By Bill Hardesty | [email protected]

A migraine is not just a bad headache, as over 39 million Americans know. Instead, migraines have more to do with functionality.

The American Migraine Foundation describes migraines as a disabling disease that can lead to isolation as patients try to recover. Migraine sufferers miss a countless number of workdays or social gatherings.

According to the 2020 Perspectives of People with Migraine survey by the National Headache Foundation, 77% said their migraine disease limits their ability to do the things they want to do, such as exercise, be productive at work and school, take care of their children, and make social plans.

In addition, 93% agreed that those who don't suffer from migraine don't understand the severity of the disease.

"I feel as though if you lose more than two hours of function, then you should want to try medications because there are safe treatments that can allow the function to return very quickly and not lose time due to a migraine," Corey Dahl, PA-C with Omega Interventional Pain Clinic in Salt Lake City, said.

What is a migraine?

There are various types of migraines. They also differ in terms of length and frequency. Migraine attacks can last anywhere between four and 72 hours. An essential difference between a headache and a migraine are other symptoms.

"A migraine is a headache that can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. It's often accompanied by nausea, vomiting, and extreme sensitivity to light and sound," according to the Mayo Clinic website.

The causes of migraines are not fully understood. However, genetics and environmental factors play a role.

The Mayo Clinic reports that "Changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway, might be involved. So, might imbalances in brain chemicals including serotonin, which helps regulate pain in your nervous system. Researchers are studying the role of serotonin in migraines. Other neurotransmitters play a role in the pain of migraine, including calcitonin gene-related peptide (CGRP)."

Risk factors

Researchers have identified some risk factors for migraines. Family history is a significant risk factor. If you have a family member with migraines, you have a good chance of developing them.

Age is another risk factor. Children, teenagers, and adults all can suffer from migraines. Migraines often start during adolescence and peak during a person's 30s. They can lessen in severity and frequency as one gets older.

Gender seems to be a key risk factor. Women are three times more likely than men to have migraines. This factor is related to the last risk factor of hormonal changes. Women might have migraines before or shortly after menstruation. Migraines can also come during pregnancy or menopause. Migraines usually improve after menopause.

Triggers

Migraine triggers are very individualized. Triggers range from alcohol or caffeinated drinks to stress to sensory stimuli like loud noises or bright lights to weather changes to food such as aged cheeses, salty, and processed foods to food additives like aspartame or MSG.

Many migraine sufferers can sense when an attack is coming on. They can move through four stages: prodrome, aura, attack, and post-drome.

The prodrome stage occurs one or two days before the migraine and might include such events as mood changes, food cravings, neck stiffness or frequent yawning.

Many people report having an aura before or during a migraine. For example, they might have vision problems or weakness in an arm or leg.

The post-drome stage is after the migraine attack. People might feel drained or washed out. However, others feel elated.

Treatment

Migraine treatment is very individualized. It is essential to work with a pain specialist. Taking too much medications can backfire. The highest risk of overuse headaches is with aspirin, acetaminophen, and caffeine combinations. Another concern is taking aspirin or ibuprofen (Advil, Motrin IB, others) for more than 14 days a month or triptans, sumatriptan (Imitrex, Tosymra), or rizatriptan (Maxalt, Maxalt-MLT) for more than nine days a month.

Triptans are older migraine medications, but they have side effects. This class of drugs causes vasoconstriction. Vasoconstriction is the process of shrinking blood vessels in the brain. In the case of migraines, blood vessels have enlarged. This type of medication brings the blood vessels back to normal size.

"Other treatments include medication management with a class of CGRP therapies. These medicines block a protein in the brain called CGRP, which is thought to lead to migraine symptoms in most patients when the levels are higher. So, medications have been designed to lower the levels of CGRP in humans, and it lowers the migraines from occurring," Dahl said.

Dahl also said, "Nurtec ODT is a very unique medication that is an orally dissolving tablet that can be dosed in the prevention of a migraine or also for the acute or (time of the event) treatment to try and get rid of a migraine when they occur."

Studies show that Nurtec ODT works within an hour and can last up to 48 hours. 

Botox treatments are also available. Botox is injected at trigger points.