Migraine Headaches: Types, Triggers and Treatments

Wednesday, June 25, 2014 2:48 PM

Headaches can be more than just a pain; they can make work and day-to-day activities feel impossible. Headaches and migraines are as different as the individuals who experience them and the key to treating them is proper diagnosis.

Steven Meyers, MD, Neurologist and Headache Specialist at NorthShore, discusses common headache and migraine triggers and some treatment options that might help take the pain away:

How do you determine the cause of a migraine?
Many patients search for "the cause" when in fact most of the time there is no single cause. We believe migraine is a genetic disorder, meaning the tendency to experience migraine is passed down in your genes. Everyone wants a simple fix. If they can find the one thing to avoid or eliminate, they can eliminate their headaches but that rarely happens.

Migraine is a chronic illness and like all other chronic illnesses, the severity can vary from person to person. Treatment must be individualized to the specific patient, taking into account their individual desires regarding treatment options. I recommend always starting with your primary care physician. Schedule an appointment to discuss your headaches specifically. Don't wait for a yearly physical or when seeing your doctor for something else. If you cannot get the information you need then ask for a referral to a headache specialist.

How can you figure out what type of headache you are experiencing?
Proper diagnosis is essential for treatment. Your doctor should be able to make an appropriate diagnosis. If uncertainty persists, then you should see a headache specialist. Migraine, tension and cluster are the three most common primary headache disorders. Primary means no underlying cause, such as a tumor, aneurysm or other disorder, can be pinpointed as the cause of the headache.  Doctors have specific features and there are well-established criteria for making specific diagnoses. I cannot emphasize enough the importance of making a specific headache diagnosis. If your doctor cannot tell you the type of headache you have, get a second opinion.

Is there any evidence that migraines are genetic?
Yes. As I briefly mentioned earlier, migraine is definitely a genetic disorder. Most persons with migraine have a positive family history. In rare cases, specific genetic abnormalities can be tested for, but in the vast majority of migraine sufferers we don’t yet know what the genetic abnormality is.

What are some common migraine triggers?
There are many possible triggers and no two patients are the same. Why one trigger brings on a migraine in one person but not another is not known. Common triggers can include certain foods, though this has become somewhat controversial, with some recent studies questioning food as a trigger.

Alcohol, particularly red wine and beer, are common triggers. Missing meals, alteration in normal sleep patterns (too much or too little), weather changes, stress, and hormonal changes in women during the menstrual cycle are all possible triggers.

It is also important to keep in mind that triggers are rarely all or none. This means that a trigger may not trigger a migraine every time the patient is exposed; it may only happen every other or every third time. This makes identifying these triggers even more difficult.

What can you do about triggers that aren’t controllable, like weather and hormones?
In general I divide triggers into those you can control and those you can’t, like weather. Hormonal changes are potentially treatable but this can be tricky and there are pros and cons of pursuing this approach. Avoiding those triggers that are preventable could be helpful. When that is not sufficient, it’s time to speak to your doctor. If migraines occur frequently enough, then there are medications that can help prevent them or at least reduce the frequency of attacks.

What can a migraine sufferer do to shorten the duration of a migraine?
There are many options to treat migraine attacks. We refer to this type of treatment as abortive therapy. There are migraine-specific medications that we prefer to use. When these medications can’t be used for a specific reason or if they don’t work for a specific patient, we may prescribe other types of pain medications and/or anti-nausea medication. Some patients find relaxation, massage, or the use of ice or heat beneficial as well. Sleep, when possible, can also shorten the duration of an attack.

Is this normal to experience headaches at certain times of day, particularly in the morning?
Some patients do get headaches at very specific times of the day; however, it’s important that the type of headache be correctly diagnosed in order to come up with an appropriate treatment plan. Treatment of migraines that wake someone from sleep depends in part on how often this happens and under what circumstances. Sometimes a preventative medication at bedtime might be appropriate. 

Are there any new medications for migraines with minimum side effects?
Truthfully there is not much new out there at present. There are some very exciting new medications that we hope to see on the market in the not-too- distant future but drug development and research can be frustratingly slow. All medications have side effects, which vary greatly from person to person. There is some evidence that migraine sufferers are particularly prone to drug side effects and many persons will need to try a variety of medications before finding what works for them.

Are feverfew and butterbur effective herbal treatments for migraine prevention?
Feverfew and butterbur are two plant-based supplements available without a prescription. They both have been used for decades, particularly in Europe, to prevent headaches. They both have been studied in good scientific research trials in the U.S. and both have been found to be effective, safe and with few potential side effects. Overall, they tend not to be as effective as prescription medications in my experience but can be beneficial in certain persons and do tend to have fewer side effects.

The main problem is finding out what dose to use, as every supplement may be different in terms of strength and purity. Additionally, there are potential interactions with other medications. I would definitely recommend speaking to your doctor before starting any treatment.

What are your thoughts on combining acupuncture and chiropractic adjustments with conventional treatments from a neurologist for migraines?
Both acupuncture and chiropractic treatments have been studied and found to be helpful in some individuals with migraine. I have many patients who use these therapies and find them helpful either alone or in combination with "conventional" treatments.

When suffering from a headache, does consuming a little caffeine help a headache or make it worse? Any other recommendations, suggestions or treatments do you have to help ease the pain of a migraine headache?
Caffeine is interesting. Consuming caffeine can be helpful.  Several common headache medications add caffeine to make them more effective. Many patients will drink some coffee or cola along with whatever medication they take when they get a headache. However, the frequent/regular use of caffeine can actually cause headache or make headaches worsen over time. 

If you use a medication that contains caffeine such as Excedrin, be careful to follow the directions very carefully. These medications should not be used more than 1-2 days per week. I usually recommend that frequent headache sufferers limit caffeine consumption to the equivalent of 2-3 cups of coffee per day. Short of medication, some patients use relaxation therapy, biofeedback, ice, heat or sleep to treat migraine attacks.

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