of medications specifically designed for migraine prevention, called calcitonin gene-related peptide (CGRP) monoclonal antibodies. They block CGRP, a protein that causes inflammation in the brain and triggers migraines in many patients. The first drug in this class, Aimovig, was approved last year. Ajovy and Emgality have since come to the market. The drugs are given as a monthly injection and are useful for both episodic headaches and the chronic variety.
“We’re cautiously optimistic about these drugs,” says Mauskop. “They appear to be, at least at this stage, very safe and effective for 50 percent of people. For some people, they are dramatically effective. One out of five will get almost complete relief of their attacks.”
Consider other options
An electrical nerve stimulation device, called Cefaly, targets the trigeminal nerve, the main nerve involved in a migraine. Mild stimulation is delivered through an electrode placed on the forehead. It’s used for 20 minutes once a day as a preventive treatment.
Behavioral treatments like biofeedback, relaxation or cognitive-behavioral therapy (CBT) may offer relief. They often address lifestyle challenges, like stress, sleep disturbances and mood disorders, that are common migraine triggers.
Even yoga can make a difference. In a study published in the journal Headache, migraine patients who practiced yoga had significant decreases in headache intensity, frequency and the use of migraine medication.
Patients may also get benefits from supplements and herbs like feverfew. A recent review of studies showed that vitamin B2 may help lower the frequency of migraines. In another study, patients who took 600 mg. a day of magnesium saw a 41 percent reduction in the frequency of migraines compared to 15 percent in patients given a placebo pill. (Always discuss the use of supplements with your doctor.)
Read the full series on chronic pain