Migraines: Causes, Prevention, and Treatment

You can feel it coming on.  Sometimes you’ll see auras or you’ll get sensitive to light before the pain hits, and you know you’re headed for a migraine headache.  In the US alone, migraines affect about 36 million people.  And while women are three times more likely to suffer from migraines than men, both sexes can experience these debilitating headaches.  Western Medicine offers some relief with prescription medication, but these treatments can have significant unwanted and uncomfortable side effects, such as nausea, vomiting, diarrhea, and fatigue.

Migraines are extremely debilitating and expensive in time lost from school and work as well as paying for the expensive drugs that may or may not help. Those who suffer from chronic migraines also face a lower quality of life and an inability to accomplish their goals due to the extreme pain and, in some cases, regular reoccurrence patterns.


Headache Types

Not all bad headaches are necessarily migraines. There are four main types of headaches: tension headaches, cluster headaches, hormone headaches, and migraines. Of course, there are also other types of headaches (those based on medication rebound, sinus headaches, and those caused by tumors or other serious ailments). However, these headaches are rare and most can be classified as one of the four main types.  The chart below details the most common symptoms of each type of headache:

Tension Headache Cluster Headache Hormone Headache Migraine
What Does It Feel Like? Tightening 'vice-like' pain encircling head; Pain is continuous, but not throbbing 'Jabbing' or 'pulling' pain around eye; Piercing, burning, pulsating pain Painful throbbing Dull ache develops into constant throbbing, pulsing pain.
Associated Symptoms: Anxiety or depression Blood shot eye and runny nose on affected side Nausea, vomiting, Sensitivity to bright lights and sound Nausea, sensitivity to light and noise, loss of sight possible
Affected Areas: Muscles between head and neck contract for hours or days Usually occurs on one side of the head Begins as a one-sided headache, but may progress to both sides Usually occurs on both sides of head
Other Notes: Usually occurs in the morning or late day, when stress levels should have dropped Sufferers unable to sit still because of pain, compelled to move or bang head against wall. Occurs in women only; PMS version accompanied with fear, panic attacks, impaired judgment or memory, sensitivity to rejection, and paranoia Usually lasts from four hours to a week, depending on severity and type


Causes, Triggers, and Symptoms

The actual causes of migraines are currently unknown. Although it was originally thought that migraines were the result of restriction and constriction in blood vessels in the head, doctors now believe that the predisposition to migraines is genetic. Other factors that can contribute to migraines are stress, food allergies or intolerances, a sudden drop in stress levels, lack of food or sleep, exposure to light, and, in women, hormonal imbalances. These triggers do not cause the migraines, but they are thought to activate the processes that lead to migraines.

Many doctors focus on triggers that are specific to each patient.  In order to tailor treatment to each individual, it is necessary to find out which triggers are affecting the patient.  Therefore, a headache diary may be useful.  Patients can keep track of anything that triggers a migraine, including diet, odors, sleep patterns, stress, food, weather changes, etc.  It may also be useful to track when migraines occur, since many are hormonal and occur at certain times every month when hormone levels fluctuate.  The diary could easily be used to tract the frequency and intensity of the migraines, as well.  By studying what triggers are causing headaches, the patient can take steps to either desensitize themselves or simply avoid the triggers.  Depending on the circumstances surrounding each trigger, the patient and doctor can decide whether desensitization or avoidance is the best course of action.

The most overwhelming symptom with migraines is the pain affecting both sides of the head.  In most people, it beings as a dull ache, which can worsen into constant, throbbing agony.  Migraines also have a host of other symptoms that go along with the pain.  Many people report seeing auras, having blurred vision, or losing their sight completely.  Nausea, vomiting, and sensitivity to light and sound are all common symptoms for migraine sufferers. 


Prevention and Treatment

Since migraines are so incredibly painful, prevention seems like a worthy goal, rather than dealing with acute symptoms during every episode. However, most prevention plans are not terribly effective and can involve a lot of lifestyle changes that may be hard to keep up.  Most people who suffer from migraines eventually give up on the treatment plans and just treat the pain when it flares up.  Drugs and medical treatment for migraines can be extremely expensive and do not always alleviate the symptoms. Also, the side effects of these drugs can be severe. Doctors are still searching for effective ways to prevent and treat migraines from occurring, but there is no 'final answer' to this question.

Even though Western medicine has yet to develop a final answer, there have been many promising studies into alternative treatments that may prove effective.  For example, in 2009, a group of scientists reviewed 22 studies in which acupuncture was used to treat migraine pain.  The scientists concluded that acupuncture was at least as effective as conventional migraine treatments, such as oral pain medications. 

“Sham acupuncture” is a term that comes up a lot when researching scientific studies about acupuncture.  Traditional acupuncturists adhere to the concept that life energy (“Qi”) flows throughout the body via pathways called meridians.  When the meridians become blocked, the Qi doesn’t flow and symptoms occur.  To ensure that the Qi is flowing freely throughout the body, the acupuncturist inserts tiny needles into specific places on the body, called “acupuncture points.”  With sham acupuncture, needles are placed in specific spots on the body, but not in any known acupuncture point.  During a clinical trial, scientists will use both sham and traditional acupuncture techniques to ensure that their results are accurate.  Testing both types of acupuncture is similar to when scientists run trials on new drugs.  Placebos are usually giving to some study participants while others receive the actual drug being tested.  The use of a placebo allows the scientists to ensure that the drug being tested is actually working, and patients are not seeing results due to other factors.

While the 2009 review of studies cited above did find that acupuncture was as effective as conventional treatments for migraines, it also found no significant difference between the results of patients who received sham acupuncture and those who received traditional acupuncture.  This raised the question of whether people suffering from migraines in the study had decreased pain because of acupuncture or if they responded to the attention, human touch, and care they received while getting the acupuncture treatments.  Because pain is subjective, feeling cared for may, in fact, have a beneficial impact on someone suffering from a migraine.  It is also interesting to note that patients receiving sham acupuncture reported better pain reduction than patients who received oral placebos (rather than oral pain medication).  Clearly, there is something in sham acupuncture that is having a pain relieving effect on migraine sufferers, although it is unclear just what is happening.

While the 2009 review of studies found no significant difference between sham and traditional acupuncture in pain reduction, there have been studies conducted since that have gotten different results. In particular, a study in 2015 compared traditional and sham acupuncture over 20 weeks of treatment.  Patients who received traditional acupuncture not only reported less severe headaches, but also reported significantly fewer headache days.  In other words, people who received acupuncture had fewer headaches, and those headaches they did have were not as painful.  In general, to effectively treat migraines, doctors suggest acupuncture 10 times a week in 20-minute treatment sessions, or two times a week for hour-long sessions.

If human touch and care can help relieve migraine pain, then massage may be the perfect remedy.  Not only does massage have a relaxing effect on the body, it can also help ease muscle pain and tension caused by the physical reaction to having a migraine. Trigger-point therapy can help release tight muscles in the shoulders, neck, and upper back, leading to a release of tension-points triggered during a migraine.  If the patient’s triggers include muscle tension in the neck and shoulders, massage could be particularly helpful.  For relief of migraines, massage is recommended once or twice a week for a four- to six-week period.

Doctors also recommend that chronic migraine sufferers prevent an attack by setting aside time for relaxation. Meditation, involving quiet thought and deep, restful breathing, is recommended to achieve the relaxation required. It has been discovered that patients who meditate tend to use less oral pain medications than migraine sufferers who do not meditate.  Since oral pain medications tend to have unwanted side effects, replacing them with meditation could be a viable option for some people.
Finally, experts agree that getting plenty of exercise is beneficial for combating migraines.  Not only is regular exercise as effective as conventional drug therapies in reducing migraine pain, it has been shown to reduce the frequency of migraine attacks.  It also has very few negative side effects.

By using the therapies detailed above, migraine sufferers have an arsenal of tools available to combat their migraines.  Several promising studies have shown that acupuncture can relieve migraine pain at least as well as oral pain medications, without the side effects.  The healing touch of massage can also help to alleviate symptoms and reduce the stress and tension that go along with migraines.  Finally, meditation and exercise can have dramatic effects on the amount of pain medication migraine sufferers take during flare ups.  Together, these therapies can be used to create treatment plans that not only help prevent migraines before they start, but also are easy to maintain.
 
 
Resources

Armstrong L, and Gossard G.  “Taking an Integrative Approach to Migraine Headaches.”    The Journal of Family Practice.  Vol. 65, No. 3.  March 2016.  P. 165-176.
 
Göksel, Ka┼čak Karakurum.  “The Use of Complementary and Alternative Medicine in Patients with Migraine.”  Archives of Neuropsychiatry.  Sept. 2013.  Supplement.  P. 41-46.
 
Six-Means, Amy.  “Migraines and CAM.”  Journal of Consumer Health on the Internet.  2013.  Volume 14, Issue 4.  P. 432-438.
 
Wang S, and Young W.  “Needling the Pain and Comforting the Brain:  Acupuncture in the Treatment of Chronic Migraine.”  Cephalalgia.  Volume 31, Issue 15.  P. 1507-1509.