A Comprehensive Migraine Spectrum Guide: Types, Phases, Triggers, and Prevention
Why Did I Write This Article?
- Frustration: None of my doctors (not even specialists) were able to help me properly manage my migraines or provide any long-term relief. I discovered that I suffer from many different types of migraines with numerous causes. My body is just very sensitive to stimuli and overreacts for any number of reasons (stress, loud noises, hunger, dehydration, hormones, and the list goes on). Identifying which type of migraine and what triggered it is crucial in determining an appropriate treatment regimen. While conducting months of research on this topic, I found that there are helpful articles online. However, many seem to be written by people who study migraines but who have never actually experienced one themselves (never mind various types), which may become obvious to those of us who do suffer from them. In those cases, the information provided doesn’t seem to be 100% accurate.
- Determination: When I reached age 42 and migraines seemed to come just about daily, I realized that I needed to take matters into my own hands and figure out what was causing them and how to best treat and prevent them. Thankfully, by the time I finished writing this article, I finally figured out how to best manage my migraines by identifying the different types that I was experiencing. Unfortunately, everyone is different, so what works for me may not necessarily work for you, but this article was written to help you understand the types, phases, and reasons migraines can occur so that you can properly pinpoint which type of migraine(s) you tend to suffer from.
What Is a Migraine?
A condition (which is also referred to as a disorder or a disease) that typically presents itself as an intense headache, causing throbbing head pain (unilaterally—sometimes on one side of the head), sensitivity to light (photophobia), sound (phonophobia), smells (hyperosmia), and may also be accompanied by nausea or vomiting. It is important to understand the difference between a headache vs. migraine. Depending on the cause of the migraine, it may last from a few hours up to a few days or longer. In addition to the symptoms experienced by a person suffering from a regular migraine, between 20 to 30% of migraine sufferers will experience aura, which is an undesirable phenomenon that may affect vision, speech, hearing, or give tingling sensations. It is important to consult a physician because migraine aura symptoms may mimic those found in stroke. Unfortunately, research has shown that sufferers of a migraine with aura are twice as likely to experience a stroke, so symptoms should be closely monitored by a physician. My mother told me the sad story of when she was as a child and she unknowingly witnessed the death of her grandmother, who complained of having the worst headache she ever had in her life. No one around her that day knew what she was experiencing was life-threatening, so she died in the chair she was trying to recover in. Everyone just thought it was a bad headache, but it was obviously much worse. It was likely a massive stroke (ischemic or hemorrhagic) that took her life.
Phases of a Migraine
This condition is so complex, that it comes in a variety of stages. You may find yourself in the first stage for days before the actual migraine attack strikes, although a certain percentage of individuals will experience all four phases. The 4 different phases of a migraine include:
- Prodrome: The period of time preceding a migraine that takes place between 1 to 24 hours before onset. Symptoms may include cravings, yawning, irritability, stiff neck muscles, or trouble saying words correctly. Note: I always know that I’m getting a migraine the next day when I have trouble speaking. A random word in a sentence that I’m trying to say comes out slurred or garbled. I usually laugh and say (after a few failed attempts to repeat the word), “Well, looks like I’m getting a migraine, tomorrow!” And I actually do.
- Aura: Roughly 25% of migraine sufferers will experience a migraine with aura, which typically lasts around 20 to 60 minutes. It is sometimes referred to as “Silent (or acephalgic) Migraine” because it is during this phase that an individual can experience migraine-like symptoms without feeling head pain, which is likely to follow this phase but doesn’t always. The aura phenomenon isn’t limited to visual disturbances, such as seeing spots, obstructed vision, or flashes of light, usually occurring in one eye. Aura can also include a number of other symptoms such as a prickly sensation, vertigo, weakness, or speech problems (garbled or slurred words). Some of the visual disturbances associated with aura have also been labeled other names, such as “retinal,” “ocular,” or “ophthalmic migraine.”
- Migraine Attack: This is usually experienced as a debilitatingly painful headache and might also cause nausea or vomiting. The attack may last between a few hours to a few days, depending on the trigger. Attacks like these usually send a person to seek refuge in a dark, quiet room and may feel bedridden until symptoms subside. Someone suffering from a migraine will have problems with irritability and a lack of concentration. Migraine pain that lasts for days is usually due to hormonal imbalances or medical conditions. Short-term migraines are usually due to stress, weather, strain, food intolerance, or some other minor trigger.
- Postdrome (a.k.a. “migraine hangover”): This is the recovery period when the migraine pain is fading away or has ended due to either the headache running its course or something has stopped the pain from continuing, such as medication, food, or hydration. Your body feels drained and depleted, after the intensity of a migraine has passed. Keeping yourself hydrated and well rested will quicken the recovery process and help you get back to normal, again.
Calm the Storm: Migraine Phases Video
What Types of Migraines Exist?
Although migraine is a common household word, there are different ways in which a migraine can present itself. I don’t particularly care for the way the word migraine is generally defined since there are so many different variables including triggers, types, and which nerves are affected.
- Cluster Migraine: These headaches may recur 1–6 times a day and will typically last anywhere from 15 minutes up to 3 hours, but these daily attacks can happen for a duration of weeks and up to months at a time. Pain is usually felt on one side of the head and behind the eyes. It may be accompanied by a stuffy nose and watery eyes. It is sometimes confused with a sinus headache. Many argue the difference between cluster headaches vs. migraines, but it is important to remember that any headache, feelings of discomfort, or overstimulation can trigger a migraine.
- Episodic Migraine (EM): This type of migraine is characterized by the number of days it presents itself per month, which is typically 14 days or less per month. These individuals have a higher likelihood of becoming chronic migraine sufferers in the future, if lifestyle changes aren’t addressed, such as diet and exercise.
- Chronic Migraine (CM): Is characterized by migraines recurring more than 15 days per month. Triggers may vary and medications range from OTC painkillers, triptans, to preventatives. There are also numerous clinical trials that work toward finding more effective treatment for this condition.
- Typical Migraine (without Aura): Roughly 70-80% of migraine sufferers experience the condition without aura symptoms. There are many variables that can set off a migraine for any given individual. Triggers such as stress, weather, or a food allergy (among many other things) may be the culprit. Symptoms may include throbbing headache pain in addition to sensitivity to sound, light, and smells. The feeling of nausea or vomiting may or may not be present.
- Migraine with Aura: An additional set of migraine symptoms may appear for the remaining 20-30% of migraine sufferers that also experience aura. Aura symptoms may include the following:
- Visual Disturbances (or Scotomas), such as seeing spots, blurry vision, zig-zag pulsating strobe light-like patterns that typically appear in only one eye, which last for around 20-30 minutes. It is usually followed by head pain post-aura, during the migraine attack phase, if it makes it to that stage.
- Aphasia: Speech problems, such as garbled or slurred words can occur from the day before a migraine to hours or minutes before, or even during the migraine attack, itself. In migraines, this is usually transient (or temporary), but aphasia due to stroke, may lead to a more serious condition.
- Paresthesia (Pins & Needles) or Chills: A tingling sensation may occur on the face or arm. You may even feel the hair raise on the back of your neck with a prickly sensation.
- Allodynia (Painful Touch): Some sufferers complain of over-sensitivity to daily routines, such as hair-brushing, showering, wearing jewelry, or rubbing up against fabric that actually causes pain. It is part of Central Sensitisation, which is a process within the central nervous system using nociceptors that overreact to stimuli.
- Neck Pain or Stiffness: Before head pain from a migraine can even be detected, many aura sufferers may feel a stiff neck, before onset.
- Hearing Impairment: Temporary diminished hearing may be associated with aura.
- Weakness: Aura symptoms may include, muscle weakness or a temporary decline in gross or fine motor skills.
- Yawning or Hiccups: Bodily functions, such as a hiccup or yawn can warn you of the onset of a migraine.
- Brainstem Aura Migraine: (previously known as Basilar Type) may have a few different symptoms associated with it, such as visual disturbances, pins & needles, speech problems, vertigo, imbalance, ringing in the ears, and more. This complex form of migraine is believed to be caused by mutated genes (such as ATP1A2 or CACNA1A).
- Hemiplegic Migraine: Is considered to be a rare inherited condition that presents with stroke-like symptoms, muscle weakness, and is a subset of migraine aura. It is believed to be caused by a defect or mutation of genes (such as in ATP1A2, CACNA1A or SCN1A).
- Menstrual or Hormonal Migraine: Many women with migraines suffer from hormonal imbalances. There is a point in a woman’s cycle when there is a spike in estrogen with not enough progesterone to counter it. This can cause severe migraines in women. In his video, Dr. Giles has given some great advice on how to treat menstrual migraines.
- Male Hormonal Migraine: It is believed that some men suffer from migraines due to low testosterone levels (a.k.a. “Low T”); However, studies have shown that testosterone therapy may have associated health risks (such as heart attack).
- Abdominal Migraine: This condition is far more likely to occur in children, than adults. It’s believed that children who suffer from this type of migraine outgrow the abdominal discomfort before or around adolescence and then go on to acquire typical migraines with head pain, as they mature. This leads researchers to believe that there could be a significant link between colic and migraine.
- Hypnic Migraine (a.k.a. “Alarm Clock Headache”): A rare condition that attacks a person, while they sleep and wakes them up with pain on one side, but can also be felt on both sides of the head. The duration can range from minutes to hours and it can recur more than once per night or multiple times per week. This is more commonly found in people over the age of 50.
- Mixed Tension Migraine: A mixture of a migraine with tension headache symptoms.
- Vestibular Migraine (Vertigo): This may be difficult to diagnose since it doesn’t always include head pain. These patients may experience dizziness, spatial disorientation, involuntary movement, nausea, or vomiting associated with their migraine attacks.
- Positional or Postural Migraine: This can also be referred to as an Orthostatic Headache or Intracranial Hypotension. It is an uncommon condition, but if you are among those susceptible and you are forced to stand up (or stay in a certain position) for an extended period of time, it could provoke a migraine that usually starts at the back of the neck and radiates down to the lower spine. I’ve had this type of migraine many times and usually due to events where I had to stand for most of the day (horse shows, holidays at my home, etc…). You will feel like you really need to sit, recline, or lay down. For this type of migraine, taking yourself from a vertical to a horizontal position with the addition of drinking plenty of fluids, will help to slowly relieve the symptoms. It is possible that this condition is due to a minor spinal fluid leak. It is more commonly found in childbearing women that have used an epidural during childbirth. It could also happen after a spinal tap or sustaining trauma (e.g. sports-related injury, car accident, a bad fall, etc...). However, position migraines may also occur from other sources, such as problems involving muscle tissue, joints, vertebrae, discs, etc…
- Migraine Triggered by Injury: It is certainly possible to suffer from an injury-related migraine, especially after a Traumatic Brain Injury (TBI). Migraines or head pain can occur after head, neck, and/or back injuries (a.k.a. cervicogenic headaches or CGH). It can even happen from something as simple as a pinched nerve. I once had a co-worker who suffered from frequent migraines due to a bad car accident. I felt sorry for the person, since I suffered from frequent migraines, myself and had a good idea of how painful and disruptive they could be, but this person’s migraines seemed much more severe and unbearable. She would take many sick days off of work, where I would always just worked through the pain.
What Triggers a Migraine?
Migraines are very complex and may have a variety of different symptoms for each individual. For example, a young boy may get migraines that cause abdominal discomfort, while a 40-year-old woman may see spots or zig-zag patterns in one eye, 20 minutes before a painful migraine headache begins. Migraine triggers may include:
- Hormones: Hormonal levels in females will fluctuate throughout each month, as well as shift during her lifetime. An imbalance of estrogen in relation to progesterone can cause a nasty migraine headache that can last 3 days or longer. Hormonal migraine relief is best treated with a migraine relieving diet, including ingredients rich in Magnesium (which calms and may prevent a cortical spreading depression and aura symptoms) and Omega-3s (which acts to reduce the swelling of blood vessels). Eating a well-balanced diet and staying physically fit can combat hormonal imbalances that may be causing the migraines. Taking too much headache medication, eating processed food, and drinking alcohol or caffeine can delay the body’s natural ability to rid the body of toxins through the liver. In a perfect woman’s body, estrogen is quickly metabolized, but in many women experiencing menstrual migraines, various toxins may be blocking liver functions that can cause a hormonal imbalance.
- Too Much Caffeine: Although 1 – 2 cups of coffee or tea may help you combat a migraine, drinking too much caffeine can make it worse, which may include nausea or vomiting. Be mindful of the number of caffeinated beverages you are consuming per day and keep it to a minimum. There are other foods and beverages out there that also contain caffeine, so always be mindful of what you are consuming.
- Genetic Defect / Mutation: Though controversial, there have been studies that attempt to prove or disprove that genetics play a key role in the existence of migraines. I’ve noticed a huge similarity in my own family history.
- Food Intolerance: If a certain type of food gives you a migraine, then you’ll eventually learn to avoid it, but unfortunately this is through trial and error. Migraines can be triggered by certain ingredients found in food, beverages, or even chewing gum, such as:
- Aspartame, which may include foods containing artificial sweeteners or items labeled sugar-free. Check the chart to find which artificial sweeteners have better alternatives for migraine sufferers.
- Tyramine, which may include preservatives, processed meats, aged dairy products, soy products, and certain types of beans.
- MSG (Monosodium Glutamate) may be found in broth, Chinese food, dipping sauce, gravy, and many other delicious foods, but look out for “clean labeling,” which some manufacturers may use to allow MSG into their product, without full disclosure.
- Phenylethylamine, includes some protein-rich foods, eggs, chocolate, meats, cheeses, and so many others. Learning to develop a proper diet is essential.
- Nitrites/Nitrates, which may be found in some alcoholic beverages, medications, food additives, preservatives, and more.
- Sodium Benzoate, which is a chemical found in condiments, sweets, and fizzy drinks, such as soda.
- Dehydration: One of the most painful types of migraines that I’ve ever experienced was due to dehydration. This type of migraine hurts so bad, that just tilting the head or laying down is an agony. A person may feel that they can’t even get comfortable. The best thing to do is drink lots of water and if you have any sports drinks handy that contain electrolytes, those will work even faster! The more you drink, the better you’ll feel, so force yourself to drink plenty of nourishing fluids. Stay away from sodas, alcoholic beverages, coffee, or tea, which all can exacerbate dehydration.
- Stance / Excessive Physical Activity: Triggers may include:
- Bad Posture: If you sit in an awkward position for an extended period of time (such as at a stadium, slouched over a computer or handheld device, using public transportation, reading a book, etc...), this strain on your back, neck, and shoulders can really wreak havoc on the brain stem. Making an effort to remember to sit up straight, every so often and taking frequent breaks, may help to keep this type of migraine at bay.
- Strain: Carrying something heavy or uncomfortable around for an extended period of time (such as a backpack, baby, stack of wood, cooler, heavy shopping bag, etc...) can cause muscles to become tight, cramped, agitated, or fatigued. Studies at Tufts claim that there is a correlation between muscles and migraines. A good old fashion massage may do the trick in relieving migraine pain due to stiff muscles. I would NOT recommend using a jacuzzi tub, when you have a headache, because although they are good at loosening up muscles, they are also really good at dehydrating your body considerably, which can lead to an even worse migraine than you ever thought possible. If you do try a jacuzzi tub, don’t stay in it for very long, make sure it isn’t too hot, check for any age restrictions, and drink plenty of fluids before, during, and after. I’ve learned all of this the hard way.
- Overexertion: Some migraine sufferers are unfortunate enough to experience migraine pain due to exercise, aerobic workouts, sex, sports, or engaging in other aerobic activities. If this happens to you, accept your limitations, consult your doctor, and figure out an exercise regime that works best for your body type without overdoing it.
- Weather: Have you ever noticed that you’re more apt to get a migraine during rainy or stormy weather? This may not be your imagination. There are a number of weather conditions that can trigger migraines, but it likely depends on the person. Not every migraine sufferer will get weather-related migraines, just as not every person who typically suffers from weather-related migraines are guaranteed to get a migraine headache, whenever they encounter these types of weather conditions. It just varies.
- Loud Noises: Whether it be a sudden loud unexpected noise (fire alarm, car accident, shouting, fireworks, etc...) or a constant irritating sound that goes on for a certain duration (parade, concert, construction, baby crying, etc...), migraine sufferers cringe at the thought of coming within range of any of these inescapable situations because they know a migraine can come on quickly and furiously from the stress associated with it. The best thing to do is use clever ways to minimize and manage the noise to keep the peace.
- Bright Lights: A direct beam of light is something many migraineurs try their best to avoid. Driving into the sun during a morning or evening commute, driving into the extra bright headlines or high beams, or even something as simple as someone shining a flashlight into your eyes can actually trigger a migraine. Add a flickering strobe light or flashing lights to your list of what to stay away from. Some people even claim that blue light can cause a migraine.
- Stress: The stress hormone, Cortisol released into the body can overwork the adrenal glands, which in turn may cause the body and brain to become oversensitive to pain, leading to muscle aches, headaches, or migraines. Tense muscles, such as in the neck, back, and jaw may cause pressure, pain, or overstimulation to different sets of nerves that are prone to causing migraines, such as the trigeminal nerve (affecting eyes, face, jaw, etc...) and the occipital nerve (found near the back of the neck).
- Eye Strain: Poor eyesight or overusing digital devices may increase the risk of headaches or migraines. Give your eyes a rest and take frequent breaks when using electronics. Visit your eye doctor for visual problems, such as nearsightedness, farsightedness, astigmatism, glaucoma, or cataracts that may be causing headache or migraine.
- Odors, Fragrances, or Chemicals: Migraines can be caused by breathing in harmful chemicals, car exhaust, perfumes, air fresheners, flowers, candles, and many other fragrant products. Those who are sensitive to smells may opt to speak their mind and fight back about being forced to breathe in these annoying odors that can cause them a day of agonizing pain.
- Allergies: Migraines can be associated with different types of allergies, including seasonal hay fever and food sensitivities.
- Air or Water Pressure: Being underwater, while scuba diving, traveling to high altitudes, or barometric pressure changes in the weather, may all stimulate enough force to generate a migraine.
- Genetics: Though this topic has been controversial over many years, doctors believe they are getting closer to finding substantial evidence to suggest that migraines can be an inherited trait, especially those suffering from Migraine with Aura.
- Vitamin or Mineral Deficiencies: The human body needs a variety of vitamins and minerals to stay healthy. Check your diet, make a point to eat more healthy whole foods, reference the food pyramid (or food plate), and talk to your doctor about proper nutrition catered to your own dietary needs. It is possible for vitamin or mineral deficiencies to trigger migraines. There is also a link between iron and copper deficiencies and frequent migraines with cracked sides of the mouth. I did a double take when I read this since I suffer from both frequent migraines and cracked sides of my mouth (or Angular Cheilitis).
- Disease: When a person’s immune system is diminished (such as with the onset of Lyme, Crohn’s, Lupus, or Heart Disease), individuals prone to migraine headaches may notice an increase in migrainous episodes. It may be the body’s way of letting you know there is an underlying condition. It is best to be examined by your doctor, as soon as you realize something seems abnormal.
- Jaw Tension: The tension caused by teeth grinding or jaw clenching may provoke a migraine, since the trigeminal nerve has been irritated. Those suffering from TMJ (temporomandibular joint) problems are likely to be affected by this type of migraine. A soft occlusal splint may be used to prevent pain by a neuromuscular dentist.
Anyone suffering from migraines will have their own list of triggers. Keeping a migraine journal may help you to anticipate and manage some of the preventable attacks. My own migraine triggers include monthly hormonal imbalances, stress, food, bright light, loud noises (especially from loud voices, music, sirens, etc...). Unfortunately, I am one of the 25% of migraine sufferers who also experiences aura. My own aura experiences have consisted of seeing spots in my teens and 20s, flashing zigzag patterns (multi-color or black & white, reminiscent of a strobe light) in one eye, while in my 30s, and Garbled Speech or the inability to pronounce a particular word or phrase correctly (sometimes even with multiple attempts), in my 40s. I have also experienced intermittent bouts of weakness, tingling in the back of the neck, and temporary diminished hearing, at different points in time.
Who Can Get a Migraine? Women, Men, Children, and Seniors.
Migraines don’t discriminate. They have the potential to develop in any person for a variety of reasons, no matter if they are healthy, ill, disabled, able-bodied, young, or old. Migraines have many triggers and anyone can get them, although some people are more prone than others for various reasons. Migraine triggers may include exposure to certain chemicals or ingredients, bright lights, loud noises, stress, hunger, strain, dehydration, or overexertion.
- Migraines by Age: Migraines typically start to develop in children prone to this condition between ages 10 – 12. The intensity and frequency of migraines may then skyrocket between the ages of 20 – 50 years old. Finally, after age 50, there is a downhill spike in the number of migraines, until age 70 – 80, where it tapers off.
- Migraine in Babies: It is possible for an infant to get a migraine. They may become irritable, have excessive crying spells, and be very fussy. Research suggests that there could be a possible link between babies who experience colic and children diagnosed with migraine. It is possible that they could be experiencing an abdominal migraine.
- Childhood Migraines: Stress, emotional issues, hunger, genetics, lack of exercise, bad posture, hormones, and dehydration are among the many reasons children get migraines.
- Migraines for Women: Women have an additional migraine trigger than men, which accounts for the majority of female migraines. In an article from NPR, Neurologist J. L. Brandes explains how many women get migraines from fluctuations in hormone levels of estrogen and progesterone, especially once they begin menstruating in young adulthood and these levels also change over time, as they age.
- Migraine for Men: Male migraines are typically triggered by either hormonal, genetic, or other external sources. Many of the types of migraines that men encounter are usually those that can affect either gender.
- Geriatric Migraines: While older individuals can still get regular migraines from something they ate, hunger, bad posture, side effects of prescription drugs, and a variety of other triggers, they are also more prone to experiencing what feels like a migraine, but is actually a “silent stroke” or blood clot that may permanently injure the brain. It is riskier for the elderly to treat a migraine headache with aspirin since it acts as a blood thinner and could be hazardous with older individuals prone to falling, especially if they are already on blood-thinning prescription drugs that help with certain heart conditions.
- Animals Too? It is believed that animals can also suffer from migraine headaches, but there is no solid evidence. However, animals have responded positively to migraine medication, when they seemed to have had migrainous symptoms. Also, Did you know that service dogs can alert owners of their onset of a migraine, so they can treat it before it becomes a real problem.
A Very Comprehensive Migraine Video (by M. Barad, MD)
Study and Treatment of Migraine: Resources
The treatment of migraine depends on the type. Since there are various triggers for migraine, there is always extensive ongoing research being conducted on the topic. Listed below are the various treatments and resources available.
- Medicinal Antibodies: While writing this article, I was blown away when I heard a segment on NPR about new treatments in migraine prevention. It boasts of two new drugs (fremanezumab and erenumab) that use antibodies to block migraine provoking brain waves from wreaking havoc in the section of the brain that signals pain, without the risk of side effects. They say it is like soundproofing and was created to block “noise” from reaching areas of the brain that overreact to stimuli responsible for bringing on a migraine attack.
- Nerve Stimulation Therapy: There are certain areas of the body, where a doctor can perform nerve stimulation therapy using a device and possibly even wire implants to treat migraines. This type of therapy may even come in the form of a patch. These procedures are typically only used after conventional methods of migraine management have been deemed to be ineffective.
- Forehead Device: A trigeminal nerve stimulation device (such as a Cefaly) may be used on the forehead for 20 minutes per day, as a migraine prevention strategy. Though it is believed to have minimal side effects, only time will tell, as more data is gathered on the use of this trial product. A migraine patient would need to have their doctor prescribe one of these devices since they are not sold over the counter (OTC). Results may not be noticeable until 2 weeks to 3 months into the treatment. Not recommended for patients with pacemakers, acrylate allergies, or certain skin conditions.
- Base/Back of the Head: For chronic migraine, a device may be implanted near the base of the head to provide migraine relief through Occipital Nerve Stimulation.
- Neck: Transcutaneous Vagus Nerve Stimulation therapy can be used externally, holding a handheld device up on the side of the neck, in the hopes of reducing the frequency of migraines.
- Spine: Neurostimulation may be used by doctors to relieve migraines by implanting stimulators just underneath the skin of the lower back, above the spinal cord. Learn more about the Omega procedure.
- Chiropractic Care: While traditional spinal adjustments may be performed by a chiropractor to help relieve migraine pain, these specialists may also assist patients with postural and nutritional advice. Spinal adjustments may also be made by the use of technological advancements, such as the use of an Arthrostim or Vibracussor device.
- Physical Therapy: Icing, stretching, and massage can all be beneficial practices for relieving migraine pain with the help of a physical therapist. These specialists may focus on relieving pressure around the back, neck, and jaw. Physical therapists work on strengthening muscles, realignments, and joints that can become imbalanced due to injury, bad posture, or lack of physical activity. They look for weak points that trigger discomfort and pain, which can lead to migraines.
- Pharmaceuticals: There are many different medications on the market that your doctor may prescribe for the treatment of migraine. Triptans (ex: Imitrex, Zomig, etc...) that may relieve active migraine symptoms, migraine preventatives (such as Botox, Amitriptyline, etc...), anti-nausea (ex: metoclopramide), and even treatments for vertigo (ex: dimenhydrinate). These drugs may work well for some individuals, but many medications tend to lose their effectiveness over time. This may mean your doctor will need to prescribe you higher doses or move you on to some other treatment.
- Cognitive Behavioral Therapy (CBT): A form of psychotherapy that aims to help people ease the symptoms of migraine without the use of medication. CBT is focused on changing the way people think and behave. It is also used to relieve emotional and sleep problems, depression, substance abuse, and a number of other issues.
- Surgical Procedures: There are two routes a specialist or plastic surgeon may take after fully understanding the background history of the patient’s migraines. This process is not for everyone, since messing around with the nerves in the head can have serious consequences if done incorrectly, but doctors may agree that this procedure is the best course of action for some patients with extreme cases, who suffer from debilitating migraines that prevent them from carrying on normal day to day activities, such as holding down a job, doing daily chores, or caring for themselves and others.
1. Botulinum Treatment: Botox injections may be administered for temporary relief, which only paralyzes a muscle from causing pressure on the affected nerve for a limited amount of time.
2. Muscular Surgery: A minimally invasive procedure may be administered to separate the facial muscles from pinching nerves for permanent relief.
- OTC Medications: Sometimes all you need to resist the onset of a migraine is to stop it in its tracks by using an old-fashioned over-the-counter medication (such as aspirin, ibuprofen, naproxen sodium, or acetaminophen). If I find myself in a stressful situation that sets off a migraine, I can usually take care of it quickly, before it becomes a problem with an ibuprofen, aspirin, and a cup of caffeinated tea. This method isn’t for everyone, so talk to your physician before trying it. For example, patents on heart medication or blood thinners, such as coumadin or warfarin should NOT try this method!
- Case Studies: There are many case studies that concentrate on migraine research. There are also online case study communities. Do your research first, if you think that this is something you’d like to try and definitely be wary of scams.
Alternative & Natural Treatments of Migraine:
Although it is intriguing to believe that a person can heal their own ailments through alternative methods, it is still important to consult a physician before beginning any natural, holistic, or home remedy to make sure there are no medical side effects, interactions, or negative outcomes that can result from experimenting with different types of alternative treatment. Everyone’s body is different and only your own physician would know what works best for your particular body.
- Biofeedback: Behavioral medical techniques, such as breathing exercises (4-second long deep inhales and exhales for a one-minute duration, as practiced by Navy SEALs) and relaxation exercises can significantly help with migraine management. There are many online tools at your disposal that can help you find which relaxation exercises work best for you, including audio techniques.
- Hypnosis: Migraines may be treated with hypnotherapy methods, such as hand warming. Perhaps this is why a migraine sufferer tends to cling their hands around a cup of warm soothing tea. A hack that I learned from this was sitting on my cold hands for 3 minutes. It actually did help my migraine feel better and even if that was only a result of a placebo effect, so be it! I often find myself listening to my favorite hypnotic recording that is used to help with sleep and pain management. It eases my mind to help rid myself of stress that triggers my migraines.
- Holistic Method: Treating the person as a whole, while considering mind, body, and spirit, as well as environmental factors, instead of treating an individual for a specific symptom. Holistic migraine therapies may suggest that patients make lifestyle improvements (such as diet, exercise, meditation, sleep habits, etc…) to prevent the frequency of migraines. The point is to correct any imbalances (physically or mentally).
Homeopathy: Treating a disease with tiny doses of something that would otherwise make a healthy person experience symptoms of the disease. A German scientist developed this idea of “like cures like” (a.k.a. Law of Similars), in the 1700s. For example, If someone has seasonal allergies with watery eyes and runny nose, then they will be treated with onion (which causes watery eye and runny nose). There are very helpful homeopathic medicines out there focused on the treatment of migraine.
- Natural Home Remedies: plant-based herbal remedies, such as feverfew and butterbur may significantly help with migraine symptoms. Feverfew helps with nausea and sensitivities, while butterbur helps to reduce inflammation. Other home remedies may include using essential oils, vitamin and mineral supplements, chiropractic care, proper diet, and exercise.
Placebo Effect: In many migraine case studies, it has been found that the placebo effect (or a patient’s belief that they were given a certain treatment to relieve their ailments, when actually they were only given a sugar pill or sham treatment), which suggests that our own minds may have the ability heal itself.
- Intuitive Guidance: This is a very powerful, yet mysterious tool in migraine prevention and there has even been a case study about it. It can come in the form of tarot readings, astrology, numerology, and countless other methods. The most important idea that comes for this type of healing is to realize that there are some aspects of your life that you can change for the better, but you just have to have the courage and determination to make it happen. Intuitive guidance can significantly boost morale, even when times are tough if there seems to be a clear vision of better times to come. It generates hope, basically.
- Aromatherapy: Fragrances that can soothe headaches and migraines can come in many forms. Essential oils are very popular. Some individuals may prefer incense, but I personally stay away from it, since it has triggered migraines for me in the past. I wonder if it is because incense psychologically reminds me of funerals, which is not a comforting thought and disrupts my normal calming thought process. Scented candles are also an option. Be careful and read the packaging. Many essential oils must be diluted before use, so use as directed.
- Ginger: May help to relieve nausea.
- Eucalyptus: May relieve sinus pressure.
- Lavender: Helps to relax tense muscles.
- Myrrh: May assist with hormonal imbalances.
- Rosemary: May improve memory, help brain functionality, reduce stress, act as a pain reliever, and relaxes muscles.
- Peppermint: May improve concentration and relieve headaches, migraines, or muscle pain caused by tension.
- Frankincense: May assist in reducing inflammation and improve brain function.
- Teas: Whenever I get a migraine, the first thing I go for is a cup of tea. Not only does the caffeine help to kick a migraine (as long as you don’t overdo it since too much caffeine can cause a worse migraine), but there are different types of teas out there that can help with certain types of migraine symptoms, such as:
- Relieving Nausea: Chamomile, Ginger, Peppermint
- Soothing Effect: Lavender, White/Green Tea, Lemon Balm, Rosemary
- Pain Relievers: Black tea or Feverfew
- Dietary Needs: As the old adage says, you are what you eat. This is true, especially for migraine sufferers with certain foods that often trigger their migraine attacks. In addition to avoiding the foods that are likely to cause migraines, it is also helpful to eat beneficial foods that prevent migraines, such as certain fruits, vegetables, and omega-3 fatty acids. I’ll explain this further toward the end of this article.
- Smoothies: There are many recipes out there that help to relieve different symptoms of migraine. Discover the different types of smoothie recipes to find out which one works best for you.
- Vitamins & Minerals: Migraines can often result from nutrient deficiencies. Certain supplements may be taken daily to help prevent migraine. After a trip to the neurologist, I was told to take Vitamin B Complex and Magnesium to help prevent migraines, but there are many other deficiencies to consider depending on your own body’s needs, such as low iron (better absorbed by taking it with vitamin c).
- Go to Your Happy Place: During a migraine attack, if you are able to close your eyes and remember a pleasant time in your life, when you were happy, peaceful, and feeling well, then chemicals in your brain will follow suit and trigger the release of serotonin and endorphins, which are your body’s natural painkillers and will help you feel better.
- Acupuncture for Migraine: This method can be used to relieve a migraine that currently exists or it may be used as a preventative measure. Fine needles are inserted into certain points on the body to stimulate blood circulation and encourage the body to release beneficial hormones that act as the body’s natural pain-killers. As an added measure, a specialist may even try a gentle electrical current to further encourage blood flow. Make sure to find a certified specialist using sterile equipment. Unfortunately, the cost is typically paid out of pocket, since acupuncture isn’t covered by a number of health insurance companies. For those afraid of being pricked, a needless option does exist.
- Acupressure for Migraine: Fingers and hands may be used as a tool for this type of treatment. There are certain regions of the body that are said to relieve migraine symptoms when pressure is applied for a certain amount of time.
- Reflexology: There are certain points on the foot (and hands) that are said to relieve headache and migraine pain. This has been practiced for hundreds of years and is more commonly used in traditional Chinese medicine.
- Self-Healing Techniques: Some believe that their migraines are a product of their third eye chakra being blocked. In order to relieve migraine pain, it is said that there are certain ways to re-channel that energy to reduce the pressure and discomfort. Learn more about the human body’s 7 chakras.
- Cannabis: It is believed that medical marijuana can help relieve migraine symptoms, as well as prevent them. It has also been argued that inhaling it (in smoke form) works much better than edibles. I don’t partake in this treatment, but new and inventive strategies involving clinical trials have been established in the use of this product. The lasting effects are unknown.
The Importance of Maintaining a Proper Diet:
Migraines can be managed by eating healthier. This means watching out for and reducing the amount of flour, sugar, starch, alcohol, and other non-essential food products that are consumed in your daily routine. I’ve learned that I needed to reinvent my diet to include whole foods, green leafy vegetables, omega-3s, wild-caught fish, and so much more. The doctors aren’t kidding when they say diet and exercise is key to healthy living. Now that I’ve been eating well for a couple months now, I don’t get anywhere near the number of migraines as I used to, which was just about daily. Hormonal migraines are still a problem, but I find that simply eating walnuts alone helps to relieve the pain for a few hours. However, it is important to note that some people get a migraine that is triggered by eating walnuts or pecans. I keep a container of walnuts near my desk at work and grab 3 or 4 small pieces at a time to nibble on, as the pain resurfaces and then within 20 minutes, I feel relief again. Walnuts work great because they reduce inflammation, which is part of the problem with hormonal migraines. Check with your doctor to make sure you aren’t allergic to any of the foods mentioned below before giving them a try. There are far too many people these days with dangerous life-threatening food allergies (such as to tree nuts, shellfish, peanuts, dairy, etc…) and food allergies can strike at any age. I’ve seen women in their 30s and 40s be healthy all of their lives, until one day they found themselves allergic to many different types of foods all at once, so it is a topic not to take lightly.
MA Sample Diet for Migraine Prevention:
- Breakfast: Greek yogurt with flaxseed and chia seeds mixed in
- Lunch: White albacore tuna on whole grain bread (learn frequency of eating tuna)
- Light Snack: Trail mix of walnuts, sunflower seeds, almonds, (check for migraine triggering preservatives or food allergies)
- Smoothie: Granny Smith apples, carrots, and beet
- Dinner: All-natural steak, baked potato, and broccoli
Important Foods to Maintain Migraine-Free Health:
1. Omega-3 Fatty Acids: Can be consumed to help reduce inflammation. Try to include the following in your diet (as long as you're not allergic to them):
- Wild-caught fish (salmon, mackerel, herring, albacore tuna, sardines, or trout)
- Chia Seeds
- Grass-fed beef
- Wild Rice
Eating better has significantly reduced my migraine issues. I have learned that any twinge of migraine pain can be relieved by eating a small handful of walnuts (around 4 whole pieces). I have been experiencing so many more migraine-free days, after making some important and necessary changes to my diet.
2. Riboflavin (Vitamin B2):
- All-natural beef
- green leafy vegetables (such as spinach, kale, or broccoli)
- brown rice
4. Cater to the Liver: For Menstrual Migraines and for better liver function to process hormonal imbalances quickly, try:
- Smoothies: Granny Smith Apples, Beets, and Carrots
- Salad: spinach, kale, arugula, tomatoes, carrots, beets (shredded small)
Steps to Take in the Treatment of Migraine:
Seek Medical Attention: Since migraines can be caused by other ailments, such as a blood clot, stroke, brain tumor, or different types of diseases, it is important to seek medical attention, first to rule out any other causes.
Doctor’s Orders: Talk to your doctor and follow their instructions on how to best treat your migraine symptoms, such as nausea, headache, visual disturbances, dizziness, etc…
Determine the Cause(s): This is up to you to keep a journal of possible triggers. The doctor can’t do this for you. It is extremely important in your day-to-day life to figure out what is causing your migraines after underlying health conditions have been ruled out by your doctor. Once you understand the cause (weather-related, food intolerances, stress, hormonal changes, etc…), then you and your doctor can figure out a more comprehensive plan to properly manage your migraines, in a more effective way. Just treating a migraine, in general, doesn’t get to the root of the problem and allows the vicious migrainous cycle to recur.
See a Specialist: Your doctor may encourage you to see a specialist and refer you to a neurologist to investigate your condition further. The severity of your migraine history will determine if an MRI is necessary, but that is not always the case. Before visiting the specialist, it is in your best interest to understand the types of migraines you suffer from so that you don’t receive generic advice that may not be helpful to you.
My personal experience was going to my primary care physician, where I was prescribed a migraine preventative and then was referred to a neurologist. When I finally visited the neurologist (it takes months to even get an appointment), she told me that the medication that my doctor prescribed seemed to be an effective treatment for my situation, since I had reported that the medication seemed to be working. The neurologist only suggested that I take some additional vitamin supplements to aid in migraine prevention. I was not given a full workup and only had to answer a bunch of questions. I was then told by the specialist that I could always come back if I had any other problems in the future. The neurologist had me return for a follow-up, which I had nothing new to report since the medication still seemed to be working okay at the time. Unfortunately, around a year later, the medication stopped working for me, since my body got too used to it. I started getting migraines regularly, again. I probably should have returned to the neurologist, but I figured they’d just increase my dosage of the preventative medication, which frankly made me gain too much weight, so… 20 pounds later… I decided to quit the medication cold turkey and sought healthier alternative treatments, on my own. I figured there must be more natural ways to prevent and relieve migraines, which seems to be the case.
Where to Begin?
Before you do anything else, check with your doctor to make sure you are given a proper diagnosis, when it comes to the treatment of migraine. It is necessary to rule out the possibility of a more serious condition that may have similar symptoms, such as stroke. Migraines are so complex that it can be difficult to get a full understanding of the various forms they come in. There are also many different types of triggers that can cause this relentless condition. Individuals susceptible to migraine may avoid certain foods, beverages, loud noises, bright lights, or things that cause them stress, but there are some triggers that may be unavoidable, such as weather conditions, disruptive events, or hormonal changes in the body. Understanding the different migraine triggers can facilitate in finding effective pain management strategies. If you can successfully identify what is causing your migraines, then your doctor can assist you in finding suitable ways to provide you with the right treatment for relief and prevention.
Though there is no cure for migraines, there are many resources out there to help you cope with managing frequency and duration of migrainous attacks. This article was designed to be comprehensive enough to help you narrow down the path that you may need to take to prevent future bouts of your particular type of migraine.
This article is no substitute for seeking expert medical advice from your physician or specialist. A migraine may be an indication of a much more serious (even life-threatening) condition, so it is extremely important to speak to a trained medical professional before focusing on how to combat the migraine pain, itself. Our bodies are very good at letting us know when something is wrong, but the cause may not always be clear. That said, if you’ve gone through the motions of consulting with your physician and you aren’t getting the help you need, then this article may shed some light on your situation and steer you on the right direction.
Migraine Terminology & Vocabulary:
Cortical Spreading Depression: An electrically charged wave of energy that develops, much like a thunderstorm, that travels across the brain (from the back of the head to the front of the head) during a migraine. It may be the culprit of aura symptoms, especially since it comes into contact with areas of the brain that control sense of feeling, cognition, language, and vision. This electrical storm encourages chemicals in the brain to be released, causing inflammation and pain that brings on a migraine.
Transient Aphasia: Is a fully reversible phenomenon in which a person has difficulty speaking or understanding language. The sufferer may encounter confusion, garbled speech, or slurred words, which is usually only temporary during the aura phase of a migraine (Note: aphasia can also present itself in a person suffering from a brain-damaging stroke and only a trained medical professional can tell the difference).
Paresthesia: A tingly feeling of pins and needles or even numbness caused by pressure on area nerves, which may be experienced during a migraine (or may signify nerve damage during a stroke).
Migrainous Stroke (or Infarction): A migraine induced stroke, where a stroke takes place after an extended aura stage of a migraine.
Triptans: A class of migraine medication that is taken by patients at the first sign of a migraine to relieve pain, discomfort, and/or nausea. This type of medication does not prevent migraines, but helps to relieve existing symptoms.
Lacrimation: One or both eyes become watery and tear up due to a migraine.
Scotoma: A temporary disturbance or visional obstruction in part of one’s visual field, usually due to migraine aura. There are many different types of scotomas that affect different parts of one’s vision.
Scintillating Scotoma: A phenomenon that occurs during the aura phase of a migraine, where visual disturbances, such as flashes of light or colorful zigzags can obstruct part of one’s peripheral field of vision unilaterally, while the rest of the vision remains unaffected.
Phosphenes: A temporary appearance of light, that isn’t actually produced by light, but is due to pressure on the eye.
Vasodilation: blood vessels that become dilated in the brain, after chemicals are released due to stress, which can cause a migraine attack.
Hemicrania Continua: A headache that is felt on one side of the head (unilateral) and continues to provide discomfort usually on a daily basis.
Status Migrainosus: An atypical migraine that lasts for longer than 72 hours.
Migraine Spectrum Disorder: Migraines are very complex and have many different phases, triggers, aspects, and variations, which leads medical professionals to refer to this wide range of symptoms and types of migraines as being part of a spectrum.
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