Migraines in children from toddlers to teens

This article discusses migraine headaches and how they present in children from toddlers to teenagers.

A toddler is having bouts of projectile vomiting, quite frequently but not every day. Fearing something is "terribly wrong" with her daughter's digestive system, her mother takes her to the doctor. Within 20 minutes, the pediatrician has traced the girl's symptoms to motion sickness – she gets sick every time she rides in the car, or shortly after. Although she's never had a headache, by age 3 the girl is diagnosed with the neurological disorder called migraine.

What Is Migraine?

A simple definition is a “recurrent, episodic headache, or head pain, that typically lasts between two and 72 hours untreated,” says Andrew Hershey, chair and a professor of neurology at Cincinnati Children's Hospital Medical Center​​​​. For some people,​ migraine comes with nausea or vomiting, while others experience light and sound sensitivity. Headaches are usually throbbing and partial​​ (involving one side of the head) and moderately or severely intense.​ Migraine has a strong genetic component.

Hershey, director of the CCHMC Headache Center, says while most migraine episodes come and go, they can evolve into chronic migraine: “About a third of our patients get to the point that the headache just never leaves them.”

At least 10 percent of kids have migraine, Hershey says.​ While the rate is about 4 percent in preschoolers, by late teens it affects up to 15 percent of boys and 20 to 25 percent of girls. The youngest patient Hershey ever treated started at 10 months old.

What Triggers Migraine​?

“Migraine is more than a headache. It’s a generalized disturbance of function that involves brain and body,” says Joel Saper,​ a neurologist and director of the Michigan Head Pain and Neurological Institute in Ann Arbor.

Although many people believe stress "causes" migraine, researchers are still working to determine the complex causes for the condition. What's known is that children have a variety of migraine triggers that can set off an episode, including food sensitivities, fatigue, bright lights, loud noises and sleep changes.​

In younger kids, non-headache signs or “migraine equivalents” can include stomach pain, episodes of dizziness, vertigo (spinning), visual disturbances and sudden mood changes, Saper says. Motion sickness is migraine equivalent, he notes, and it’s been recently established that colic in babies is a forerunner to migraine.

Before starting any kind of treatment, it’s crucial to pin down the diagnosis. Some 300 other medical conditions cause headache in kids, Saper says. Emotional causes also have to be ruled out – like school avoidance in a kid who’s anxious or being bullied.

For parents, Saper says it’s key to find a knowledgeable health care provider, whether it’s a specialist, family practice doctor, nurse practitioner or physician assistant.

Life With Migraine for Kids

Two decades ago, Cathy Glaser ​was concerned about her 3-year-old daughter Samantha, who was having cyclical bouts of vomiting and upset stomach. Through careful questioning, the pediatrician traced the episodes to motion sickness.

Glaser knows a lot about migraine. “We like to say my daughter was doomed since both parents have migraine. It runs through both of our families,” says Glaser, who eventually started the Migraine Research Foundation in New York.

Although Samantha was stoic, Glaser could always tell when she had a migraine coming on. “I could look into my daughter’s eyes and see she was getting a headache,” she says. “I could look at her face – she was ashen. All of a sudden those sparkly child’s eyes were absolutely dead. And her whole affect changed.”

Migraine invaded every aspect of Samantha’s childhood, and she visited the emergency room several times a year. It hijacked family trips. On their way to a family reunion at Hersheypark in Pennsylvania, they were forced to pull off the New Jersey Turnpike, because Samantha was green with motion sickness.

School presents many challenges for kids with migraine. Glaser says that as a parent, you need to be your child’s advocate. And you have to be proactive.

“I used to go to school every year at the beginning, or before, with a doctor’s note about migraine and my own daughter’s treatment explain when she raises her hand and says, ‘I need to take my medication now,’ they need to let her go,” she recalls.

Samantha “didn’t want to miss her life,” Glaser says. Even as an 8-year-old, she would say “Mom, I can be alone and feeling horrible, or I can be at school with my friends feeling horrible. I choose school.”

Every summer Samantha's parents sent her off to sleep-away camps, ​and every time they got calls in the middle of the night to come get her – the camp couldn’t handle it. “This is the life of a child who has regular headaches who insists on living the life of a kid,” Glaser says.

Sameness Helps

Boys and girls get headaches equally until age 12 or 13 – but when girls start their periods, the picture changes. Migraine is an “estrogen-vulnerable” disorder, Saper explains. Hormone cycling in girls and later women – from menstruation, oral contraceptives and menopause – can make migraines worse. Boys are more likely to grow out of migraines than girls.

As she entered her teens, Samantha developed menstrual migraine. (She also gets weather headaches, when there’s a change in barometric pressure or a storm’s coming on.)

With migraine, “Sameness helps,” Saper says. Sleep is a big issue, and regular bedtimes and waking times are important. If kids have trouble sleeping, he says melatonin “is a particularly good medicine” to help.

Some children with migraine are food sensitive. “What they eat may make a difference, whether it be the gluten, cheese or dairy products – there’s a long list,” Saper says. Kids shouldn’t miss meals or skip breakfast.

Dehydration can also trigger migraines, and healthy habits include drinking plenty of water or other non-caffeine drinks. Exercise also helps, and so do relaxation and stress-management techniques. 

Not Your Parents’ Headache

For migraine that goes beyond a headache or two a month, research suggests the best approach combines medication and cognitive behavioral therapy. The two main drug categories are medications for treatment and for prevention.

NSAIDs such as Aleve and Ibuprofen are used to break acute headaches in kids, Hersey says ­– aspirin should be avoided because of the risk of liver problems. And parents and patients should be alert to overuse. For prevention, the drugs amitriptyline and topiramate are most commonly prescribed.

At Cincinnati Children’s Headache Center, after kids undergo a neurological and headache exam, the team comes up with a multipronged treatment plan, including medication choices and learning healthy habits. Kids with chronic headaches return for cognitive behavioral therapy, which takes about six weeks to absorb.

Part of the goal is getting kids to accept that they have a chronic illness and teaching them to manage their own care, Hershey says: “We often say to the kids, ‘It’s your headache – it’s not your mom and dad’s.”

Scott Powers, a pediatric psychologist at the center, is working with his team to fine-tune a migraine app that kids can use to track their episodes and symptoms electronically. The app also allows researchers to better connect the dots between triggers and headache timing.

College and Migraines

With the importance of regular sleep, healthy eating habits and keeping stress on an even keel – what could possibly go wrong when kids with migraine leave for college?

But when the time came, Samantha insisted on going away to a big school, Glaser says. After much discussion they agreed that Samantha would go to a school within driving distance, near a hospital and with a well-staffed campus health center.

“Her view about college was ‘I want to stop being 'Migraine Girl,'" Glaser recalls her daughter saying. “’I want to stop being defined by my disease.’” 

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Common treatments for migraines

This article provides information on migraine headaches and discusses treatments for migraine headaches.

Suffering from migraines can have a seriously negative impact on both your work and social life, but what exactly causes those splitting headaches?

Men, women and children can suffer from migraines. Some people may have a migraine as often as a few times a week, whereas others might only experience them occasionally.

According to the NHS, there are several types of migraine. These include:

• Migraine with aura – where there are warning signs before the migraine begins, such as seeing flashing lights.

• Migraine without aura – where the migraine occurs without warning signs.

• Migraine aura without headache, also known as silent migraine – where an aura or other migraine symptoms are experienced, but a headache does not develop.

Although the exact cause of migraine is unknown, triggers are thought to include hormonal, emotional, physical, dietary, environmental and medical changes to your usual routine.

If you suffer from regular migraines it is important to visit your GP, as some experts have found migraines to indicate other underlying health issues such as abnormal blood vessel structure in the brain.

Migraine remains undiagnosed and under-treated in at least 50% of patients, and less than 50% of migraine patients consult a physician – but your GP could really help you to reduce your suffering.

GPs can help you to identify the triggers of your migraine and also prescribe medication to help you manage your condition like painkillers, triptans (medications that can help reverse the changes in the brain that may cause migraines), or anti-emetics (medications often used to reduce nausea and vomiting).

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App to track migraine headaches

An app, currently only available overseas, helps people track what triggers their migraine headaches.

A new migraine tracking smartphone app analyses what causes your headaches and suggests how to stop them from happening.

The app, Migraine Buddy, asks questions about your migraine, habits, and medication with a questionnaire.

It also collects data about your sleep and movement patterns using your smartphone’s sensors.

Once the app collects enough data, it creates a report highlighting when the symptoms happened, and what were the top triggers.

It also finds out the most effective medication for you by recording when you used them and comparing that information with the severity of the migraines, Mashable reported.

“It mimics how a doctor prescribes different medication to patients to figure out what works,” said Veronica Chew, co-founder of Healint, the Singapore-based company behind Migraine Buddy.

“Most other migraine apps are not as comprehensive. We collect data that’s action-driven, so that we can help patients make the right decisions,” Chew said.

Currently, the application is only available in Singapore through a neurologist that is working with Healint.

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What can I do about my migraines?

This article discusses what someone who suffers from migraines can do about their headaches.

If you are one of the roughly 30 million Americans who suffer from the intense, throbbing misery of migraines, you'd probably try anything to ease the pain. Here are some options to consider and discuss with your doctor:

Pain-relieving medications.

Over-the-counter aspirin, ibuprofen or acetaminophen, as well as formulations marketed specifically for migraines, may help relieve mild to moderate pain. Take at the first sign of a headache. Prescription drugs may be needed for more severe attacks. Preventive therapies may also be an option if you suffer from frequent attacks, if they last a long time or if pain-relievers aren't helping.

Biofeedback.

This alternative therapy uses electrical sensors on your body to detect and monitor physical responses related to stress, such as muscle tension. Having that information helps you learn to make subtle changes — such as relaxing those specific muscles — to relieve headaches. A form of this therapy called neurofeedback, or EEG biofeedback, focuses on helping people alter brain waves, which some research suggests may ease migraine pain. Other alternative treatments include acupuncture and massage therapy.

Avoid your triggers.

Whether it's a type of food or smell, a specific medication, or even disrupted sleep or missed meal – many factors can set off an attack. Do your best to steer clear of them and maintain a consistent routine.

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Pediatric migraines may be caused by environment

Different environmental factors, such as sleep deprivation, diet, and school, could play a role in pediatric migraines.

Environmental stressors play a large role in triggering migraines in children, according to Dr. Eric Pearlman.

"Migraine is definitely a pediatric disorder. It peaks in young adulthood, but it definitely occurs in kids," Dr. Pearlman, chair of the department of pediatrics at Mercer University in Savannah, Ga., said at the annual meeting of the American Academy of Pediatrics.

Epidemiologic data suggest that migraine occurs in 10.5% of 10- to 15-year-old children and 3% of 7-year-olds, and that headaches – possibly including migraines – occur in 4% of 3-year-olds. By about 13 years of age, the prevalence of migraines starts reaching adult levels of about 6% in males, and 18% in females.

Environmental factors such as sleep deprivation, dehydration, dietary factors, school stressors, hidden stressors (like peers), and hormonal fluctuations represent triggers that can be particularly pronounced in children, he noted.

With International Classification of Headache Disorders, third edition (ICHD-III) criteria, migraines can be differentiated from acute, acute recurrent, and chronic progressive or chronic nonprogressive headaches if a child has experienced at least five attacks lasting up to 72 hours (whether untreated or unsuccessfully treated), if nausea and/or vomiting or photophobia and phonophobia are present, and if the child has at least two of four characteristics, including unilateral location, pulsating quality, moderate to severe intensity, and a tendency to be aggravated by – or avoid – routine physical activity.

In children, photophobia and phonophobia can be inferred (if they report having to lie down in a dark, quiet room, for example), as many have difficulty describing or understanding these symptoms

Unilateral headaches are rare in children, Dr. Pearlman noted.

If a diagnosis of migraine is established, it is important to make the diagnosis known to the child, and to educate the child about the condition and treatments.

Consider providing handouts and referring to websites (such as theAmerican Headache Society or the National Headache Foundationsites), to help educate patients and to manage their expectations, as they need to understand you cannot cure their migraine, he advised.

Involving both the patient and their parents in decision making can improve compliance with treatment recommendations, he said.

Pharmacologic interventions can include nonspecific short-term therapies, migraine-specific therapies, and preventive treatment.

Nonspecific short-term therapies may include acetaminophen, nonsteroidal anti-inflammatory drugs, or combination drugs. Migraine-specific therapies include ergotamine and dihydroergotamine, and the "triptans."

Seven triptans are available, including two that are approved for use in children; rizitriptan (Maxalt) is approved for children older than age 6 years, and almitriptan (Axert) is approved for those aged 12-17 years.

Maxalt comes in both an oral and orally disintegrating form, and is available as a generic drug. Generic sumitriptan (Imitrex) also is available.

"There are good data for most of the triptans for adolescents aged 12 and older," Dr. Pearlman said.

Rescue medications for those who have an inadequate response to short-term therapy can include a combination of an analgesic like a nonsteroidal and an antiemetic, or an opiate and an antiemetic if the patient used a nonsteroidal initially. Rescue medications may be needed "because nothing is going to work 100% of the time," he said.

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Common migraine triggers to avoid

This article discusses seven common migraine triggers that those prone to migraines should avoid.

It’s estimated that 28 million americans suffer from migraines. Migraines are intense headaches that are often accompanied by nausea, vomiting and sensitivity to light. They don’t simply come and go; each migraine can last between four hours and three days. Most migraine sufferers know to avoid certain things like dairy, alcohol and food with excessive additives, but there are other external factors that could trigger a migraine. Here are some to watch out for.

1. Change in Routine

For some migraine sufferers, routine is key to keeping the headaches at bay.  Change in sleep patterns, work hours or even holidays can create stress and lead to migraines.

2. Stress

As mentioned above, migraines and stress are strongly linked. Some people report migraines start when stress reduces, sometimes leading to “weekend headaches” after a stressful work week.

3. The Environment 

High altitude, weather changes and humidity can all trigger migraines.

4. Computer Screens

Both the posture you take when sitting in front of a computer and the glare from the screen can lead to migraine pain. Be sure to sit comfortably to avoid muscle tension and use an anti-glare screen.

5. Lack of Food

Insufficient food is one of the main dietary triggers of migraines. Avoid missing meals or snacking on treats high in sugar. Eating small, nutritious snacks throughout the day can help control migraine attacks.

6. Hormonal Change (In Women)

Fluctuation in estrogen may cause headaches in women who suffer from migraines. These women often report an increase in migraines immediately before or during their menstrual cycle, when there is a major drop in estrogen levels.

7. Sensory Overstimulation

Bright lights, loud noises and unusual smells, including perfume and secondhand smoke can trigger migraines. 

Migraine triggers are unique to every individual, and can happen as early as 6 to 8 hours prior to a migraine attack.

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Most common migraine trigger is stress

General practitioners in the UK claim that stress is the most common trigger for migraines.

Stress has been blamed as the most common trigger for Migraines, according to GPs.

Certain foods like cheese and chocolate, excess caffeine intake or withdrawal and drinks containing Alcohol are also common triggers for migraines too. 

What’s more, 37 per cent of GPs believe that prevalence of migraine is probably on the rise, according to the research from Imigran Recovery.

Classed as among the most disabling illnesses by the World Health Organization, migraine is likened to the pain of childbirth by 44 per cent of GPs.

Despite this, almost half of GPs report that people often struggle with migraine for too long before seeking advice or taking action. This also applies to diagnosis, with at least 50 per cent of patients estimated to be undiagnosed.

Media medic and practising GP, Dr Sarah Jarvis said: “The impact of stress on our Health can never be underestimated. Where there’s a migraine attack, then for a lot of my patients, there’s normally stress involved. Certainly, there are a number of reasons stress may have increased over the years, including the economic downturn to name but one. As a result, migraine prevalence may be increasing and I have seen this among my own patients."

More than half of GPs agree that sufferers are not doing enough to avoid migraine triggers and, as a result, some migraine sufferers can go their whole life without getting their condition under control. Without changes in lifestyle, avoiding triggers and taking medication, migraine cannot be fully controlled, according to 46 per cent of GPs.

Dr Sarah Jarvis continued: “Avoiding stress can be difficult, but it is only through sustained lifestyle changes, alongside medication, that migraine can be controlled. Treatments, such as sumatriptan-based products, can relieve symptoms of a migraine attack, but it’s also important that patients take preventative steps between Migraines.

"I often suggest starting with a migraine diary to help pinpoint the triggers. Almost always small lifestyle changes will help, for example taking regular exercise, regular sleeping habits, eating a healthy Diet and avoiding caffeine.”

GPs also report a lack of patient awareness about treatments, with 77 per cent believing that migraine sufferers are unaware of the range of treatments available. Often sufferers have misplaced faith in painkillers, unsuccessfully trying to control the condition. Analgesics, such as paracetamol, ibuprofen and aspirin, are overused by some migraine sufferers, according to 87 per cent of GPs. As a result, three quarters agree Medication Overuse Headache can be common amongst sufferers.

Despite their overuse, nearly three quarters of GPs believe analgesics provide insufficient relief for some migraine sufferers. As a result, treating and diagnosing migraine can be frustrating, according to 65 per cent of GPs, and 35 per cent believe it is still a poorly understood condition.

According to a separate study of 3,000 migraine sufferers by Imigran Recovery, 86 per cent of sufferers take no preventative action between migraine attacks. This could explain why nearly half of migraine sufferers feel helpless, believing that migraine is untreatable.

It’s no wonder then that more than a quarter of migraine sufferers believe their life would be happier if they could get control of migraine and more than a fifth believe their life would be significantly improved.

Experts believe that the widening of blood vessels in the brain causes the throbbing pain of migraine.  

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Things you may not know about migraines

This article lists three things you may not know about migraine headaches.

You're familiar with the pain of a migraine—the intense throbbing concentrated mostly on one side your head and often accompanied by nausea, vomiting, or hypersensitivity to light and sound. You know that these recurring headaches can last a while and that a number of factors might trigger an attack. Here's what you might not know about migraines:

Obesity may raise your risk. Researchers at Johns Hopkins recently analyzed data from nearly 4,000 adults and found the odds of episodic migraines (the kind that occurs 14 days or fewer a month) were more than 80% higher in the obese participants. The risk was greatest among women, whites and those under age 50. What might cause the link between obesity and migraines is still up for debate, but experts do know other factors—such as family history and gender, for example—make you more prone to having migraines.

Lightning could spark one. Changes in weather or barometric pressure are known migraine triggers, but results from a study of patients suggest lightning may affect the onset of headaches. Researchers found that people were nearly 30% more likely to experience a migraine on days when lightning struck within 25 miles of their home; they speculate that electromagnetic waves, an increase in ozone or fungal spores caused by the lightning could be the culprits. Another surprising time that could set off a headache? At the start of a weekend or first day of vacation. To help determine your triggers, keep a headache diary: note when your headaches start, how long they last and what, if anything, provides relief.

Poor treatment could lead to more frequent headaches. That's according to research recently presented at a meeting of the International Headache Congress. Scientists found that people with episodic migraines who received inadequate treatment for acute headaches were more likely to develop chronic migraines, defined as 15 or more migraine days a month. Migraines can't be cured, but you can prevent attacks or relieve symptoms with the right mix of meds, behavioral changes and even alternative remedies. Work with your doctor to determine your treatment plan.

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Drug uses sensors in eye to stop migraines

A new drug uses light sensors in the eye to stop from triggers for migraines.

For many migraine sufferers, bright lights are a surefire way to exacerbate their headaches. And for some night-shift workers, just a stroll through a brightly lit parking lot during the morning commute home can be enough to throw off their body's daily rhythms and make daytime sleep nearly impossible. But a new molecule that selectively blocks specialized light-sensitive receptors in the eyes could help both these groups of people, without affecting normal vision.

"It took almost ten years to find and test a molecule that fit all the properties and acted in vivo as we wanted," says senior study author Satchidananda Panda , an associate professor in Salk's Regulatory Biology Laboratory.

Scientists have known for nearly a century that humans and animals can sense light even when they can't see. Before they've opened their eyes, and even before cells that allow vision have matured, newborn mice still scurry away from bright lights, and set their sleep-wake cycles based on the patterns of light and dark throughout the day. The same is true of many blind people-though they can't see what's in front of them, their bodies still follow daily circadian rhythms, and the pupils of their eyes constrict in response to light.

More than ten years ago, Panda's lab group discovered that melanopsin, a receptor found in neurons connecting the eyes and brain, is responsible for sensing light independently of normal vision. Since then, researchers have determined that the receptor is vital for maintaining sleep cycles and other circadian rhythms in those with healthy vision, constricting the pupil of the eye in bright light, and potentially exacerbating the light-sensitivity associated with migraine headaches. While melanopsin senses light for these non-vision purposes in the body, closely related receptors-rhodopsin and cone opsins-provide vision-forming information to the brain.

Panda figured that if he could find a compound that blocked melanopsin, but not rhodopsin or cone opsins, it could pave the way toward treating migraines or circadian rhythm imbalances. Scientists already know of one class of compounds, retinoids, which interact with opsins, but they're non-specific and so bind to melanopsin, rhodopsin, cone opsins, and a whole handful of other receptors in the body, causing widespread side effects. Panda wanted something more specific. So for ten years, his lab group, in collaboration with scientists at the pharmaceutical company Lundbeck, has attempted to find chemical compounds that specifically shut off melanopsin in animals.

In their latest search, Panda and his collaborators turned to the Lundbeck library of diverse compounds. In hundreds of 384-well plates, a team led by Ken Jones at Lundbeck tested whether each chemical from the library turned off melanopsin by measuring the calcium levels after the plate was exposed to light. When melanopsin is functioning, calcium levels increase after light exposure indicating that light has been sensed and a signal is being generated. Several compounds from the chemical library stopped this calcium increase from happening, suggesting that they were blocking the function of melanopsin.

None of these compounds looked like retinoids, so it was an exciting breakthrough, Panda says. The chemicals, dubbed opsinamides, also showed no interaction with rhodopsin or other opsins. "We wanted to make sure they were specific to melanopsin," says Panda. To find out whether the opsinamides would have a physiological response in addition to binding to melanopsin in bench experiments, Megumi Hatori and Ludovic Mure from Panda's Salk lab group next looked at whether the drug affected the pupillary constriction in mice. Normally, in extremely bright light, the pupil of the eye shrinks to its smallest size. But when the mice were treated with one of the opsinamides, their pupils didn't shrink as usual. Most importantly, the drug had no detectable effect in mice lacking melanopsin, further showing its specificity for melanopsin. Finally, newborn mice treated with the compound no longer avoided bright lights. The results, Panda says, show that the drug is stopping melanopsin from signaling the brain when the eyes are exposed to bright light.

"So far, everything known about melanopsin has been discovered using knock-out mice that completely lack the receptor," says Panda. "So this offers a new way to study the protein." Kenneth Jones, the former project head at Lundbeck, notes that "the two compounds require further optimization in anticipation of clinical testing but are extraordinarily useful for research purposes and as leads in the discovery process." Co-author Jeffrey Sprouse has co-founded a start-up company, Cyanaptic, to do just that.

Once more effective compounds are developed, Panda expects that they could eventually have utility in a variety of clinical settings. "There are many people who would like to work when they have migraine pain exacerbated by light," he says. "If these drugs could stop the light-sensitivity associated with the headaches, it would enable them to be much more productive."

Moreover, Panda says, the drugs could help shift-workers set their sleep schedules without exposure to sunlight interfering with their circadian rhythms. His lab group doesn't yet have results on how the drugs affect circadian rhythms, but based on the known mechanisms of melanopsin, Panda says that it is likely the new opsinamides alter sleep.

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Understanding migraine headaches

This article discusses what migraine headaches are, what we should know about them, and how to alleviate them.

Just about everybody gets a headache now and then, but migraines can feel like a world apart from what we think of as garden-variety, everyday headaches. At their worst, they bring nausea and vomiting, obscured vision and pulsating pain, leaving their victim unable to do much other than wait it out.

But the effects of migraines can span hours or even days, and with more than 37 million Americans experiencing migraine headaches, that’s a lot of time devoted to misery. Migraines can occur in anyone at any age, but are three times more common in women than men.

What causes migraines is not fully understood, but they stem from an inherited neurological disorder that causes the central nervous system to be hypersensitive, says Karen P. Lauze, MD, a neurologist with a subspecialty in headache and facial pain at Portsmouth Regional Hospital. “It’s a biological abnormality that you’re born with,” Lauze says. Many migraine sufferers have a family member who has a history of migraines.

What it feels like

Migraine symptoms vary, but often progress through phases, beginning with what are called “prodrome” warning signs that can signal an approaching migraine up to one or two days before the headache pain hits. Prodrome symptoms include irritability, excessive yawning, fluid retention, constipation and nasal congestion, Lauze says. And, “some people actually feel euphoric a day or so or hours before a migraine,” Lauze says.

Know your migraine triggers
A number of factors can trigger the onset of migraine headaches. Some of the most common triggers are:
■ Stress
■ Red wine
■ Too much, too little or non- restorative sleep
■ Skipping meals
■ Perfume
■ MSG in food
■ Hormonal imbalances

Sources: Karen P. Lauze, MD, a neurologist with a subspecialty in headache and facial pain at Portsmouth Regional Hospital Andreja Packard, MD, PhD a neurologist and neurophysiologist at Foundation Neurology and Southern New Hampshire Medical Center

In some individuals prodrome symptoms are followed by a visual aura, during which flashing lights or jagged lines appear and partially obscure their vision, or they experience other neurological symptoms, such as numbness or tingling in their hand or difficulty putting words together. Auras usually last for 10 to 60 minutes and precede headache pain, but some people have auras without ever feeling pain.

In fact, despite the common assumption that migraines bring searing head pain that prompts sufferers to seek refuge in a dark, quiet room, migraine pain can be moderate or even mild, so much so that some people don’t realize that they’re having a migraine, believing instead that they’re feeling the effects of a less-intense tension headache, Lauze says.

In other cases, though, migraine pain is “incapacitating,” says Andreja Packard, MD, PhD, a neurologist and neurophysiologist at Foundation Neurology and Southern New Hampshire Medical Center in Nashua. Typically, migraines cause throbbing pain on one side of the head. The pain can last for hours, and be accompanied by nausea and vomiting. In addition, migraines often induce sensitivity to light and sound, Packard says.

"Migraines can occur in anyone at any age, but are three times more common in women than men."

Unlike tension headaches, which can be alleviated by exercise, migraine-associated pain typically is aggravated by activity, even low-key movement, such as standing, walking and bending over, Lauze says.

After the headache pain subsides, some people experience “postdrome” symptoms, as remnants of headache effects linger. Some individuals “feel hung over for a few hours,” Lauze says, “or the following day, they feel a little achy, a little run down.”

Feeling better

Doctors commonly prescribe medication to treat migraine headaches, but patients who have frequent migraines might find themselves going under the needle— the Botox needle — as a preventive measure.

Headache varieties
Variety might be the spice of life, but headaches are one area in which we wouldn’t mind a little blandness. Be that as it may, medical experts classify headaches into many different categories, including migraine headaches, sinus headaches, cluster headaches, and tension headaches. Some headache classification systems sort headaches into more than 100 different types.

Botox injections, well known for their cosmetic application in smoothing wrinkles, can decrease the frequency and severity of migraines by about 50 percent, Packard says. “We inject it in the muscles that are involved in the spread of neck pain and head pain within the migraine,” she says. Small-gauge needles loaded with Botox are used to target seven areas of the face and neck, Packard says, amounting to about 30-plus injections. Botox prevents strenuous tightening of the muscles, relaxing them along with the surrounding area. The injections typically need to be re-administered every three months to maintain effectiveness.

Migraine sufferers can also benefit from changing personal behaviors that make migraines more likely to occur. Keeping a headache diary, for example, helps people identify and avoid headache triggers. Noting the timing of headaches leads many people to find that changes in their biological rhythm set off migraines, Lauze says. You might find that not eating regularly, eating certain foods, drinking red wine, sleeping in or not getting enough sleep, or smelling particular odors precipitates migraines. Or you might notice that you’ve been stricken with migraines while on vacation, which by definition disrupts routine, and might involve altitude changes —another known migraine trigger, Lauze says.

Doctors have found that, ideally, a mix of therapeutic approaches will be in a migraine patient’s anti-migraine toolbox. “You need to have a combination of treatments,” Packard says. In addition to receiving medicine for the headache pain and recognizing and avoiding triggers, people who experience migraines should try stress relievers like yoga, relaxation training and massages, and if needed, they should see a psychologist to help them handle stress and anxiety, she says. Behavioral therapies such as biofeedback, in which electronic monitoring is used to enhance control over bodily functions, have also proven beneficial to migraine sufferers.

But don’t try to just ignore or live with migraines. Otherwise, they might occur more frequently since being in a migraine state can become the default mode for the brain, or more commonly, frequent self-treatment with over-the-counter medicine can spur withdrawal headaches, also known as rebound headaches, on the days that you try to go without the medication, Lauze says. Left untreated, migraines can become increasingly frequent until “you’re having them almost every day, and that can just basically ruin your life and make you chronically debilitated,” Lauze says.

And trying to live with discomfort can have meaningful health consequences, particularly in people who experience pain on a regular basis. Chronic pain shortens life expectancy and increases the chance of developing many long-term disorders, Packard says, “so treatment of any chronic pain issue is wise.” 

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Tips to help headache and migraine pain

This article gives tips that can help lessen pain from headaches and migraines.

Migraines, considered to be the most debilitating of all headaches, affect 12% of the population worldwide and approximately 28 million people in the U.S.  Sufferers frequently live in fear of the next headache onset, experience a disrupted sense of well-being, have a restricted ability to work and can develop family and other relationship problems.

For relief, most turn to over-the-counter pain medication, including Tylenol, Excedrin and prescription medication. However, if taken too often - or incorrectly - for prolonged periods of time, these medications can lead to ulcers, gastrointestinal bleeding, medication-overuse headaches and even death. 

During June, which is Migraine and Headache Awareness Month, Accelerated Physical Therapy is encouraging headache sufferers to visit their physician and consider physical therapy as an integral part of treatment.

"We see many headache patients in our centers," explains Denise Schneider, PT, head of the Accelerated headache program.  "As specially-trained physical therapists, we are very successful in evaluating and treating headaches and, in some cases, reducing the pain to a point where medical intervention is no longer required."

Pharmaceuticals can play a role in treatment, but physical therapy can enhance and prolong their pain-reducing effects.  Medication sometimes does not resolve headaches caused by mechanical or soft tissue dysfunction or postural deficits.

"There are specific techniques we use, including soft tissue massage, head/space orientation exercises, deep neck muscle exercises, manual traction and joint-specific mobilizations that are highly beneficial," Schneider explains. 

Schneider offers these tips for migraine and other headache sufferers to try at home:

• Eat regular meals
• Get regular sleep
• Exercise regularly
• Avoid known triggers such as food and smells
• Use a good pillow
• Try hot showers or heating pad
• Try cold pack or ice
• Watch your posture
• Drink plenty of water

Schneider recognizes that physical therapy can't treat all headaches.  "It has to have a musculo-skeletal or mechanical component," she explains.  This is also why she recommends a medical evaluation first to rule out causes that may require medical intervention, such as a tumor, vascular disease of infection.

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Lightning may trigger migraines

Researchers found that people are more likely to have a migraine headache on days when lightening is striking somewhere around their home.

Weather has long been considered one of many potential migraine triggers, but a new study links lightning, specifically, to the onset of the severe headaches that plague more than 28 million Americans.

Based on headache logs and weather data for Ohio and Missouri, researchers found that people were 28 percent more likely to experience a migraine on days when lightning struck within 25 miles of their home.

"We're very surprised and very happy with the results in that this is the first study to link lightning to migraines," said Dr. Vincent Martin, the study's senior author from the University of Cincinnati College of Medicine in Ohio.

Migraines are severe headaches - sometimes accompanied by light sensitivity, visual hallucinations or nausea - that can disable a person for hours or even days at a time. The majority of migraine sufferers are women.

Martin told Reuters Health that a migraine may result from a person experiencing certain "triggers," such as stress, lack of sleep and dehydration.

Previous research has also found links between the onset of migraines and high barometric pressure, high temperatures and high humidity.

Most of the past studies looking at weather and migraines, however, relied on an individual's observations and did not always account for other, possibly unseen, local weather conditions, the researchers write in the journal Cephalalgia.

For the new study, they used information collected from three sensors that track lightning near Cincinnati, Ohio, and five sensors near St. Louis, Missouri. Those sensors allowed the researchers to know where and when lightning struck and the intensity of each strike.

They also used the headache diaries from two previous studies of 90 migraine sufferers in those areas who were between 18 and 65 years old. In those diaries, the participants recorded their headaches for three to six months.

After comparing the weather data with the headache journals, the researchers found that a lightning strike within 25 miles of a person's house was linked to a 31 percent increased risk of any kind of headache, and a 28 percent increased risk of the more severe migraine headache.

Martin said that could mean an extra one to three migraines per month for an individual, but he added that it depends on the person and the weather.

As for how lightning might affect migraine occurrences, Martin said it could be that the electromagnetic waves and ozone created by the lightning have something to do with it.

"The other theory is that when these thunderstorms roll in they can create more allergy spores in the environment," he said, which could create a problem for some people.

But the researchers cannot say for certain that lightning causes migraines, even though they used a computer model to account for other meteorological changes that occur during a thunderstorm.

In an accompanying editorial, Dr. Hayrunnisa Bolay of Gazi University in Ankara, Turkey, cautioned that the study had limitations, including its failure to account for the participants' own individual risk factors.

"In brief, one can only conclude that weather conditions associated with lightning have the potential to induce headache in migraine patients," she wrote.

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Migraine Triggers may not directly cause Migraines

Research has shown that migraine triggers may not be to blame for causing migraine headaches.

People who suffer from migraines often try to avoid potential triggers like bright or flickering lights or vigorous exercise. But, new research suggests that these events may not cause the painful and debilitating headaches.

"People with migraine with aura are told to avoid possible triggers, which may lead them to avoid a wide range of suspected factors," said study author Dr. Jes Olesen, with the University of Copenhagen in Denmark and a Fellow of the American Academy of Neurology, in a press release. "Yet the most commonly reported triggers are stress, bright light, emotional influences and physical effort, which can be difficult to avoid and potentially detrimental, if people avoid all physical activity."

Migraine with aura is a migraine which normally occurs with sensory warning signs like flashes of light, blind spots or tingling in your hands and face, according to the Mayo Clinic. "Aura" refers to a group of symptoms, including vision disturbances, that are a warning sign that the bad headache is coming.

A recent study showed that women who suffer from migraines with aura are at a greater risk for heart problems and blood clots.

For the study, researchers looked at 27 people who had migraines with aura who believed that bright or flickering lights, vigorous exercise or both had caused a prior episode.

They then subjected the participants to the trigger either by going on an intense run or using an exercise bike for an hour so they could reach 80 percent of their maximum heart rate. They were also exposed to bright, flashing or flickering light for 30 to 40 minutes. After each period, the subjects were monitored for three hours and asked if they had a migraine or migraine with aura.

Only 11 percent of participants said they had a migraine with aura after the light or exercise episode. Another 11 percent of people had a regular migraine.

"Our study suggests that if a person is exposed to a suspected trigger for three months and does not have a migraine attack, they no longer have to worry about avoiding that trigger," said Olesen.

Dr. Randall Berliner, a neurologist specializing in headaches at Lenox Hill Hospital in New York City, told HealthDay that the triggers may only work in specific situations. He was not involved in the study.

"Perhaps the triggers only exert their effect when the brain is already susceptible to a migraine," he said. He added that the study helps people understand the complex relationship between migraine triggers and migraines.

However, Dr. Stephen D. Silberstein, a professor of neurology at Thomas Jefferson University and the director of the Jefferson Headache Center who wrote an accompanying editorial, said to TIME that supposed triggers may in fact be symptoms of the migraine itself.

"You eat chocolate and you get a headache. Does that mean chocolate triggers the headache?" Silberstein explained. "What probably happens is the first symptom of your migraine attack is the desire to eat chocolate. Just like when you're pregnant, you might want pickles or ice cream. That's one end of the spectrum, where the desire to do something is part of the migraine attack, not the trigger."

The study was published online on Jan. 23 in Neurology.

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Link Between Women and Migraines

This article discusses the basics of migraine headaches and why there is such a strong link between women and migraines.

THE fact that three out of every four persons struck with a migraine are women has resulted in this condition being considered the most common disabling problem faced by women globally that results in them having to see a doctor.

Here are some of the most common questions women ask about migraines.

What are migraines and who gets them?

It is a severe type of headache that is accompanied by other changes apart from just pain. For example, some persons might feel nauseous, some persons may actually vomit and, some persons may have visual changes like blurred vision or flashing lights. Some persons also have numbness on one side of their body.

While the causes of migraines are still not known, researchers say that those with a family history of migraine are more likely to have it. This is also the case for those who have a history of depression, anxiety, stroke or high blood pressure.

Why do more women than men suffer from migraines?

Researchers have noted that migraines mostly affect women who are between the ages of 15 and 55 years old. However, there are no definitive reasons as to why. "It could be hormonal, but I couldn't give you a good explanation for that," said Dr Campbell.

What are some of the things that trigger migraines?

Food allergies, bright lights, loud nights, strong odours, weather changes, hormonal changes during menstruation, lack of or too much sleep, stress and anxiety, caffeine, skipped meals, alcohol can be triggers.

Food additives like dyes are usually important triggers. For some people it's chocolate, for others, citrus. MSG is a culprit too.

What is the difference between a migraine headache and a bad tension headache?

There are several other types of headaches besides migraines. There is the tension headache, for example, which is less severe and debilitating.

"For a tension headache, the presentation is going to be different. That has to be a sort of a clinical diagnosis, but usually with a tension headache, the headaches come as a result of spasm of the muscles in the head," explained Dr Campbell. "But to determine which is which, one ought to be examined by a physician."

What can I do to ease my migraine pain?

While there is no cure, there are certain medications that can help to ease the pain. It is always important to be diagnosed by a doctor who can prescribe these treatments. However, magnesium, fish oil and guinea hen weed are generally helpful. The doctor said she personally uses guinea hen weed.

"I get the root of the guinea hen weed, wash it, chop it up, throw rum on it, and if I feel a headache coming on, I inhale it," she said.

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