The Misery Of Migraine
This debilitating attack by your nervous system is more than just a headache. Happily, there's help.
A migraine attack brings a throbbing, painful headache, typically on one side of the head, but it doesn’t stop there. It can turn everyday stimuli into excruciating pain. An overhead light, a friend’s perfume, the droning of a TV in the next room—all can become almost intolerable. Migraines can also cause nausea and impair vision, as, according to the National Institutes of Health, about 25 percent of people who have migraines also experience an “aura” before or during an attack that causes them to see bright spots, shapes or flashing lights.
A migraine is a disorder of the nervous system. “Much is still unknown about what causes migraines,” says Kirk Levy, M.D., a neurologist at Bergen Neurology in Englewood and a member of the Englewood Heath Physician Network. “A common genetic neurologic condition, migraine affects approximately one in five women and one in 16 men, as well as children and adolescents.”
As Dr. Levy explains, a series of inflammatory events in the brain plays a key role in the condition, initiating changes in the brain and body. Patients may experience either episodic migraines (less than 15 headache days per month) or chronic migraines (15 or more). These attacks are, he says, “disabling for many people.”
Is migraine pain keeping you from enjoying activities you love? To mark National Migraine & Headache Awareness Month in June, BERGEN sat down with Dr. Levy and Tracy Scheller, M.D., medical director of the Graf Center for Integrative Medicine at Englewood Health in Englewood, for advice on how to make sense of the condition and find relief.
• Figure out your triggers. A migraine attack often follows a specific trigger. While that trigger may be difficult to identify, doing so is an essential first step to feeling better. “Stress, sensory stimulation, insufficient or excessive sleep, missed meals, consumption of alcohol and certain foods and hormonal changes—particularly estrogen fluctuations in women during menstrual periods, pregnancy and perimenopause—are all common migraine triggers,” says Dr. Levy. “Environmental factors, such as cold-weather fronts, also play a role.” He recommends keeping a log of your migraines, noting their duration, their intensity, how they affect your activity and potential triggers you were exposed to, including foods you’ve eaten. This is important information to share with a neurologist.
• Make adjustments. Learning to avoid and manage migraine triggers is essential. “It can be beneficial to adopt a lifestyle aimed at preventing and reducing the severity of your headaches,” says Dr. Scheller, who adds that managing stress is a key factor. Incorporating exercise, meditation, relaxation techniques and yoga into your daily routine can help lessen the number of headache days you experience. Changes in diet can also help—avoiding food triggers and emphasizing anti-inflammatory foods. “At the Graf Center, patients often consult with one of our registered dietitians,” she says.
• Give yourself a break. Dr. Levy stresses that a migraine isn’t just a bad headache. “Migraines make your entire nervous system more sensitive to stimuli,” he says. If you’re experiencing an attack, in addition to over-the-counter or prescription medications, other comfort therapies such as cold packs or massages may help provide relief. “Find a peaceful environment, turn down the lights and avoid loud noises and strong smells,” says Dr. Levy. “You can also try sipping caffeinated tea; small amounts of caffeine can relieve migraine headaches in their early stages.”
Communication about your condition, says the doctor, is also key. “Patients often need to lie down and rest during a migraine episode,” he explains. “Share your experience with your family, friends, colleagues and teachers. Their understanding can go a long way in supporting you through migraine attacks.”
• Learn long-term options. Though there is no surefire cure for migraine headaches, there’s also no need to despair. Medical technology and research continue to advance. Dr. Levy explains: “In the past five years, there have been advances in understanding the pathophysiology of migraines. As a result, newer medications that block pain signals, which can be taken by injection, orally or as a nasal spray, are now available. They can be effective in treating or preventing acute migraines.” Besides over-the-counter and prescription pain relievers and anti-nausea medication, there are other preventive options. “Other therapies may include periodic Botox injections, neuromodulation devices and nerve blocks,” says Dr. Levy.
Dr. Scheller adds that patients also find success with treatments such as acupuncture. “We offer acupuncture for migraine—it has been shown to reduce the frequency and severity of symptoms,” she says. “Many migraine patients also benefit from cognitive behavioral therapy with a licensed therapist.”
• Be patient. Dr. Levy says that finding a treatment plan that truly improves your migraines can be a long process. He also stresses that the time you put in will be worth it. “It may take some trial and error with a variety of preventive activities, medications and interventions,” he says. “However, over time, a plan can lead to improved quality of life for patients of all ages. Consult with a neurologist to seek out a diagnosis and an appropriate treatment plan.”
