Everything We Know About Migraines & How To Treat Them

Photographed by Eric T White.
Whether you're sick of hearing your friends complaining about migraines or you're the one complaining, we've all had run-ins with the awful-mega-headache monster. But, despite how common they are, there's so much that we're only beginning to understand about migraines. Here, we've collected everything we know about what those monsters actually are — and the best ways to get rid of them. What are the symptoms of migraines?
The most obvious one is the painful, throbbing headache on one or both sides of the head that can last for hours. But, "the real hallmark of migraines is that people are very sensitive to light, sound, and odors," says Dawn Buse, PhD, of the Montefiore Headache Center. "And, people have nausea or even vomit during the headache phase." Some people experience other symptoms up to two days before the headache hits, though. During this "prodrome stage," sufferers may feel extra-irritable or anxious. They may even experience tingling skin sensations or a visual "aura" that changes their vision and can lead to difficulty speaking. After the headache, people are usually pretty wiped out. But, not everyone experiences all of these stages with every migraine, and your specific symptoms may change over time. Who gets them?
Migraines affect about 16% of the U.S. adult population, but some people are more likely to get them than others due to the presence of certain risk factors. Women are three times more likely than men (check out the infographic below to learn more about these differences). And, there's a huge genetic component: About 80% of migraine sufferers have a first-degree relative who also gets them, says Sheena Aurora, MD, of the Headache Clinic at Stanford Health Care. They tend to flare up during adolescence, and most people get their first one before turning 40. Hormonal changes are also thought to play a role: Migraines can follow the pattern of your menstrual cycle and may become more or less frequent during pregnancy or menopause. What causes them?
Well, that's the thing — we don't know. Researchers have a few (very) educated guesses, though. The basic idea is that migraines are the result of an oversensitive brain. For some reason, your brain is overreacting to triggers in the environment, including things like light, sounds, and smells. One brain area in particular, the thalamus, acts as a sort of relay station between other parts, and researchers think it may be the key to calming things down. What we do know is that the characteristic throbbing pain of a migraine is caused by the constricting of some of the brain's blood vessels. To compensate, other blood vessels dilate, causing a painful pressure inconsistency. How can we treat them?
From anecdotal experience, we know that most people find a dark, quiet room to be essential. But, if you're looking for something a little stronger, there are medications available. In addition to over-the-counter painkillers and opioid analgesics, you've also got options including triptan medications (which act on the neurotransmitter serotonin), medications containing caffeine (such as Excedrin), and nerve blocks. But, because we all have different triggers, and migraines may affect each of us in different ways, Dr. Aurora says treatment needs to be individualized. And, overuse of some medications can actually cause headaches, perpetuating the cycle. How can we prevent them?
Even better than treating migraines is keeping them from happening — ever. This requires a little extra work on your part: Namely, you've got to keep track of your triggers. This has been made a bit easier by the introduction of migraine-tracking apps, such as Migraine Buddy and iHeadache. These allow you to take note of what sets your migraines off so you can act quickly to get outta there. But, figuring out your triggers is especially important because they may be surprising. Stress is an obvious one, but certain dietary changes (such as cutting out alcohol or aspartame) or activities (regular exercise for the win) may also keep your headaches mild. What if that doesn't work?
You're in luck! There are several interesting new treatments coming our way right now. In one option, a spaghetti-sized catheter delivers an anesthetic to a nerve bundle in the back of the nose. Participants in this trial were able to use over 80% less pain meds than usual. And, if stress is one of your triggers, there's a growing body of research suggesting that relaxation through meditation can significantly reduce your migraine frequency and severity. You can try Dr. Buse's own guided meditations or choose from a plethora of relaxation apps out there. But, the bottom line is that a headache specialist can point you in the right direction for treating your specific headache issues. With a little individualized TLC, you could find a way to say goodbye your migraines. Or, at least, find a way to say hello to them a little less often.

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