Migraine Headaches
What is migraine headache?
Migraine headache is a recurrent type of headache, commonly lasting 4-72 hours at a time. Migraine headaches are usually unilateral (one-sided), moderate to severe in pain intensity, worsened by physical activity, and associated with nausea, photophobia (sensitivity to light), and/or phonophobia (sensitivity to noise). They may occur with or without aura, which is a “unilateral, fully reversible visual, sensory, or other central nervous system symptoms that usually develop gradually and are usually followed by headache and associated migraine symptoms.”
According to the International Headache Society, the diagnostic criteria for migraine headache are as follows:
- Headache lasting 4-72 hour
- Headache has at least two of the following four characteristics:
- Unilateral (one-sided) location
- Pulsating quality
- Moderate or severe pain intensity
- Aggravation by or causing avoidance of routine physical activity
- During headache at least one of the following:
- Nausea and/or vomiting
- Photophobia (sensitivity to light) and phonophobia (sensitivity to noise)
There is wide variety of potential causes or triggers of migraine headaches that may include…
- Genetic predisposition
- Serotonin imbalance
- Trauma or concussion
- Cervical spine injuries
- Medication overuse
- Stress or emotional changes
- Dehydration or missed meals
- Sensoy/screen time overload
- Dysregulation of the trigeminovascular system
- Hormonal fluctuations (menstruation, menopausal, or pregnancy-related)
- Sleep disturbances (lack of sleep or excess sleep)
- Dietary factors (aged cheeses, processed meats, chocolate, alcohol, caffeine)
- Environmental factors (bright lights, loud noises, strong odours, weather changes)
- Associated with other comorbidities (anxiety, depression, fibromyalgia, insomnia)
First, optimization of lifestyle factors may aid in the prevention of migraine headaches. This can include getting consistent and adequate quantity and quality of sleep, maintaining good hydration, avoiding skipping meals, getting regular exercise, managing stress (mindfulness, relaxation training, psychotherapy), limiting caffeine and alcohol intake, becoming aware of migraine triggers (foods, stress, light, etc.), taking regular breaks from screen time and utilizing blue-light filters, and optimizing workstation ergonomics and posture.
Treatment options for acute migraine headaches may include Tylenol, nonsteroidal anti-inflammatory drugs (NSAIDs; e.g. ibuprofen, naproxen, Cambia), or triptans (e.g. sumatriptan, rizatriptan).
Treatment options for migraine headache prevention (prophylaxis) may include…
- Nutraceuticals/supplements such as magnesium, riboflavin (vitamin B2), coenzyme Q10, and melatonin
- Antiseizure medications such as topiramate or gabapentin
- Antidepressant medications such is amitriptyline, nortriptyline, duloxetine, or venlafaxine
- Blood pressure medications such as propranolol, candesartan, or verapamil
- CGRP-targeting medications such atogepant (Qulipta), erenumab (Aimovig), or fremanezumab (Ajovy)
- Botulinum toxin (Botox ) injections
At a Glance
Dr. Craig Best
- Harvard Fellowship-Trained Interventional Spine & Sports Medicine Specialist
- Double Board-Certified in Physical Medicine & Rehabilitation and Pain Medicine
- Assistant Professor of Physical Medicine & Rehabilitation and Orthopedic Surgery
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