What you need to know about migraines

June 23, 2021 Swedish Health Team

According to the World Health Organization, migraine is the second leading cause of disability worldwide. Migraine is the most common headache disorder, with more than 75% of adults between ages 18 to 65 years old have had a headache in the last year. Of those, at least 30% have reported a migraine. Despite how commonplace headache is, it is often misunderstood and not recognized as a legitimate health concern. People suffering from a headache disorder are often not professionally diagnosed and treated, which may be due to lack of awareness of available treatments, poor access to healthcare or perceived stigma of having a headache disorder.

What is a migraine?

A person has migraine if they have suffered:

  • Five or more attacks of unprovoked headaches in their lifetime
  • A headache lasting four to 72 hours
  • Severe enough to restrict daily activity
  • Associated with nausea, light and/or sound sensitivity 

Some people with a migraine may experience auras, which can present as a temporary visual or sensory change, that usually occur before the migraine.

What causes migraine?

While it is not entirely clear what causes migraine, the leading theory is that migraine likely has a genetic component and external triggers activate a chain of events involving neurovascular inflammation and hypersensitive areas in the brain leading to a migraine attack. While researchers believe there is a genetic cause, there are also a number of factors that can trigger a migraine, including:

  • Stress
  • Anxiety
  • Hormonal changes in women
  • Bright or flashing lights
  • Loud noises
  • Strong smells
  • Medicines
  • Too much or not enough sleep
  • Sudden changes in weather or environment
  • Overexertion (too much physical activity)
  • Tobacco
  • Caffeine or caffeine withdrawal
  • Skipped meals
  • Specific foods such as alcohol, chocolate, cheese, MSG, processed meats and pickled foods
  • Medication overuse (taking medicine for migraines too often)

What can be done for migraine?

If you are suffering from uncontrolled headaches, you should make an appointment with your primary care doctor, neurologist or a headache specialist for further evaluation and treatment. It is important to describe your symptoms in a concise manner so that your doctor can get the best sense of your headache and help you as best as possible. Your doctor will likely ask you the following questions:

  • When did you first start getting headaches?
  • Did any particular event(s) lead you to have increasing headaches?
  • How often are you getting a headache in an average week or month?
  • How would you describe your headache (location, quality of pain, duration, associated symptoms)?
  • Does anything make your headache better or worse?
  • Have there been any changes in the character or frequency of your headache?
  • What medications have you tried in the past or currently taking for your headache?
  • What testing have you had for your headache, if any?
  • Do you have any other medical conditions? Are you taking any other medications?
  • Does anyone in your family suffer from headaches?

It would also be helpful to both you and your doctor if you keep a headache diary. One easy method is to mark the days on a calendar that you have a headache and bring the calendar with you when you have a doctor’s appointment. This information will help you and your doctor identify any patterns and response to treatment.

How are migraines treated?

There is no cure for migraines. Treatment is aimed at lifestyle changes, trigger avoidance, relieving the acute symptoms and preventing further attacks.

There are several different medications used to relieve migraine symptoms, and your healthcare provider may prescribe triptan drugs, ergotamine drugs, gepant drugs, ditan drugs, and both prescription or over-the-counter pain relievers.

If you have more frequent and/or severe migraines, you may need to take preventative medications. These can include blood pressure medicines, anti-depressant drugs, anti-seizure drugs, as well as injectable medications.

Again, if you are suffering from uncontrolled headaches, you should make an appointment with your primary care doctor, local neurologist or headache specialist for further evaluation and treatment.

About the author

Brian Droker, M.D., is a neurologist at the Swedish Neuroscience Institute. He is board certified with the American Board of Psychiatry and Neurology in both clinical neurophysiology and neurology. Dr. Droker believes communication and education are the pillars for providing excellent neurologic care. As the patient and the physician are partners in care, it is his goal is to provide individualized and comprehensive care to his patients.

Find a doctor

Whether you require an in-person visit or want to consult with a doctor virtually, you have options. Swedish Virtual Care connects you face-to-face with a nurse practitioner who can review your symptoms, provide instruction and follow-up as needed. If you need to find a doctor, you can use our provider directory.

Additional resources

American Migraine Foundation

National Headache Foundation

Family Doctor

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