Health & Wellness
A real head case

A real head case

Identify and manage migraine headaches
By Amy Meadows

When you’re struck with a migraine, it can feel like no one understands the pain you’re going through. It can feel like you’re the only one experiencing it.

But according to the National Headache Foundation (NHF), more than 29.5 million people suffer from recurrent migraine headaches. “Migraines occur in approximately 15 percent of the United States population. However, this figure is likely an underestimate since with migraines are never diagnosed by a doctor or treated with prescription medication,” says Jaffar Khan, M.D., assistant professor of neurology and director of Neurological Education and the Neurology Residency and Fellowship Programs at Emory University. “In general, migraines are less common in childhood, tend to peak in adulthood at age 30-50 and lessen at older ages, but remain 2-3 times more common in women than men.”

“At least 60 percent of women—and 20 percent of men—will have at least one migraine in their lives,” adds Matthews Gywnn, M.D., president-elect of the Medical Association of Atlanta and partner of Atlanta Neurology. “In any given year, 1 in 7 women and 1 in 20 men will have a migraine.” Of these individuals, some will have as few as one migraine a month, while others will have chronic daily migraines.

While the cause of these headaches is not known, there are certain triggers to be mindful of, as well as a number of treatment options, depending on the frequency and severity of the episodes. Of course, the key to managing migraines is first to know whether you’re actually having them.

Headache or migraine?


Keep a headache diary—it can be very helpful as you try to find associations between your migraines and any possible triggers. According to Matthews Gwynn, M.D., writing down everything you can when a headache occurs, from what you were doing when the headache started to what you may have eaten before the migraine developed, can give you the details you need to make those important connections. Because migraines can be triggered by certain foods, caffeine intake, stress, situational depression and more, it’s important to track what’s been going
on around the time of your migraines. And when you visit the doctor, take your diary with you. Jaffar Khan, M.D. explains, “The headache diary provides a mechanism for you to track the essential details of your headache history and for your clinician to obtain objective evidence of your treatment response and subsequently modify your treatment regimen as needed.”

If you’re having a classic migraine as opposed to a standard tension or sinus headache, you’ll most likely know it thanks to its rather distinctive symptoms. As Khan explains, a migraine is characterized by attacks that last between 4 and 72 hours and typically features such manifestations as moderate to severe throbbing or pulsating pain on one side of the head, nausea, light sensitivity (photophobia) and possibly sound sensitivity (phonophobia). Often, the pain is aggravated by physical activity, causing you to feel the need to lie down—many times in a dark, quiet room to ease the photophobia and phonophobia.

Additionally, sufferers (referred to as migraineurs) normally will have migraines that fall into one of two categories: migraine without aura and migraine with aura. “About 10 percent of the time, there’s some kind of neurological complaint before the headache actually begins,” Gwynn says. “Usually it’s visual. An aura begins with a blind spot that may be subtle at first. It starts in the center of the eye and, over time, turns into a shimmering, zig-zaggy line that’s shaped like a ‘C’ and moves outward—this is called a scintillating scotoma, and it will last a few minutes to an hour. It goes away when the headache starts.” However, some auras are not visual in nature; they can appear as a sensory disturbance like numbness or weakness of an extremity or on one side of the body. As with a visual aura, though, the feeling will end before the headache commences.

Causes and triggers

Although the exact cause of migraines is not known, doctors do have a basic understanding of what’s going on when one happens. “In the not-so-distant past, a migraine was thought to be a disorder of the blood vessels in and around the brain. However, migraines are now understood to be an inheritable brain disorder that produce signals from the nerve cells within the brain, which result in head pain and alter the function of blood vessels,” Khan says. “This process is likely modulated by multiple factors including hormones, neurotransmitters and electrolytes. As a result, the primary abnormality is dysfunction of the brain rather than the blood vessels.”

Recently, the NHF revealed that genetics play an even bigger role than previously thought. In fact, the organization reported that if one parent has severe headaches, then that individual’s children have a 50-percent chance of also having them. And if both parents have migraines, that figure skyrockets to 75 percent. Of course, a predisposition to migraines does not necessarily mean that a person will get them. If they do experience migraines, Gwynn observes that the headaches could be triggered by a variety of factors, from weather changes and certain foods (such as wine, chocolate and sharp, aged cheeses) to hormone fluctuations (which is why many women find themselves having migraines around their menstrual cycles). The NHF adds to the list the alteration of the sleep-wake cycle, missing or delaying a meal, medications that cause swelling of the blood vessels, stress and even underlying depression.

Treatment options

Knowing your triggers certainly can help when it comes to identifying the best treatment for your migraines. When you know what causes them, you can stay away from those causes, prepare yourself for the headaches or try to alleviate them. However, sometimes pinpointing those triggers can be very difficult. In any case, there are both medical and non-medical treatment options for migraineurs. You just have to remember that there is no cure, which is why Khan emphasizes the importance of understanding what the actual goals of migraine treatment are. “In addition to reducing the intensity, severity and frequency of the headaches, the goal of migraine treatment is to improve the quality of life by reducing the disability resulting from the headaches, optimizing medication use while avoiding its overuse and maximizing non-pharmacologic therapies,” he says


Medication is the traditional first line of defense when it comes to treating migraines. With prescriptions, Khan notes that the medications fall into two major categories: abortive and prophylactic (or preventative). In recent years, the FDA has approved several over-the-counter migraine medications, including Excedrin Migraine (a combination of aspirin, acetaminophen and caffeine), Motrin Migraine (ibuprofen-based) and Advil Migraine (also ibuprofen-based); these medications fall into the abortive category, as they are designed to help alleviate or stop the headache once it begins. In terms of prescription medication, your doctor may write you a script for a medication such as Imitrex, a Triptan medication that was introduced in the 1990s and is used to abort a migraine at its onset. “About half the time we can stop a migraine cold if something is taken early, whether it’s over-the-counter or prescribed,” Gwynn says. “You don’t want to wait until the headache is very bad—once a person is nauseous or incapacitated, it’s hard to stop the headache.”

Sometimes, abortive medications simply are not enough. If this is the case, or you find yourself having a migraine more than twice a month, it’s a good idea to see a doctor, as a preventative approach may be what you need to control your headaches. “This approach requires taking a medication on a daily basis regardless of whether or not a headache is present,” Khan says. “The goal is that, over time, taking a daily medication will gradually reduce the intensity, frequency and severity of the migraines.” Preventative therapies include medications that are commonly used for other conditions, such as epilepsy, depression and high blood pressure. For instance, beta-blockers, typically prescribed for high blood pressure to relax blood vessels, have proven to be very effective in the treatment of migraines


Did you know?

Botox isn’t just for beauty anymore. According to Marc Yune, M.D., a double board-certified facial plastic surgeon with an Aesthetic Specialty Centre in Roswell, when used off-label, Botox can be a very useful and effective treatment for migraines. However, Matthews Gwynn, M.D. points out that while Botox does seem to work for patients who suffer from chronic daily migraines, it does not appear to be effective for those who have infrequent migraines.

For patients seeking alternatives to medications, there are a few options. The most commonly discussed holistic alternative is biofeedback, a relaxation technique in which a patient is trained to gain voluntary control over specific bodily functions, such as blood pressure and muscle tension. When stress or depression precipitates a migraine, this type of treatment can be useful.

Khan also points to such options as acupuncture, hypnosis, electrical nerve stimulation and chiropractic manipulation, which may be beneficial to patients on a case-by-case basis. However, he comments, “Although these methods exist, specific recommendations regarding the effectiveness of these therapies cannot be made.” This is when recognizing and understanding your personal triggers becomes important; if you know what may be bringing on your headaches, you can do what’s necessary to stop them or cut them short

Hope for the future

According to Gwynn, doctors have seen on a PET scan how a migraine starts in the mid-brain and spreads outward. “The next big step is finding ways to keep that activation—whatever it is—from happening in the first place,” he states. “That may be several years down the road, but many of today’s preventative treatments now focus on that area.”

In the meantime, Khan recommends that migraineurs keep one crucial detail in mind: “A migraine is a benign and treatable condition,” he says. If you’ve been reassured that your headaches are not being caused by a tumor, infection or stroke, you can find comfort in the fact that you can gain some control over the condition. And in the end, as Gwynn concludes, “I always tell my patients that one of the best things about getting older is that your migraines get better.”


I was 12 years old when it happened the first time. It started as a faint, shimmery blind spot in the center of my left eye. I kept blinking, trying to make it go away. But the spot quickly grew larger and soon blocked my vision completely in that eye. It was a terrifying experience, but within an hour, the blind spot somehow disappeared. Unfortunately, before I could revel in the restoration of my sight, the right side of my head started throbbing and intense nausea set in. I spent the rest of the afternoon in bed, virtually incapacitated. By that evening, though, the entire episode was over, and I was left wondering what had happened to me. As it turned out, I had just suffered my first migraine. While it’s not extremely common for pre-teens to experience migraines, I’m proof that it does happen. My experience also proves that migraines do dimish over time—I haven’t had one since my late 20s. If I do sense another one approaching, though, I’ll be more than ready to react and get it under control.
—Amy Meadows, writer for Best Self Atlanta