Not Right Now! I have a headache: Migraines, their causes, and their treatments

Do you have that friend that says, “Oh, I just can’t do it it’s giving me a migraine,” but they are out and about doing other things?  I am beginning to believe that the word “migraine” is one of the most over used excuses in the English dictionary.  Now, I am not saying that there is no such thing as a migraine.  There absolutely is!  I’ve had them.  They are hell on earth!  There is, however, more to a migraine than just a “really bad headache.”

What is a migraine exactly?

Migraines are caused when the blood vessels in the brain over dilate.  There really isn’t that much space between your brain and your skull so when those blood vessels expand they create a lot of pressure within your head.  This usually means that certain senses can be effected.  Many patients, just before a migraine, get what is called an aura.   Some people say that they “just don’t feel right,” while others can get these shiny points of light or can even loose parts of their vision!
The aura occurs just before the migraine which can last hours to days.  The pain is extreme.  It is often only felt on one side of the head.  It can bring on blindness, nausea, sound sensitivity, and light sensitivity.  Often people suffering from a migraine can only lie under a blanket in a cool, quiet, and dark room and pray to fall asleep.
There are other headaches like tension headaches and cluster headaches, which are horribly unpleasant, but rarely as debilitating as migraines.

What causes a migraine and how do you treat them?

Any number of things can cause migraines.  What causes them is usually the best way to treat them, but it’s not the easiest thing to figure out the cause.
Migraines can be caused my a hormone imbalance which can sometimes be treated by simple hormone replacement therapy, but if done incorrectly it can make things worse.  Young girls just entering puberty or women going through menopause often end up with hormone induced migraines.  Sometimes birth control can help, sometimes they can make things worse.  Women with menopause can sometimes be treated with hormone replacement therapy compounded to their specific needs.    The key, as usual, is to find the best balance for each woman.

Migraines can be caused by low serotonin levels.  Sometimes patients see a correlation between depression and their migraines.  This is where the use of medications like Imitrex and Maxalt come into use.  These medications are great for the treatment of a migraine, especially if caught in it’s aura stage, but there are some problems with the use of these medications.  Using them too much can sometimes cause migraines.  Medications like Fioricet, Vicodin, Percocet, and Excedrin can cause the same problem.    Ideally treating the patients low serotonin levels would be best.  SSRIs like Prozac, Celexa, and Lexapro, can be very helpful to these patients, but in some patients it can deplete their serotonin stores further.

Stress is often associated with migraines although, as I mentioned in the beginning, many times people blame their headaches on migraines, when they are really suffering from a tension headache.  If it truly is a migraine that is triggered by stress one of the first things that should be done is to learn to manage stress better.  Biofeedback and yoga have been shown to be highly effective.  The migraine sufferer should also make sure that they sleep better (please see our blog on sleep hygiene).  If these things do not work beta-blockers (sometimes used for high blood pressure) can help prevent migraines.  Amitriptyline may also be used to help increase the patient’s serotonin levels while helping them sleep better (that’s what we call two birds with one stone folks).

Other things that can cause migraines can be a change in the weather, certain light frequencies, certain sounds, allergies… etc. etc.  The brain is a mysterious thing.

My favorite treatment?  The minute I get an aura I pop 3 ibuprofen and toss an ice pack (or frozen peas ) on the back of my neck.  The ibuprofen brings down the inflammation of blood vessels and the frozen peas cool the blood entering the brain.  The cool blood shrinks the blood vessels and if I cannot completely abort the migraine I can at least shorten it.  I’ve also had some patients who told me they get themselves an Icee and give themselves a brain freeze.  Same concept!

Other treatments can include compounded BAK gel (sometimes called ABC gel) which can be treated and used topically.  Anti-inflammatory suppositories can be compounded and be very effective.  The whole point is finding what works best for you.  But as you can see there are many options (and many more.  I didn’t want to bore you by writing a novel).  If you have exhausted all your options in your local pharmacy I challenge you to try acupuncture, yoga, message therapy, biofeedback, and compounded medications as well.  Migraines are complicated and there is no magic pill, but don’t give up and just keep trying.

What works best for you?  Please share!

2 thoughts on “Not Right Now! I have a headache: Migraines, their causes, and their treatments

  1. This made me LOL. I hear so many people say while they are out out and about “oh I have a migraine”. I laugh to myself and think clearly you have NEVER had a migraine. I frequently lose vision, vomit profusely and am in such unbearable pain I can barely move when I have one never mind run errands.

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