you and your health

Migraine headaches

By JAMES D. LOMAX
Posted 6/3/20

Frequency of migraine headaches in the U.S.

A migraine is a specific type of headache that can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. Migraine attacks …

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you and your health

Migraine headaches

Posted

Frequency of migraine headaches in the U.S.

A migraine is a specific type of headache that can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. Migraine attacks can last for hours to days, and the pain can be so severe that it interferes with your daily activities.

The frequency of self-reported migraines and severe headaches in the U.S. adult population is high, affecting roughly one out of every six Americans. It is more frequent in women (about 15 percent) than in men (9.7 percent). The prevalence of migraine or severe headache in a study done in 2015 found the highest in American Indians and Alaska Natives (18.4 percent) compared with whites, blacks, or Hispanics, with the lowest prevalence in Asians (11.3 percent).

Other social factors associated with a higher rate of migraines include people who are unemployed (21.4 percent), those with family income less than $35,000 per year (19.9 percent) and the elderly and disabled (16.4 percent).

Headache is the fourth or fifth most common reason for visits to the emergency department, accounting for roughly 3 percent of all emergency department visits annually. In reproductive-aged women, headache is the third leading cause of emergency department visits.

Signs and symptoms of a migraine

 Migraines, which often begin in childhood, adolescence or early adulthood, can progress through four stages: prodrome, aura, attack and post-drome.

Prodrome

One or two days before a migraine, you might notice subtle changes that warn of an upcoming migraine, including:

  • Constipation
  • Mood changes, from depression to euphoria
  • Food cravings
  • Neck stiffness
  • Increased thirst and urination
  • Frequent yawning

Aura

For some people, aura might occur before or during migraines. Auras are temporary symptoms that are visual but can also include other disturbances. Each symptom usually begins gradually, builds up over several minutes and lasts for 20 to 60 minutes.

Attack

A migraine usually lasts from four to 72 hours if untreated. It can come on gradually or rapidly. There are a number of different migraine patterns that can change over time. A common presentation includes the following:

  • Pain usually on one side of your head, but often on both sides
  • Pain that throbs or pulses
  • Sensitivity to light, sound and, sometimes, smell and touch
  • Nausea and vomiting

Post-drome

After a migraine attack, you might feel drained, confused and washed out for up to a day. Some people report feeling elated. Sudden head movement might bring on the pain again briefly.

Causes of migraine

The causes of migraines are not clearly understood. It is suspected that the headache results from abnormal activities in the brain, affecting the way nerves communicate, as well as the chemicals and blood vessels in the brain. There are a number of triggers that are also associated with bringing on a migraine: additives, alcohol, artificial sweeteners (e.g., aspartame), caffeine (overconsumption or acute withdrawal from regular use), delayed/missed meals, exercise, foods (e.g., chocolate, soft cheese), light, menses, odors (e.g., perfumes), oral contraceptives, psychiatric comorbidities, red wine, sleep disturbances (e.g., obstructive sleep apnea, insomnia), smoke, stress and weather changes.

Treatment of migraine headaches

Treatment of migraine headaches centers on prevention or reduction of headaches and suppression of symptoms once the attack starts.

Indication for the use of preventative medication for controlling the frequency or pattern of headaches includes having more than four headaches per month and/or more than eight headache days per month, overuse/abuse of acute medication and/or unable to tolerate acute medications. There are a number of medications that are used, but each person reacts differently and often there needs to be different medications tried before finding the right one.

Suppression of migraine

There are a number of medications used to suppress the pain associated with acute attacks. Acetaminophen, nonsteroidal anti-inflammatory drugs, triptans, antiemetics, ergot alkaloids and combination analgesics are commonly used. Acetaminophen and nonsteroidal anti-inflammatory drugs are first-line treatments for mild to moderate migraines, whereas triptans are first-line treatments for moderate to severe migraines. Other medications such as dihydroergotamine and antiemetics are reserved for persistent and difficult-to-treat migraines.

When to see a doctor

Migraines are often undiagnosed and untreated. If you experience new or frequent headaches that seem similar to migraines, keep a record of your attacks and make an appointment with your doctor. Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different.

See your doctor immediately or go to the emergency room if your headache is abrupt and severe like a thunderclap; comes with fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or trouble speaking; or comes after a head injury, especially if the headache worsens. Any of those signs and symptoms could indicate a more serious medical problem.

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