It is difficult to explain to someone who has not experienced a migraine exactly what is happening when one occurs. In fact, misunderstandings about migraines have led many people to say that they are having one when they may actually be experiencing a stress headache or a sinus headache. These misconceptions can leave potentially serious health issues unaddressed, so understanding migraines is important for those who may mislabel their own intense head pain as well as for those who truly suffer from these attacks.
For caregivers, migraines can be especially debilitating. Normal routines for sleep, meals, and other activities often fall by the wayside, which can contribute to one of these painful attacks. It is crucial for family caregivers to be knowledgeable of their condition and know when it is time to seek medical help, especially since they are providing care for someone else.
My own history with migraines started when I was a teen. The aura, the vomiting, the full body involvement of chronic migraines has had a huge impact on my life. Hormonal changes that come with age have changed my patterns, which are now, thankfully, not as bad as when I was young, but I still live with them. So does my youngest son.
I asked Christina Peterson, M.D., medical director of The Oregon Headache Clinic and author of “The Women’s Migraine Survival Guide,” to educate all of us about this health issue.
AgingCare: Can you please explain the physiology of a migraine to us?
Dr. Peterson: Many people assume that the term “migraine” refers to a very bad headache, but that is not what it really means. A migraine is a particular type of headache that is actually a reflection of a quite complex neurological process in the brain. In fact, you can have a migraine (meaning the process itself) without even having a headache, although most are associated with some level of headache pain which is often moderate or severe.
Many people with migraines will experience a warning of some sort before the more painful symptoms start. About 20% will have a warning called an aura which consists of neurological symptoms lasting for five minutes to an hour before the headache phase begins. Often these are visual symptoms like vision loss, seeing spots, lights, or more complex visual things like lightning bolts or crescent shapes in rainbow colors. People can also experience other neurologic phenomena during an aura like numbness or tingling in the face or extremities, difficulty speaking or confusion. Other people have warnings that are vaguer called a prodrome. Prodromes consist of things like emotional changes, cravings, goose flesh, thirst, excessive urination and fatigue. A prodrome can last a short time or can last a day or more.
People with these headaches generally have moderate or severe pain that is often one-sided, although it doesn’t have to be. The pain is often pulsating or throbbing in character, though researchers have found that it does not pulsate with your heartbeat. This pain is often made worse by routine physical activity, like going up a flight of stairs or bending over. It can also be exacerbated by exposure to light or sound. Migraines are frequently accompanied by nausea and are sometimes made worse by exposure to certain odors. Many sufferers have difficulty thinking clearly during one of these attacks. About half of all attacks will begin in the back of the head and neck first, and most last between four and 72 hours.
AgingCare: Could you please tell us what scientists say causes people to become susceptible to these episodes?
Dr. Peterson: Migraines run in families, and most researchers now believe it to be a genetic disorder. Several genes have been discovered, but this thought to be a very complex disorder with many genes involved, therefore many more genes need to be discovered before the genetic underpinnings are fully understood. We do know that if a careful three generation family history is taken, there is a family history in over 90% of cases. It is thought that exposure to triggers in those who are genetically susceptible brings on migraine attacks.
AgingCare: What are common triggers for most people?
Dr. Peterson: Triggers are things you are exposed to in everyday life that lower your threshold for experiencing a migraine. These can be things like changes in your schedule, sleep deprivation, dehydration, stress, skipping meals, hormonal changes, weather changes, and certain foods. It is important to realize that triggers can be additive.
AgingCare: What is your approach to treating migraines?
Dr. Peterson: If attacks are infrequent, it is sufficient to simply treat each one as it happens. There are effective antimigraine medications that act to abort the attack quickly.
If migraines occur several times a month, it is better to look into a prevention strategy to reduce the number of instances. Good results have been shown in studies of magnesium, CoQ10, and riboflavin. There is also a single study supporting the use of boswellia. There are also a number of medications available for the prevention of these attacks. All preventive strategies are usually used in conjunction with an abortive medication for acute attacks, as it is unrealistic to expect 100% suppression.
AgingCare: When should people see a doctor?
Dr. Peterson: As a physician, I am continually astonished at the patients I see who have suffered for years before deciding to see someone about their headaches. We now know that allowing migraines to occur without suppression encourages the brain to create more and more of them until, without intervention, a chronic problem can occur. If you realize that you are having an increasing number of headaches and that over-the-counter medications are not helping anymore, please do yourself a favor and see a doctor.
AgingCare: When can symptoms that we think may be migraine-related actually be a warning of something more dangerous, such as a stroke?
Dr. Peterson: If you have a fever or experience weight loss, this is not part of migraine. This means something else is going on, and you should see a doctor.
If you have neurological symptoms, like those described in the section on aura, but they last longer than an hour or so, that is a problem that should be evaluated as it could be a stroke. If you have migraine-like headaches, but they have come on late in life (50 or older), you should be evaluated by a physician as migraines usually start earlier in life and this could indicate another problem. If you have the sudden onset of severe headache, or if you have a headache that comes on with exercise or sexual activity, these are things that indicate the need for evaluation as they could indicate other health issues.
AgingCare: Thank you, Dr. Peterson. Even though I’ve had decades of experience with migraines, I’ve gained fresh information from you. It is crucial for family caregivers to look after their own health, avoid their triggers, and have some sort of back-up plan in place for their loved one in case they have an attack.