Migraines are the sixth most debilitating health condition in America, and can really interfere with your quality of life. Join Nice’s Jill Gauger as she goes in-depth on what migraines are, what can trigger them, and how to diagnose and treat them–and potentially improve other symptoms in the process. 

What is a Migraine?

A migraine is an intense, throbbing headache that typically lasts 4-72 hours. The pain is usually on one side of the head. 

Migraines are genetic and generally chronic, affecting approximately 12% of Americans, including children. They don’t cause brain damage, but 1-2% of sufferers may go on to have a stroke.

What Causes Migraines?

We still don’t fully understand what causes a migraine, but some theories are that they’re related to blood changes in the brain during migraine attacks (vascular theory). It may be that complex events in the brain and vascular systems lead to a migraine (neuro-vascular theory). It’s also possible that electrical changes in brain cells activate nerve fibers, which trigger neurological events, pain, and inflammation, causing a migraine (cortical spreading depression theory).

Other Possible Causes:

• Medication overuse (such as opioids, barbiturates, NSAIDs, or triptans)

• Dysfunction in the lining of blood vessels

• Histamine

• Brain stem activation causes inflammation

• Too much dopamine or a serotonin deficiency

• Magnesium deficiency, triggering chemical reactions in the brain which cause blood vessels to expand

Migraine Risk Factors and Triggers:

• Bright lights

• Strong odor

• Injury or head trauma

• Being too hot or too cold

• Lack of exercise

• Not eating

• Eating histamine-containing or inflammatory foods, such as caffeine, artificial sweetener, MSG, or aged meats and cheese

• Inflammation

• Obesity

• High blood pressure

• Stroke

• Heart disease

• Hormonal imbalance

• Stress

• Too much or too little sleep

• Smoking

Who Gets Migraines?

Migraines affect three times more women than men, and an average of 39 million Americans. This typically includes 10% of school-aged children, as well as adults.

How Common Are Migraines?

30 million Americans have one or more migraine per year, some having as many as 15 migraines, which qualifies as a chronic condition. The cost of migraine-related workplace productivity loss is $13 billion per year.

Because migraines are genetic, you have a 50% increased risk of getting migraines if your parents have them. Before puberty, more boys have migraines than girls–but this statistic flips after puberty. After menopause, migraines typically decrease, and a new onset of migraines after 50 is rare.

Migraines are less prevalent in African Americans and Asians, and most common in Caucasians. 

Migraine Symptoms

Migraine symptoms typically follow a pattern.

1. Premonitory Stage

   • Tiredness

   • Food cravings

   • Neck stiffness

   • Yawning

   • Lasts 1-4 hours

2. Aura

   • Affects ⅓ of people at least some of the time

   • Flashing lights, blindness, or other visual symptoms

3. Headache or Main Attack Stage

   • Severe throbbing in the head, made worse by movement, light, or sound 

   • The pain is typically on one side but can be on both

   • Nausea and/or vomiting may occur

   • Lasts 4 hours to 3 days

4. Resolution

   • Most attacks fade slowly, but some stop suddenly. 

   • Sometimes, a few hours of sleep may end the attack.

5. Recovery (aka Postdrome) Stage

   • Feels like a hangover, which can take days to disappear. Symptoms may mirror those from earlier stages.

Headache vs. Migraine

Headaches typically involve short-lived pain around the forehead in the form of mild, dull pressure. They’re not usually accompanied by other symptoms.

Migraines, on the other hand, involve pain on the sides of the head in the form of intense pulsing or throbbing. Symptoms can last for days, and may include nausea, dizziness, flashing lights, or even temporary blindness. Migraines may occur frequently for some people.

How are Migraines Diagnosed?

Your clinician will assess your symptoms and family history and may order a CAT scan or MRI of your head. And additional neurological and lab testing will help to rule out other conditions.

How to Treat Migraines

Migraines are complex, so they’re best treated with a multi-faceted approach. While you can’t control your genetics, you can control your genetic expression through lifestyle factors. 

Some lifestyle changes that can help reduce migraines are eating an anti-inflammatory diet, exercising (which strengthens blood vessels), reducing environmental exposure from plastic food containers, toxic beauty products, mercury fillings, and other hormone disruptors, and reducing your stress level.

Reducing Inflammation

When your body experiences an injury, the immune system creates an inflammatory response to speed healing. Food additives, chronic conditions, lack of exercise, and other factors can cause the body’s healing response to go into overdrive, causing more symptoms, such as migraine headaches or even obesity.

Gut Health

Healing your gut is an important aspect of reducing inflammation in the body. For a healthy gut, avoid or reduce gluten, pesticides, food additives, preservatives, and simple sugars as well as carbohydrates in foods, which kill healthy gut bacteria. Taking probiotics will increase healthy bacterial growth, as will eating fiber-rich foods, such as black beans, quinoa, and vegetables with every meal.

The type of bacteria in your gut is responsible for many chronic diseases, including migraines, diabetes, and high blood pressure. Gut bacteria also affect chemicals in the brain, including dopamine and serotonin.

Medications

• NSAIDs and triptans

• Blood pressure and seizure medication

• Botox

• Emgality (“antibody” migraine treatment)

• Combine medications with diet modification for best results

Lifestyle Changes

• Sleep hygiene

  • Relax, stretch, and don’t watch screens before bed

• Avoidance of triggers

• Oxygen therapy

• Exercise

• Acupuncture

• Physical therapy

• Massage

• Stress relief

Dietary Changes

An anti-inflammatory diet such as paleo, keto, or low-carbohydrate can help reduce and prevent migraines. This includes avoiding MSG and histamine-containing foods, eating lots of vegetables and moderate amounts of fruit, and eating primarily whole foods. Eating healthy fats, such as coconut oil, avocado (although not too ripe, as those can trigger headaches for some people), Omega-3 fats, and almonds can be helpful.

You may need to try an elimination diet to identify your food triggers (eliminating gluten, soy, nuts, and dairy for 2-4 weeks

Some supplements that can help with Migraines are:

• Turmeric

• Ginger

• CBD oil

• OTC allergy medication

• Melatonin

• CoQ10

• Magnesium

• D3+K

• Omega 3 fish oil

• Riboflavin

Nice Can Help You Recover From Migraines

At Nice, we treat the whole patient by looking at your genetics, diet, stress levels, and other lifestyle and environmental factors, as well as your symptoms. If you suffer from migraines, intense headaches, or other symptoms discussed in this webinar, we can help you get back to feeling better, fast.

To learn more about how our comprehensive primary care services can help with your migraines, click here.