Amy Stone, a physician with the Neurology Center of Fairfax, says the history of migraine research is riddled with error. “Patients in their thirties and forties talk about their mom with sick headaches in her room,” she says. “Then in the ’60s and ’70s, we got a lot of marketing that said we all had sinus headaches.” Even today mysteries persist.
Scientists now believe a migraine isn’t actually the brain feeling pain but rather pain from nerve fibers and blood vessels that surround the brain. The pain is caused when blood vessels become inflamed.
The throbbing can be on one side of the head or both. It can start out moderately and get worse, come and go, or become a chronic everyday illness. Some experience an “aura” right before and during a migraine—zigzag lines, shimmering spots or stars, blind spots, flashes of light, or stroke-like symptoms such as temporarily losing the use of an arm or trouble finding words. A migraine can also include nausea and sensitivity to light and sound.
Migraines can run in families. “There is a genetic predisposition,” says Linda Porter, a program director at the National Institute of Neurological Disorders and Stroke. “If your mother had them, you may, too.”
About 18 percent of American women and 6 percent of men get migraines, according to the Migraine Research Foundation. Of those, 4 percent have chronic headaches, defined as at least 15 migraines a month. Boys suffer from migraines more often than girls until they hit puberty, after which girls experience more migraines than boys. This statistic leads scientists to believe that fluctuating hormones, such as estrogens, are a trigger.
But hormones aren’t the only things that can set off a migraine—other factors include changes in the weather, perfume, chemicals, lack of sleep, depression, some medications, fluorescent lights, and certain foods and additives such as MSG, chocolate, and caffeine.
“It’s about half genetics and half environmental,” says Richard Lipton, a professor of neurology at the Albert Einstein College of Medicine in New York City and one of the country’s leading migraine specialists.
Some patients with particularly nagging migraines search years for what triggers the pain, keeping migraine diaries and seeing specialists ranging from chiropractors to neurologists. They try new methods of treatment and lifestyle modifications until something works.
The good news is that there are more options for relief than there were in the past. “Treatment has been completely revolutionized,” Dr. Lipton says. “There are new classes of medications I never dreamed of when I started 25 years ago.”
For mild to moderate migraines, doctors mostly recommend painkillers such as ibuprofen, acetaminophen, and aspirin. If those drugs don’t help, doctors may prescribe triptans, which are designed to constrict and stabilize inflamed and swollen blood vessels. They also can relieve nausea.
Triptans come in a variety of forms, and they sound like post-Soviet states: sumatriptan, naratriptan, rizatriptan, zolmitriptan, to name a few. These medications aren’t recommended for people with heart problems and should be taken only a few times a month, as taking them more often can cause painful swelling of the blood vessels, leading to rebound headaches. Other side effects are nausea, dizziness, and pressure in the chest. If patients don’t respond to triptans, doctors may try narcotics such as codeine and oxycodone, though those medications can be addictive.
Some drugs come in an inhaler or a device that looks like a pen and that injects the medication into the body. Down the road, drugs without the side effects of triptans will be administered in a patch, says Dr. Jessica Ailani, director of the Georgetown Headache Center. Those medications are currently awaiting FDA approval.
Scientists don’t know why some acute migraines turn into chronic ones, but when that happens they may prescribe a daily preventive medication. Many of these drugs treat other ailments and were discovered to help migraine sufferers as a side benefit. Why they work for headaches is still mostly unclear.
Drugs that counter high blood pressure and some coronary diseases are known as beta-blockers, and they often take the edge off a migraine. They include nadolol, propanolo, verapamil, lisinopril, and candesartan. There can be side effects of dizziness and sleepiness.
Doctors sometimes give antidepressants and anticonvulsants to migraine patients who aren’t depressed or don’t have seizures. The drugs can lessen certain chemicals in the brain, such as serotonin, which can cause blood vessels to swell and in turn kick off a migraine. Examples of these drugs include nortriptyline, amitriptyline, protriptyline, topiramate, divalproex, and gabapentin. Side effects can be dry mouth, constipation, blurred vision, and sleepiness.
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