Migraine Headache

A throbbing or steady pain, this kind of headache occurs on one or both sides of the head and is moderate to severe in intensity. About 50 to 70 percent of sufferers get a prodrome, one or more warning signs that occur several days or hours before the pain begins. Symptoms can include fatigue, muscle pain in the neck and the shoulders, food cravings, yawning, and difficulty concentrating. About 15 percent of people also get an aura (tunnel vision, flashing, or blind spots); numbness or tingling in body parts; and dizziness, which may come on about an hour before the headache and disappear once the pain starts, says Roger Cady, M.D., a headache specialist in Springfield, Missouri. Once the pain begins, some people feel nauseated, have difficulty thinking, and are sensitive to light and sound. And because some of the nerves affected by migraines cross the sinuses, a sufferer might feel congested or have teary eyes.

How Long It Lasts and Frequency: From hours to several days. Chronic migraines can occur anywhere from a few times a year to every other day.

Who Gets Them: About one in four women of reproductive age, says Cady. Migraines are the second most common type of headache, affecting 30 million Americans (mostly women), though nearly half remain undiagnosed.

Usually Triggered By:

An intense, stimulating environment, with lots of noise and flashing lights (a loud bar or a concert); stress; lack of sleep; or caffeine excess or withdrawal. These things hyperstimulate the central nervous system and a key nerve in the brain stem. The result is an overfiring of pain signals.

Genetics. If one of or both your parents suffer from migraines, chances are you will, too.

Certain foods or smells. Drinking wine, eating cheese or chocolate, or exposure to smoke or perfume can set off an attack.

A drop in estrogen. “Sixty percent of women who get migraines get the kind that come around their periods,” says Cady. When levels of estrogen fall, right before the menstrual cycle begins, migraines can become more likely and intense.

How to Treat without Medication:

Rest. Simply sleeping off a migraine is effective for many sufferers, and escaping to a quiet, dark room can also be helpful.

Biofeedback. Since climbing into bed isn’t always possible, many sufferers try to prevent migraines with biofeedback, a relaxation technique that helps you tune in to your body processes, such as heart rate and blood pressure. “Daily biofeedback can help slow down the brain’s activity and can be as effective as preventive medication for some,” says Cady. Practicing it for a few minutes a day (even on days you don’t have a headache) can change your brain’s rapid beta waves to slower, calmer alpha waves, raising your threshold for stimulation. Cady suggests ordering an instructional biofeedback kit ($10, www.headachecare.com).

Daily nutritional supplements. Some research has shown that taking B vitamins, as well as 200 to 500 milligrams of magnesium, can help cut down on electrical misfirings in the brain.

How to Treat with Medication:

If the migraines are mild, they can be treated with the same drugs that work for tension headaches. “The key is to take the pill at the first sign of pain and stop the nervous system from being bombarded with pain signals,” says Cady. But beware: Overuse can cause rebound headaches. “The medications can change the brain receptors, so when the drugs wear off, another headache can follow,” says Mannix. If you’re taking over-the-counter meds more than one or two days a week, see a doctor to discuss alternatives.

More severe headaches may require a prescription. Drugs called triptans, such as Imitrex, Maxalt, and Zomig, have few side effects and treat both the headache pain and the accompanying nausea, vertigo, and photophobia (sensitivity to light). For extreme migraine pain, your doctor might prescribe an injectable form of Imitrex, which kicks in almost immediately.

Taking a preventive medication can also help. Ones that work include antiseizure medications (like Topamax and Depakote), antidepressants, and beta-blockers, such as propranolol (Inderal) and nadolol (Corgard), which help decrease high blood pressure and heart rate.

Tip: Keep a headache diary. Note when the pain struck, what medications you took, and how much sleep you got the night before.