Although there is no definitive answer for what causes migraines, according to the National Headache Foundation, one current theory suggests that migraines result from inflammation caused by an interaction between the trigeminal nerve and the blood vessels surrounding the brain. Serotonin, a naturally produced chemical that regulates pain, travels through the trigeminal nerve. A rise or decline in serotonin can lead to the expansion and constriction of the blood vessels surrounding the brain, resulting in headache pain.
"The migraine is generally a dysfunction in the brain," says Dr. Terence D'Souza, chair of the East Jefferson General Hospital (EJGH) Department of Neurology. "In essence, your sensory system becomes hypersensitive. That is why light and sound make the headache and pain worse. Cool and dark rooms are your best place to go."
It is estimated that more than 28 million Americans suffer from migraines. Women and people with a family history of migraines are much more likely to experience them. Migraines fit into two categories: common, which is the onset of a headache without a warning sign, and classic, which begins with an aura and affects less than 30 percent of those with migraines.
The auras that precede a classic migraine often are visual, with the sufferer seeing jagged lines, blind spots, flashing lights or even experiencing a temporary loss of vision. Other auras include muscle weakness, depression and changes in mood. Auras often happen before a headache begins and subside as the headache takes hold.
The key to avoiding migraines is to identify what triggers them. Triggers are different for each individual, and most migraine sufferers have more than one. It can be a specific smell, something you eat, disrupted sleep patterns, a menstrual cycle, change of weather patterns and, for many, stress.
"To help diagnose migraines, we look at the patient's medical history, other medications they may be on and their lifestyle," D'Souza says. "For newer patients experiencing headaches, we may have them take an MRI or a CT scan to rule out other possibilities. We can also factor in potential sinus and allergy problems."
To help discover your triggers, create a headache diary. Record key information such as time of headache, foods you ate, caffeine intake, stress levels, where the pain was located and its intensity. List the medication used to treat the headache and how long it took to ease the symptoms.
People with migraines often need to implement multiple strategies to form an effective treatment plan for them. The first line of treatment is a lifestyle change based on the potential triggers identified in your headache diary. Avoid any foods you feel might be a trigger and monitor your caffeine intake. Although caffeine can help alleviate the pain from a headache, too much can cause one.
Work with your physician to determine an appropriate exercise plan and manage stress levels with relaxation techniques. In addition, develop a sleep routine that allows for a consistent and restful night's sleep.
Your physician may include different medications in your headache plan. Over-the-counter drugs such as Tylenol, Advil, Excedrin and others are used to treat the onset of pain and often are good when the pain is mild to moderate.
"Be careful of the frequency you take these, as they can potentially cause rebound headaches and even stomach bleeding," D'Souza says. 'Overuse of Tylenol, for instance, can affect liver function and even lead to daily headaches."
People with severe migraines may find success with so-called "abortive" medications designed to stop the headache itself if taken at the first sign of a migraine. Those most often used are triptans, which include Imitrex, Maxalt and Frova.
Preventative medicaton can be prescribed for people who suffer more than two or three migraines per month. Taken daily, preventative medicines stop migraines before they begin. Certain beta-blocker and calcium channel drugs that are used to treat high blood pressure and coronary disease have proven effective, and some drugs used to treating depression as well as anti-seizure medications have shown positive results.