By Megan Madden, M.D., neurology
Q: Are my headaches migraines? How can I tell?
Migraines are intense headaches that affect one or both sides of the head. The pain often concentrates in the forehead and behind the eyes, but can extend into the neck, too. The pain starts out mild but can build into intense throbbing pain. With a migraine, you can feel sensitive to bright lights and sound, and experience nausea. Activity and moving around makes the migraine worse.
Migraines are different than tension headaches — migraines are more debilitating. They often make you want to stop what you’re doing and rest, although some people are able to work through a milder migraine. Migraine headaches worsen with daily activity, where tension headaches usually do not.
It’s always a good idea to let your doctor know if you are experiencing headaches. Your doctor can confirm whether they are migraines and can make sure there is not another cause.
Q: When should I worry that something else might be going on?
Migraines usually start in a person’s teens or 20s, so headaches that start when you are older should be discussed with your doctor. Headaches that last longer than three days also are unusual — a migraine usually goes away within a few hours to three days.
Talk to your doctor about new headaches that start out of the blue, are daily or frequent, are getting worse, are positional (worse when standing, better when lying down), or are accompanied by vision changes, other neurological symptoms or fever.
Any new, severe, sudden-onset headache — such as one that reaches maximum intensity within a minute — should be evaluated promptly by a doctor or in an emergency department.
Q: What home treatments can relieve migraines?
Lying down in a dark, quiet room with a cold pack on your head can help. Some people find that drinking a caffeinated beverage helps, too.
Q: Should I take over-the-counter pain relievers?
For a mild migraine, Tylenol (acetaminophen), Advil (ibuprofen), Aleve (naproxen) or Excedrin Migraine (acetaminophen, aspirin and caffeine) may be enough. However, prescription medications are often needed for migraines. Talk to your doctor about what you are taking, and ask about other options.
When using over-the-counter medications, don’t combine them or exceed the recommended dosage, and don’t take more than 10 doses a month — more frequent use can cause medication-overuse headaches (aka “rebound” headaches). If you find that you need more, ask your doctor about prescription medicines that can relieve or prevent migraines. Triptan medications can help stop a migraine. Newer CGRP inhibitors, available as injections or pills, are also options.
Q: What can I do to prevent repeat migraines?
The biggest migraine triggers are stress, lack of sleep and skipping meals. Hormone changes in women are another common trigger. Finding ways to manage these issues can be of tremendous benefit. Exercise can reduce stress, improve sleep and reduce headaches — a win win.
Things to avoid include tobacco smoke and excess or irregular use of caffeine. Certain foods can trigger migraines, too — simply being hungry is a common food-related trigger. Specific food triggers are different for everyone — keeping a headache journal can help you identify and eliminate yours.
There are daily preventive medications that can help reduce your headaches. There are pill forms and injectables. The preventive medications for migraine can help reduce the frequency and intensity of the migraines.
Dr. Madden is a neurologist and headache specialist. She practices at our South location.
