Migraine

Overview

What Is It?

Migraine is a biologically based disorder. Its symptoms are the result of changes in the brain, not a weakness in character or an inappropriate reaction to stress.

As busy women, we can barely fit in everything we have to do as it is. Let alone while juggling the crippling pain of a migraine. But unfortunately, up to one in five women deal with migraine headaches on a regular basis.

Migraines differ from other types of headaches in that they are brutally painful and are often accompanied by nausea or sensitivity to light and sound. As anyone who's suffered a migraine can tell you, these headaches can disrupt every aspect of a person's life, from the ability to work to day-to-day activities to relationships. They can eventually lead to lower self-confidence and a feeling of losing control.

In the United States, about 12 percent to 16 percent of the population suffers from migraine headaches.

Women experience migraines three times more frequently than men. Researchers have found that migraines affect women more profoundly than they do men, interfering with professional development and family and social life. Gender aside, nearly half of migraine sufferers could benefit from preventive therapies, according to the American Migraine Prevalence and Prevention (AMPP) Study.

What Are Migraines?

Although some people equate them with a person's stress level, a migraine is a biological disorder. Its symptoms result from changes in the brain, not inadequate coping mechanisms.

For many years, scientists believed migraines were linked to the dilation and constriction of blood vessels in the head. They now believe migraine results from inherited abnormalities in certain brain cells. People with migraine are predisposed to attacks triggered by a range of factors. Specific, abnormal genes have been identified for some migraine forms.

Most migraine sufferers appear to be sensitive to various triggers, such as the menstrual cycle, weather changes, skipped meals, disturbed sleep, bright lights, odors, stress, or certain foods and beverages.

An estimated 25 percent to 30 percent of migraine victims experience what's called "aura" prior to an attack. Aura usually takes place 5 to 60 minutes before the migraine sets in and may include flashing lights or visuals resembling TV static or zigzag lines. An aura usually lasts 20 to 30 minutes but can remain for as long as an hour. Some sufferers also temporarily lose vision. Other classic symptoms of a migraine aura include speech difficulty, weakness in an arm or leg, tingling of the face or hands and confusion. Migraines with aura are known as classic migraines.

Even if you don't have an aura, you may experience a variety of vague symptoms before a migraine, including mental fuzziness, mood changes, food cravings, fatigue or unusual fluid retention. Migraines without aura are known as common migraines. Some people experience both classic and common migraines.

Migraine sufferers often describe the pain of the headache as one-sided and intense, throbbing or pounding. They usually describe feeling the pain in the forehead, temple, ear and/or jaw, around the eye or over the entire head. It may include nausea and vomiting and can last anywhere from a few hours up to three days.

People who suffer from migraines may also experience cutaneous allodynia, a condition in which you feel pain on your scalp from a source that should not cause pain, such as brushing your hair.

Migraines can strike as often as almost every day or as rarely as once every few years. Some women get migraines in predictable patterns, such as when menstruation begins or every Saturday morning after a stressful work week.

In addition to the classic migraine described above, migraine headaches can take several other forms:

• Hemiplegic migraine: Patients with hemiplegic migraine have temporary paralysis on one side of the body, a condition known as hemiplegia. Some people with this form may experience vision problems and vertigo (a feeling that the world is spinning). These symptoms begin 10 to 90 minutes before the onset of headache pain. Complete recovery may take weeks.
• Migraine with brainstem aura: Migraine with brainstem aura involves a disturbance of a major brain artery. Preheadache symptoms include vertigo, double vision and poor muscular coordination.
• Status migrainosus: This is a debilitating migraine attack that can last 72 hours or longer. The pain and nausea are so intense that sufferers are often hospitalized. The use of certain drugs can trigger status migrainosus. Neurologists report that many of their status migrainosus patients were depressed and anxious before they started getting headache attacks.
• Abdominal migraine: If you suffer from abdominal migraine, you will feel pain in the middle of your abdomen rather than your head. Abdominal migraines usually last a few hours and occur mainly in children who later develop migraines. Symptoms may also include nausea, vomiting and diarrhea.
• Acephalgic (or silent) migraine: These occur when migraine symptoms occur but there is no headache.

Chronic migraine is a secondary diagnosis for some people who have migraines. It affects about 5 percent of the world population. Chronic migraine is when you have headaches at least half the month and some are full-blown migraines. To receive a diagnosis, you must have tension-type or migraine headaches that occur at least 15 days a month for at least three months. In addition, you must have two or more of the following symptoms on eight or more days a month for at least three months: moderate to severe headaches; headaches on one side of the body; pulsating head pain; headaches aggravated by routine physical activity; headaches that cause nausea, vomiting or both; or headaches coupled with sensitivity to light or sound.

Choosing Your Provider

If you are seeking a diagnosis and treatment for migraines, it's important to choose the right health care provider. There are four levels of providers: primary care, neurologist, headache specialist (board certified in headache medicine), and anesthesia pain doctors or surgeons who can do advanced procedures, like implanting stimulators and doing decompression surgeries.

If you have one migraine per week or fewer, start by seeing your primary care doctor. If you have more frequent migraines, you may want to start with a neurologist and advance to a headache specialist if not satisfied after a few visits. If you have chronic migraine, you will likely want to start with a board-certified headache specialist. Anesthesia pain doctors and surgeons are usually only seen on referral from a headache specialist after preventive treatments fail.

Diagnosis

Because migraine headaches may have a genetic component, it's important that you talk to your health care professional about your family history. Even if you are not sure whether any of your relatives suffered from migraines, try to think of past illnesses and lifestyles that may have indicated headaches. Keep in mind that the term "migraine" was not used until the 1950s, and even then many migraines were not diagnosed or referred to by this term.

Regarding family history, consider these questions:

• When growing up, do you recall a family member who was sick much of the time?
• If so, did he/she exhibit any of the following symptoms: head pain that interfered with daily activities, nausea or vomiting, sensitivity to light or sound, numbness or speech difficulty?
• To what did he or she attribute symptoms of their headache: menstrual cycle, overwork, fatigue, stress or something eaten or drunk?

Be prepared to discuss with your health care professional both the symptoms of relatives' headaches and their methods for coping.

Diagnosing a headache involves ruling out other problems, such as tumors or strokes. A detailed question-and-answer session can often produce enough information for a diagnosis. Some women have headaches that fall into an easily recognizable pattern, while others require further testing to determine if symptoms are due to secondary causes such as dental pain, hemorrhage or tumor.

You may be asked:

• How often do you have headaches?
• Where is the pain?
• How long do the headaches last?
• When did you first develop headaches?

Your health care provider may also ask about your sleep habits and family and work situations.

Most of the time, a health care professional makes a migraine diagnosis by focusing on your history, asking about past head trauma or surgery, and looking into your medication use. Health care professionals may also order blood tests to screen for thyroid disease, anemia or infections that could cause a headache.

Additional tests to rule out other medical problems may include:

• A magnetic resonance imaging (MRI) scan is the preferred tool to rule out headaches associated with aneurysms (abnormal ballooning of a blood vessel) and brain lesions. MRI scans provide a more detailed view of the cerebral anatomy and are warranted in cases where migraine can't be diagnosed by history alone.
• A magnetic resonance angiogram (MRA) is a type of MRI that looks at the blood vessels inside the body. It is a refined tool to pick up minute lesions of the vascular system of the brain such as small aneurysms.
• A computed tomographic (CT) scan produces images of the brain that show variations in the density of different types of tissue. The scan enables the physician to distinguish, for example, a bleeding blood vessel in the brain from a brain tumor. The CT scan is an important diagnostic tool in cases of sudden headache caused by hemorrhage.
• An eye exam checks for signs or symptoms such as weakness in eye muscle, unequal pupil size or pressure behind the optic nerve. These could be evidence of brain lesions or elevated or low cerebral spinal fluid, among other conditions. A physician who suspects that a headache patient has an aneurysm may also order an angiogram. In this test, a special fluid visible on an x-ray is injected and carried in the bloodstream to the brain to reveal any abnormalities in the blood vessels.
• A lumbar puncture (spinal tap) can rule out conditions such as pseudotumor cerebri, meningitis, encephalitis or a brain bleed if the headache is associated with neck pain, fever and/or sudden onset. The spinal tap takes about 30 minutes and may cause a headache due to the drop in cerebral spinal fluid pressure. There is also a small risk of infection with this procedure.

Your health care professional will analyze the results of these tests along with your medical history to make a diagnosis.

Head pain is typically diagnosed as one of the following types of headaches; some people have more than one type:

• Migrainous headaches, the group that includes migraine. This type of headache is recognized as being principally "neurogenic-initiated," eventually affecting the cerebrovascular system.
• Tension-type headache. These headaches involve the tightening or tensing of facial and neck muscles.
• Cluster headaches. These are far less common than migraine and are more often found in men than women. These headaches are described as excruciating pain in one part of the head or around the eye, with features such as eye tearing and nasal congestion that occur on the same side of the head as the pain.
• Traction and inflammatory headaches. These headaches involve symptoms caused by other disorders, ranging from stroke to sinus infection to eye disorders to an abnormal growth or mass.
• Chronic migraine. To be diagnosed with chronic migraine, you must meet the criteria spelled out by the International Headache Society, which includes headaches that strike 15 or more days a month for at least three months coupled with two or more of the following symptoms on eight or more days a month for at least three months:
  • Moderate to severe headaches
  • Headaches on one side of your head only
  • Headache pain that pulsates
  • Headaches aggravated by routine physical activity

Chronic migraine diagnosis also requires headaches that cause either nausea and/or vomiting, or are coupled with sensitivity to light or sound.

Treatment

Health care professionals say that many women don't express the true extent of the pain they feel with migraine, perhaps because they worry about "complaining" too much. Another problem may be that many people with migraines think there is nothing that can be done. They may have watched their mother or grandmother suffer from migraines and think they simply must suffer, too. Or, they may be resigned to resorting to the often-ineffective treatments their older relatives used to cope with their migraines, despite significant advances in medication and treatment options available today.

Patients commonly deal with a migraine by taking some kind of pain relief medication, lying in bed, struggling with nausea and vomiting and trying to minimize lights, noises and smells that can either trigger a migraine attack or make it worse.

If you have migraines, it is important to develop a good relationship with your health care professional because the condition is usually recurrent. Start by finding a health care professional with experience in treating migraine who understands that migraine is a biological disease.

Headache specialists also recommend looking for a health care professional who is willing to consider a variety of options for treatment, including over-the-counter and prescription medications, nonpharmacological treatments and lifestyle changes.

Communicating treatment needs can be difficult for migraine sufferers for a variety of reasons, but communication is key to effective treatment.

Many migraine sufferers find that keeping a headache calendar is a first step in gaining some control over their headaches. This tool is especially helpful as you begin designing a treatment program with your health care professional.

A headache calendar should include:

• when your headaches occur
• severity and duration of the headaches
• possible triggers, including dietary, stress, environmental, etc.
• dates of your menstrual periods
• interventions attempted

The National Headache Foundation at www.headaches.org has numerous tools and information to help headache sufferers, including a headache diary.

Many electronic diaries are available, including iHeadache, which is available for free online and through app stores. It allows you to track how your care affects your headaches over time, and you may be able to electronically share your information with your health care provider.

Another headache management technique is to make a checklist of your symptoms and treatment responses, then rank the effectiveness of your current treatment program. Use descriptors ranging from very satisfied to very dissatisfied with several categories in between to determine how satisfied you are with your current treatment program. Evaluate whether the treatment:

• is fast acting
• has minimal side effects
• is non-sedating
• relieves sensitivity to bright light and/or sound
• is easy to use
• relieves head pain
• requires only one dose per headache
• is available in an injection
• is available in a nasal spray
• is available in a tablet
• has a proven track record
• is available in several forms

Rank these attributes in terms of how important they are for you. Use the descriptors––very important to not important––to prioritize and personalize your treatment program.

Next, list those activities you feel your migraines most often disrupt. Be sure to include work, family interactions, personal time, sleep, exercise, social opportunities or other activities you've canceled one or more times because of migraine attacks.

In fact, recording and communicating your migraine-related disruptions and disabilities with your health care professional may be the key to receiving the most comprehensive treatment course. Health care professionals are more likely to manage your treatment more effectively and aggressively when they receive detailed information on symptoms.

Unfortunately, headache-related disability information is often overlooked during consultations. That's why there are tools designed to improve communication about headache-related disability, such as the Migraine Disability Assessment Test to improve migraine management.

Next, make an appointment with a health care professional to discuss your migraines. Bring your checklists with you. Ask for a treatment plan that incorporates those components you feel are most important to your headache treatment and lifestyle. Before leaving the professional's office, arrange a follow-up appointment to discuss the treatment's success or failure.

Finally, once you begin a treatment program, keep a diary of the frequency and severity of your headaches, as well as how your treatment plan is working. Share the diary with your health care professional on your next visit and be willing to modify your treatment plan if necessary. It can take patience and several changes to find the individualized treatment program that works best for you.

Medication-Based Treatment

In general, health care professionals develop a migraine treatment plan depending on the frequency and severity of migraine headaches. Infrequent headaches, which come once or twice a month, are usually treated with a fast-acting, acute-type medication that relieves head pain, nausea and sensitivity to bright light and/or sound. Women who have migraines more frequently or who have been diagnosed with chronic migraine need a different strategy, often a preventive medication.

Drugs to treat or shorten the duration of migraines:

One of the most popular classes of drugs for migraines are called triptans, which scientists believe bind to certain receptors in the brain to shutdown neurogenic inflammation that occurs in migraine. These drugs can reduce the pain of migraines and limit symptoms such as auras. Specific triptans include naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), zolmitriptan (Zomig), almotriptan (Axert), frovatriptan (Frova) and eletriptan (Relpax). All listed triptans are available in pill form. Sumatriptan and zolmitriptan are also available in nasal sprays. Sumatriptan is available via injection. The fastest acting and most effective form is the injectable form. In addition, a combination of sumatriptan and naproxen sodium, available generically and under the brand Treximet, is available.

Other medications used for acute relief of severe migraine pain include:

• Ergotamine (Ergomar), a drug that was the common prescription choice for migraines before triptans, is less expensive in the generic form than triptans but may not work as well. It is usually prescribed for people with long (greater than 48 hours) or frequent migraines.
• Dihydroergotamine (for example, Migranal nasal spray or injectable Migranol), an ergotamine derivative for migraines, has fewer side effects than ergotamine.
• Nonsteroidal anti-inflammatory agents (NSAIDs) are effective for treating moderate headaches. The NSAIDs include ibuprofen and naproxen sodium. NSAIDs in combination with caffeine may help moderate to severe migraine headaches, but limit use of these, especially caffeine, because of the risk of developing rebound headaches from overuse.
• Dexamethasone, a steroid medication given by injection for an acute attack or orally to break a prolonged cycle, can be used alone or with another acute migraine treatment.
• Indomethecin (Indocin), a prescription medication for arthritis pain that comes in a rectal suppository, may be helpful for people who experience nausea during their migraines.

Because ergotamine and dihydroergotamine can cause nausea and vomiting, they may be combined with anti-nausea drugs. Experts caution that these should not be taken in excess or by people who have angina pectoris; severe hypertension; or vascular, liver or kidney disease.

In many cases, health care professionals will recommend pain relievers first for mild to moderate migraine headaches. However, it's important to keep in mind that you shouldn't use these pain relievers too frequently or you could develop medication-overuse headaches or chronic daily headaches. If your headaches respond to pain relievers, you can take them for migraine attacks as long as you don't take more than one to two doses per week.

Drugs to treat/prevent frequent migraines

• Beta-blockers block specific receptors in the heart to slow it down and reduce blood pressure and may help prevent migraines. Note: Health care professionals recommend that people taking beta blockers, especially people with a history of heart problems, do not suddenly stop taking these drugs.
• Calcium channel blockers, especially verapamil (Calan, Isoptin), may help prevent migraine in people who are prone.
• Anticonvulsants. Some drugs used to prevent seizures, such as divalproex (Depakote), gabapentin (Neurontin) and topiramate (Topamax), seem to help reduce the frequency of migraines in some people. In high doses, these medications may cause side effects.
• Antidepressants. In some cases, low-dose antidepressants are used to help prevent migraines. These include tricyclic antidepressants such as amitriptyline (Elavil), nortriptyline (Pamelor) and doxepin (Silenor). In addition, atypical antidepressants, such as venlafaxine (Effexor) may help by enabling certain brain chemicals such as serotonin, norepinephrine and dopamine to remain in the brain longer. Note: The U.S. Food and Drug Administration warns that antidepressants may increase suicide risk, particularly in adolescents and children. Anyone taking antidepressants should be carefully watched for any signs of suicidal behavior. If you are planning to take antidepressants, talk to your health care professional about these risks and always read package information.
• CGRP antagonists. These drugs help block pain transmission by blocking the calcitonin gene-related peptid (CGRP) receptor—or the CGRP itself. The first CGRP antagonist—erenumab-aooe (Aimovig)—was approved by the U.S. Food and Drug Administration (FDA) in May 2018. Aimovig is an injection given once a month. Possible side effects include constipation and pain at the site of injection. The second and third—fremanezumab-vfrm (Ajovy) and galcanezumab-gnlm (Emgality), respectively—were both FDA-approved in September 2018. Each has a possible side effect of injection site reaction.

If you have migraines and are pregnant or plan to become pregnant, you will want to see a board-certified specialist about treatments before and during your pregnancy. Most headache specialists prefer to treat pregnant women with non-medication treatments. Some medications may not be used by pregnant women.

Headache specialists may also use additional treatments such as nerve blocks (most often using lidocaine or bupivacaine) or sphenopalatine ganglion (SPG) blocks for which many newer devices are now on the market.

OnabotulinumtoxinA (Botox) therapy also is FDA-approved to prevent chronic migraine, if other preventive treatments don't work. Treatments must be injected by a health care professional and typically are given about once three months.

Non-medication Treatment

Drug therapy for migraine can be combined with biofeedback, cognitive behavioral therapy or relaxation training.

Biofeedback is a technique used to gain control over a function that is normally automatic (such as blood pressure or pulse rate). The goal is to change these automatic responses. Biofeedback uses electronic or electromechanical instruments to monitor, measure, process and feed back information about skin surface temperature, blood pressure, muscle tension, heart rate, brain waves and other physiologic functions.

You can practice biofeedback at home with a portable monitor. The ultimate goal of treatment is to wean you from the machine so you can use biofeedback methods anywhere at the first sign of a headache.

Relaxation training involves learning to counteract muscle tension by relaxing your mind and body through methods such as yoga, meditation, progressive relaxation and guided imagery. Relaxation techniques may be used alone or in combination with biofeedback.

In addition, the FDA approved a medical device that uses transcutaneous electrical nerve stimulation (TENS) to help prevent migraines. Research showed that the device reduces the number of migraines experienced per month and the amount of migraine medication required. The battery-powered device, Cefaly, attaches to an electrode placed on the forehead that applies electric current to the forehead to stimulate branches of a nerve that have been associated with migraines. The device is only for adults and requires a prescription; women who are pregnant or might become pregnant should discuss usage with their health care professionals.

Cognitive-Behavioral Therapy

This therapy helps you identify areas in your life and environment that may be triggering your headaches. People with migraine have the same sorts of stressors most people grapple with, but for migraine patients, that stress can trigger migraine episodes. Thus, stress management training helps you to recognize the thoughts, feelings and behaviors that bring on headaches and work to handle them without triggering a headache.

Dietary Treatment

Some migraine sufferers benefit from a treatment program that includes eliminating headache-provoking foods and beverages. That's why it is so important to keep a migraine diary to identify your unique triggers.

A diet that prevents low-blood sugar (hypoglycemia) may help some migraine sufferers. This condition can occur after a period without food: overnight, for example, or if you skip a meal. Those who wake up in the morning with a headache may be reacting to the low-blood sugar caused by the lack of food overnight.

Treatment for headaches caused by low-blood sugar consists of scheduling smaller, more frequent meals. A special diet designed to stabilize your body's sugar-regulating system may help. For the same reason, many specialists also recommend that migraine patients avoid oversleeping on weekends. Sleeping late can lower the body's normal blood sugar level and lead to a headache. Metformin may also be prescribed to help manage blood sugar levels.

Prevention

While appropriate medication and avoiding known or suspected migraine triggers can help extinguish migraine pain, other headache management strategies can also help, including:

• Adopting regular sleeping habits.
• Establishing regular meal times—avoid skipping or missing a meal.
• Taking vitamin B2 (to increase riboflavin in the diet) and supplements to increase magnesium levels
• Increasing exercise, which improves blood flow to the brain and boosts the production of endorphins, naturally occurring painkilling substances the body produces.
• Staying hydrated.

The key to managing migraine headaches is identifying the unique triggers that provoke your headaches and then minimizing or eliminating them. Common triggers include:

• Hormonal triggers. Women may have headaches around the time of their menstrual period, possibly related to the body's fluctuation of estrogen and progesterone. But there are no steadfast rules when it comes to hormonal triggers. Taking oral contraceptives and hormone replacement therapy and even pregnancy have been blamed for causing severe and frequent migraine attacks. But other women who suffer from migraine say these things improve their condition or make the attacks disappear altogether. Following menopause, when estrogen and other hormone levels decline, women who previously suffered from migraines may find their headaches subside significantly, if not completely. In some women, however, migraines come on or worsen during menopause as a result of fluctuating hormone levels.
  
  Some migraine sufferers have an acute sensitivity to a specific food or foods. Researchers are not certain why particular foods provoke migraine headaches.
  
  Tyramine, for example, a chemical produced as a result of the natural breakdown of the amino acid tyrosine, is a common migraine provoker. Tyramine levels increase in some foods when they are aged, fermented or stored for long periods of time. Red wine, aged cheeses and processed meats (like hot dogs and bologna) are good examples. Other common food-related triggers include: champagne, ripened cheeses (cheddar, Stilton, Brie, Camembert), nuts and nut spreads, sourdough bread, onions, lentils, snow peas, citrus fruits, bananas, sour cream, chocolate and MSG (the flavor enhancer found in soups, restaurant food, artificial sweeteners, frozen foods and potato chips). Additionally, if you're used to caffeinated beverages, foods or painkillers, withdrawal from these substances can trigger a headache, though not necessarily a migraine.
  
  In addition to some foods, a change in eating patterns can trigger headache, although not necessarily a migraine. Fasting, missing meals or dieting may also cause low-blood sugar levels, another possible migraine trigger.
• Environmental triggers. Altitude changes, excessive light and noise and changes in weather patterns (such as high winds and high humidity) are a few of the many environmental triggers of migraines. Airplane travel is one of the biggest triggers. Cabin pressurization can cause significant dehydration, which can trigger migraine, so it's important to stay well hydrated during air travel. Bright light, whether from television, a movie screen or the sun, may also provoke attacks. Excessive or repetitive noises can trigger migraine headaches, as well as strong odors (such as cigarette smoke). As with food triggers, you should carefully identify environmental triggers and avoid them when possible.
• Emotional triggers. Anticipation, excitement, stress, anxiety, anger and depression are known to trigger migraine attacks. Even "positive" excitement, such as a job promotion or a wedding, can provoke a migraine. An effective stress management system can help a migraine sufferer prevent or minimize headaches triggered by these factors and can contribute to a sense of overall good health.
• Activity triggers. Changes in lifestyle patterns can also bring on a migraine. Women have reported migraines resulting from too little sleep, too much sleep, overworking and physical overexertion. Vacation time, with its inherent rushing, excitement and altered daily schedule, can trigger a migraine. Sexual activity may also provoke migraine attacks. Other triggers include motion (such as plane, car, bike and carnival rides), head injuries and interaction with certain drugs, including over-the-counter pain relievers. Always consult your health care professional about medications.

Facts to Know

1. Migraine may start in childhood, but first attacks typically occur in adolescence or early adulthood. The headaches usually continue throughout adulthood, but may diminish with menopause. Some patients complain of migraine attacks throughout their lives. Each individual attack usually lasts from four to 72 hours.
2. An estimated 12 percent to 16 percent of Americans experience migraine headaches. Migraines cost billions per year due to absenteeism and lost productivity at work, as well as medical expenses.
3. Women experience migraines about three times as often as men.
4. Migraine is a biological disorder. Its symptoms result from changes in the brain. It may be triggered by a difference in the way you react to stress, as well as other factors.
5. In an estimated 25 percent to 30 percent percent of migraine cases, the headaches are preceded by visual, auditory or physical auras, bright spots or uneven, unstable lines moving before the eyes.
6. Many women fail to seek help for their migraines, perhaps figuring there are no effective treatments.
7. Certain factors are known to trigger migraines. These include menstrual and ovulatory cycles, certain foods, weather changes, inadequate rest, strong odors, bright or flashing lights and stress.
8. Migraines can strike as often as several times a week or as rarely as once every few years. Episodes can occur at any time.
9. Many migraine sufferers have a close relative who also suffers from the headaches.
10. People suffering from frequent, long-lasting, or disabling migraine headaches may want to consider preventive medication such as antidepressants, heart medication such as beta blockers and calcium channel blockers, and antiseizure medication. In people who suffer from migraines less frequently, drugs such as triptans can help treat acute attacks.

Questions to Ask

Review the following Questions to Ask about migraine so you're prepared to discuss this important health issue with your health care professional.

1. Do you frequently treat headaches?
2. What tests should I have to find out what's causing my headaches?
3. What drug treatments do you recommend for me?
4. What nondrug treatments do you recommend for me?
5. What are the potential side effects of the drugs you recommend? What is the risk of interactions with food or other drugs I'm taking?
6. Should I make any lifestyle changes that would help me manage my migraines?
7. How can I identify triggers that can set off my migraines, and what can I do to avoid them in the future?
8. How long will it take for me to see results from this treatment plan?
9. If this treatment doesn't seem to be helping, will you help me find something else?
10. What can I do to reduce the pain of a migraine after it starts?
11. Are you sure that I have migraines and not another medical condition linked to headache?

Key Q&A

Organizations and Support

For information and support on coping with Migraines, please see the recommended organizations, books and Spanish-language resources listed below.

American Migraine Foundation
Website: https://americanmigrainefoundation.org/
Address: 19 Mantua Rd.
Mt. Royal, NJ 08061
Phone:856-423-0043
Email: amf@talley.com

American Pain Society
Website: https://americanpainsociety.org/
Address: 8735 W. Higgins Road, Suite 300
Chicago, IL 60631
Email: info@americanpainsociety.org

National Headache Foundation
Website: http://www.headaches.org
Address: 820 N. Orleans, Suite 217
Chicago, IL 60610
Hotline: 1-888-NHF-5552 (1-888-643-5552)
Email: info@headaches.org

National Institute of Neurological Disorders and Stroke
Website: https://www.ninds.nih.gov
Address: NIH Neurological Institute
P.O. Box 5801
Bethesda, MD 20824
Hotline: 1-800-352-9424
Phone: 301-496-5751

Books

Life Beyond Headaches - The Ultimate Weapon for Correcting the Real Cause of Headaches Forever!
by Jeffry Finnigan

Migraine - 50 Essential Things to Do
by Charlotte Libov

No More Headaches No More Migraines - A Proven Approach to Preventing Headaches and Migraines
by Zuzana Bic

Spanish-language resources

Medline Plus: Migraine
Website: https://www.nlm.nih.gov/medlineplus/spanish/migraine.html
Address: Customer Service
8600 Rockville Pike
Bethesda, MD 20894
Email: custserv@nlm.nih.gov