Migraine Relief: 10 Myths and Facts
By Diane Wedner
Migraines are more than just bad headaches. But many people – and even some doctors – don’t fully understand this complex condition or what’s required for migraine pain relief.
You wake up to throbbing pain on one side of your head. The sun streaming through the bedroom window scorches your eyes like a lightning flash. Moving your head even slightly is excruciating.
Like 35 million other Americans, you’re in the throes of a migraine – the most common cause of disabling headaches. About 18% of women and 6% of men experience the brain disorder, according to the Migraine Research Foundation (MRF), a Manhattan-based nonprofit organization that provides information and support.
Even some physicians don’t recognize the cluster of symptoms that makes up migraines – such as headache, nausea, vomiting, visual disturbances and sensitivity to noises and smells. As a result, they may dismiss a severe migraine headache and other symptoms as “women’s problems,” such as premenstrual syndrome (PMS) or depression.
“Because the problem is related to their head, patients sometimes feel that doctors think they’re making the symptoms up, causing their own headaches, or overreacting,” says Cathy Glaser, MRF co-founder and president.
Lack of training is a pervasive problem, says neurologist Peter Goadsby, M.D., Ph.D., director of the University of California, San Francisco Headache Program.
“If physicians aren’t exposed to current information, they have to fill in the blanks themselves,” he explains.
The result: Along with debilitating symptoms, migraine patients often endure a variety of myths about the condition.
If you suffer from migraines, it’s important to stay informed.
Migraine pain myth #1: Migraines are just bad headaches.
Reality check: Not so! Migraine is a syndrome in which “multiple symptoms often occur simultaneously because of a cascade of brain events,” says Joel R. Saper, M.D., director of the Michigan Head-Pain & Neurological Institute in Ann Arbor, Mich.
Those brain events release pain-producing inflammatory substances around the nerves and blood vessels of the head.
The cause is unknown, but the result isn’t: Disabling symptoms that often send sufferers to bed.
Interestingly, some people don’t have pain, though severe pain is the most common symptom of a migraine. In such cases, people often have visual auras and other migraine symptoms, such as nausea.
“But if they do [have pain], it might be minor compared to the drama of nausea, stroke-like symptoms and memory changes,” Dr. Saper says.
Though ordinary headaches result from a narrowing of blood vessels and can often be eased with aspirin, migraines are caused by the expansion of blood vessels. Certain treatments may provide migraine relief, but there’s no cure.
Migraine pain myth #2: Migraines occur only in women.
Reality check: Under age 12, an equal number of boys and girls have migraines, Dr. Saper says. After the onset of puberty, men still get them, but women with the condition outnumber them 3-1. The main reason is estrogen and progesterone, which play a significant role in the disorder, according to epidemiological and clinical studies.
The two hormones help regulate pregnancy, during which migraines may “settle down,” Dr. Goadsby says. Menopause may also bring migraine relief, he adds.
Higher estrogen levels sometimes improve migraines, while lower levels may make them worse, according to the Mayo Clinic in Rochester, Minn.
Some women get their first migraine headache after starting on birth control pills; for others, oral contraceptives improve the headache pattern, the clinic says.
Migraine pain myth #3: Premenstrual syndrome (PMS) causes migraines. Reality cheek: The two conditions are sometimes connected, but “not all women with periods have PMS, and not all women with migraines have PMS,” Dr. Saper says. Migraines are sensitive to hormonal fluctuations, which occur before a woman’s period. An attack that comes within two days before or three days after a period, known as a “menstrual migraine,” is similar to other migraines but usually doesn’t include an aura (visual disturbances).
Women who experience menstrual migraines can sometimes get relief from continuous birth control pills, which reduce the number of periods to four per year.
Here are other treatments for menstrua] migraines.
Migraine pain myth #4: Women get migraines because they’re more emotional. Reality check: “That’s nonsense,” Dr. Goadsby says. “The ‘hysterical female’ argument is embarrassing.”
“Women, like men, get migraines because something’s going on in their brains,” says Glaser of the MRF. “They’re usually born with that trait. The question is: If you have the trait, what triggers the migraine?”
For both men and women, emotional stress may release chemicals that provoke migraine-causing vascular expansion in the brain, according to Harvard Medical School’s Beth Israel Deaconess Medical Center (BIDMC).
“If life is stressful – you have a bad marriage, you’re hurt – you may be more vulnerable to migraines,” Dr. Saper says.
The letdown after a stressful period also may be a migraine trigger.
Remember, though, that “lots of women are stressed and don’t get migraines,” Glaser says. “You have to have the trait.”
Migraine pain myth #5: Painkillers are enough for migraine relief.
Reality check: Because migraines can provoke multiple symptoms, one pain medicine won’t necessarily sweep them away, Dr. Goadsby says.
“There are more than 100 treatments and prevention methods for migraines,” Glaser says. “If patients could pop just one pill, they’d be doing it.”
Although painkillers often are prescribed for migraines, they’re not the most effective treatment, experts say. They don’t work, for example, against triggers such as movement or noise, which may exacerbate symptoms.
Other medications can target symptoms in addition to migraine headache. But some have serious side effects, especially if patients also use painkillers regularly.
“The more painkillers you take, the greater the potential for more headaches,” Dr. Saper says.
Called medication overuse headaches, or rebound headaches, these are more like tension headaches than migraines, Dr. Saper says. Using painkillers 2-3 times weekly over several months may make patients more vulnerable to them. There are serious health dangers from painkiller overuse.
Pain relievers such as ibuprofen (Advil) and acetaminophen (Tylenol) help relieve mild migraine symptoms, but they shouldn’t be used to treat moderate or severe migraines, according to the Mayo Clinic.
Synthetic narcotics known as opioids, such as hydrocodone (Vicodin), can be more effective, but they “change the nervous system and make it easier to get the next attack,” Dr. Saper warns. They also can be addictive.
Other drags may help patients with more severe symptoms, including:
- Triptans: They work with brain chemistry to constrict blood vessels, helping relieve migraine pain, nausea and sensitivity to light and sound.
- Ergot: These combine caffeine with ergotamine, another blood-vessel constrictor, and work best in patients who have pain lasting more than 48 hours.
- Dexamethasone: This corticosteroid reduces inflammation and maybe used with other medications for migraine pain relief; it’s taken infrequently because of the risk of side effects.
- Tricyclic antidepressants: This form of antidepressant medication may help prevent migraines by altering brain chemistry, whether or not you have depression.
- Beta blockers: Commonly used to treat high blood pressure and coronary heart disease, these drags reduce the frequency and severity of migraines.
- Anti-nausea medications: These help with the migraine symptoms of nausea and vomiting.
There’s another drag treatment that you may not be aware of — one popularly known to fight wrinkles:
Following two clinical studies published in the medical journal Cephalalgia in 2010, the FDA approved Botox (OnabotulinumtoximA) for the treatment of chronic migraine headaches.
The studies were double-blind, randomized, placebo-controlled with more than 1,300 study participants. At the end of the two clinical trials, the researchers concluded that Botox is safe and effective, for the prevention of chronic migraines in adults.
Multiple studies since have shown the continuing effectiveness of Botox treatment for chronic migraines.
New treatments for migraine sufferers are emerging all the time. The latest was just announced by the FDA in March 2014. It is the first medical device approved to prevent migraines in adults, providing an alternative to medication.
According to the FDA, Cefaly is a small, portable, battery-powered, prescription device that resembles a plastic headband worn across the forehead and atop the ears. The user positions the device in the center of the forehead, just above the eyes, using a self-adhesive electrode.
The device applies an electric current to the skin and underlying body tissues to stimulate branches of the trigeminal nerve, which has been associated with migraine headaches. The user may feel a tingling or massaging sensation where the electrode is applied. It is directed for use once per day for 20 minutes.
Migraine pain myth #6: Migraines aren’t hereditary.
Reality check: The child of one parent with migraines has a 50% chance of having them too, and the risk climbs to 75% if both parents experience them, according to BIDMC. The risk is 20% if even a distant relative has the disorder.
A boy may inherit the gene, but is less likely to get migraines, Dr. Goadsby says. But he can pass the trait on to his daughters, who are more likely to experience symptoms.
Migraine pain myth #7: Migraines are caused by psychological problems.
Reality check: Migraines, depression and anxiety often travel together. The causes may overlap – a
risk of depression, for example, can also be hereditary – but one condition doesn’t lead to the others.
Not everyone with depression gets migraines, and vice versa, Dr. Saper says.
“You can treat someone with depression with antidepressants, but that doesn’t mean it will help the migraine,” Dr. Goadsby says. And “you can give anti-migraine medications to a migraine patient, but she’ll still have depressive disorder.”
“The two are related only by shared brain chemistry,” he says.
Migraine pain myth #8: Caffeine helps relieve migraines.
Reality check: It helps some people – but for others, it’s a migraine trigger, according to BIDMC.
Caffeine can help relieve a mild or moderate migraine headache if you don’t consume much of it daily, Dr. Saper says.
But 4-5 cups of coffee per day may foster a caffeine dependency, and overnight withdrawal from the stimulant could trigger a migraine the next morning.
To help determine whether caffeine affects your condition, keep a headache diary to note if you get migraine symptoms after consuming caffeinated beverages, BIDMC suggests.
Migraine pain myth #9: Certain foods trigger migraines. Reality check: Some migraine patients are sensitive to:
Cheese, which contains a natural compound called tyramine
Chocolate, which has caffeine
Processed meats made with nitrates
But many others never suffer a migraine headache from food, Dr. Saper says. “It could be 100 different triggers,” he says. “It’s hard to identify them.”
If you often get symptoms after eating a particular food, keep a diary to track what you’ve eaten when you develop symptoms, Glaser advises. These 5 foods can ease migraines.
It also matters when you eat. Inconsistent mealtimes can set off migraines.
“Eat at the same time every day,” Dr. Saper advises. “Missing or delaying meals are often a key migraine trigger.”
Exercising and going to bed at the same time daily is also wise, he adds.
Migraine pain myth #10: Overachieving women get migraines from too much multitasking.
Reality check: Stress can be a migraine trigger, but “it doesn’t matter whether a woman is under stress in an office or at home with kids,” Dr. Goadsby says.
Stress-reducing techniques, such as meditation, may help manage migraines.
It isn’t just a women’s issue either.
“It’s a myth that stress applies to women more than men,” Dr. Saper says.
Don’t let this, or any other migraine myth, deter you from living your life and getting proper treatment, Dr. Goadsby says.
“You’re not crazy, weak or second-rate if you have migraines,” he says. “You have a genuine, biologically determined problem. Don’t believe anything else.”