To many, the word “migraine” is synonymous with “severe headache.” It conjures images of people holding their heads in dark bedrooms or leaving work early to avoid loud sounds and bright screens.
But there’s more to migraines than head pain alone. In fact, migraines are considered neurological diseases that are often misunderstood—even by those who experience them.
In this article, Sashank Prasad, MD, a Mass General Brigham neurologist and chief of the Division of Neuro-Ophthalmology at Brigham and Women’s Hospital, answers six common questions about migraines.
Risk factors that increase the chance of having migraines include:
Migraine triggers include:
For many patients with isolated migraines, however, it’s difficult to pinpoint specific triggers. Furthermore, trigger avoidance alone may not be enough to control headaches.
Common migraine symptoms include:
The typical visual symptoms of a migraine—the auras—are “positive,” meaning that something shimmering or sparkling is disrupting the vision.
Migraines are less likely to cause “negative” symptoms of pure visual darkness. An episode of visual darkness typically requires further evaluation for other conditions, including a mini-stroke.
It’s quite common to have a migraine without a headache. The medical term for this is “acephalgic migraine.” Except for the absence of a headache, the visual symptoms in this type of migraine are identical to the episodes that accompany a classic migraine aura.
An isolated migraine without a headache typically does not require any acute treatment. The first few times someone experiences a visual migraine it may cause some anxiety. That anxiety, however, usually subsides once they become familiar with the symptoms.
Some patients can tell when a headache is beginning. They may find that early use of simple strategies can nip a mild headache in the bud. These simple treatments for headache relief include such things as eating, having caffeine, meditating, or taking an over-the-counter medication such as acetaminophen or ibuprofen.
When headaches are moderate or severe, some patients need other treatment. Take headache medications sooner rather than later to stop the headache before it becomes too severe. If you vomit due to migraines, you may need non-oral medicines such as injections or rectal suppositories. Some patients find over-the-counter combinations of simple pain relief medications in combination with caffeine to be helpful. Other patients try a class of prescription medications known as “triptans.”
Triptans are specially designed to work on receptors on blood vessels and brain cells to halt a migraine at an early stage. Although there are several different triptans each of these is similarly effective. You can take them by mouth, as an injection or a nasal spray. These medicines are generally not considered safe in patients with a history of strokes, heart attacks, or other vascular diseases.
Many patients who experience isolated migraines without severe headaches don’t require specific preventive treatments. If a patient is aware of the triggers that seem to bring on their episodes, however, they can avoid those specific triggers.
For patients whose migraine pattern includes frequent, severe headaches, it’s very reasonable to consider additional preventive treatments. The main goal for any of these strategies is to reduce the number of severe headaches you experience. No preventive treatment, however, is 100% effective. For example, reducing the number of severe headaches from eight per month to two to four per month would be a success.
There are many medications that can be used as a preventive treatment for migraine. Medications used as preventive treatments can cause side effects, but starting with a low dose and then increasing the dose slowly is usually a helpful strategy.
Preventive medications for migraine may include:
Other vitamins, minerals, and herbal preparations can be used to help prevent migraines as well.
Some preventive migraine treatments don’t require medication. Many people find that regular exercise makes them feel better. Other strategies include improving sleep habits, or learning to cope more effectively with stress by learning relaxation techniques such as biofeedback or meditation.