Understanding Migraines

Migraines are a frequent but complex type of headache that involve more than just pain. They are linked to issues within the brain and nervous system, and their triggers can vary from person to person. Common triggers include stress, certain foods, and environmental factors like light. Experts believe migraines occur when there’s an imbalance in the brain stem and serotonin, a chemical that regulates both mood and pain. This imbalance activates specific nerves, especially those near the face, causing pain to be felt in the layers surrounding the brain.

How Migraines Differ from Other Headaches

Not all headaches are migraines. Tension headaches, the most common type, are caused by muscle tension in the neck and shoulders and can usually be relieved by rest or over-the-counter pain relievers. Cluster headaches, which are intensely painful, occur around the eye and don’t include the migraine symptoms of nausea or visual disturbances like light flashes.

Common Migraine Triggers

Migraines are often influenced by a combination of triggers and an individual’s migraine threshold. Triggers are factors that increase sensory sensitivity, potentially leading to a migraine. These can be external, like light or sounds, or internal, such as stress or hormonal changes. The migraine threshold refers to the point at which a combination of triggers overwhelms the body, causing a migraine attack.

Here are some common migraine triggers:

• Stress: Stress is a significant factor for many people with migraines, altering brain chemicals and blood flow, which can bring on a migraine.
• Hormonal Changes: Shifts in hormones, especially estrogen, can trigger migraines in women during periods, pregnancy, or menopause.
• Sleep: Both insufficient and excessive sleep, as well as inconsistent sleep patterns, can trigger migraines.
• Diet: Certain foods and drinks, like alcohol, caffeine, chocolate, cheese, citrus fruits, and processed foods with additives, are known triggers for some people.
• Environmental Factors: Bright lights, loud sounds, strong smells, weather shifts, or altitude changes can also bring on migraines for some individuals.

The idea of a migraine threshold suggests that even if an individual encounters a trigger, it alone may not cause a migraine unless combined with other factors that push the body past its threshold. Identifying personal triggers can help manage and reduce migraine risk.

Medications for Migraines

Medications are a common treatment for migraines, with different options available to address either ongoing attacks or prevent future episodes. Over-the-counter pain medications like ibuprofen or acetaminophen are typically ineffective for treating migraines. Frequent use of certain medications can even lead to rebound headaches, known as medication-overuse headaches.

Medications for Acute Migraine Attacks

• Triptans: These drugs help narrow blood vessels and block pain signals. They come in various forms, including pills, nasal sprays, and injections.
• Gepants: A newer class of medication that blocks CGRP, a protein involved in migraine pain and inflammation.
• Ditans: Another new class of medication that works by activating a specific receptor to turn off migraine pain. The only FDA-approved ditan is Lasmiditan (Reyvow).
• Ergots: These medications combine ergotamine and caffeine to constrict blood vessels in the brain, helping to alleviate pain.
• Opioids: Strong painkillers like codeine or oxycodone that act on opioid receptors in the brain. These are reserved for people who cannot tolerate other treatments due to their potential for addiction and side effects.

Medications for Preventing Migraines

For those who experience frequent migraines, preventive medications may be prescribed to reduce the frequency of attacks:

• Antidepressants: These medications regulate brain chemicals such as serotonin and norepinephrine, which influence mood and pain.
• Antiseizure Drugs: These help stabilize brain activity, which can help prevent the onset of migraines.
• Botox: Botox injections, given every 12 weeks, can block pain-causing chemicals and are effective for people with chronic migraines.
• Cardiovascular Medications: Drugs that control heart function and blood pressure can help manage migraines by affecting blood flow to the brain.
• CGRP Inhibitors: These medications block CGRP, a protein involved in migraine pain and inflammation, and are administered through injections or infusions every month or quarter.

Some migraine medications can raise serotonin levels in the brain, which, in rare cases, can cause serotonin syndrome. This serious condition is marked by symptoms like confusion, agitation, rapid heartbeat, sweating, and tremors. If these symptoms occur, it’s crucial to stop the medication immediately and seek medical attention.

By understanding the triggers, medications, and preventive measures for migraines, individuals can better manage their condition and improve their quality of life. Always consult a healthcare professional before starting or changing treatments to ensure safety and proper care.