More than a headache gone bad, migraines, those excruciating headings whose symptoms include throbbing pain, pulsing sensations, nausea, vomiting and an extreme sensitivity to lights and sounds, are a neurological disease.
Migraines are caused by the activation of the trigeminovascular system, which then stimulates pain stimulating neurons causing the severe headaches associated with migraines says Sanjeev Maniar, MD, a board certified Clinical Neurophysiologist and Neurologist at Methodist Hospitals.
According to Maniar, there are two types of migraines—aura migraines whch come with such warning signs as photophobia or sensitivity to light, numbness and sleep difficulties and migraines without auras that start without any warning signs.
Ranked in the top 20 of the world's most disabling medical illnesses, according to the Migraine Research Council, more than 10% of the population including children suffers from migraine and nearly 1 in 4 U.S. households includes someone with migraine. For some, the pain is so intense, that they retreat to a dark and quiet room while waiting for the pain to subside.
But despite their prevalence, migraines aren’t easy to diagnose since some of their symptoms are similar to headaches including those caused by sinus infections.
Dr. Sreekant Cherukuri an otolaryngologist at Community Hospital in Munster, says that it isn’t unusual for people to confuse sinus headaches with migraines.
“Their symptoms, such as pain and pressure in the sinuses, nasal congestion, watery eyes, are similar,” he says, “because both occur with migraines and sinus infections.”.
Diagnosis can also be difficult because the symptoms can change from episode to episode.
“Migraines can be devastating in terms of how they impact people,” says Dr. Crystal Tuncay, an internal medicine physician with the Porter Physician Group. “Some of the more severe symptoms mimic strokes and can include temporary blindness and weakness on one side or the other of the body.”
The first step to treatment is an accurate diagnosis.
“When people come to my office, I ask if they, in addition to their sinus symptoms also have a moderate-to-severe headache, nausea and sensitivity to light,” says Cherukur noting that true sinus headaches are, usually occurring because of a sinus infection. Symptoms of sinus infections include fevers as well as thick nasal secretions which are yellow, green, or blood-tinged. Treating a sinus infection should make the sinus headache go away.
There are different theories of what causes migraine headaches says Tuncay.
“Sinus or tension headaches can overlap with migraines and with women hormonal cycles can impact migraines,” she says.
Studies show, reports the Migraine Research Council that more than 27 million adult women suffer from migraine in the United States which is three times more than adult men. Interesting, in childhood, boys are affected more than girls, but after adolescence the headaches increase more rapidly in girls than in boys.
“Foods with gluten or MSG, coffee and chocolate can be associated with migraine says Maniar who also recommends that those prone to migraines get eight hours of sleep and avoid skipping any meals.
Family history plays a big part as a large percentage of people experiencing migraines come from a family who have experience migraines. If one or both parents suffer from migraines that increases the odds you will too.
“People who have migraines usually start at a young age,” says Tuncay noting that is another way to determine whether a headache is a migraine. “If someone reports migraine like symptoms for the first time after age 55 we look for other causes and maybe do imagining and a normal neurological exam. Many headaches are usually caused by tension, poor posture and sinus.”
“Taking a history also is important in determining whether a person has migraines,” says Cherukuri.
There are more than 100 prescription medications available for treating migraines. According to Maniar, there are several kinds of medications for migraines. For those who have four or more a month, preventative medications like Depakote and Topamax can be effective. Abortive medications, like Imitrex, work well for those with less frequent headaches and can be taken with the onset of symptoms. For those with chronic migraines—15 or so a month—Maniar says that Botox has show to be a preventative.
Cherukuri says that many people start with over the counter medication. Prescription medications providing acute treatment can be taken at the onset of a migraine and for those with frequent attacks, preventive treatment includes drugs taken daily.
“Some people say acupuncture helps and there is some evidence that magnesium supplements might help,” says Tuncay. “Also exercise and good sleep hygiene are important. For those who take over the counter medications, one of the big problems is overuse.”
Tuncay also suggests that migraine patients keep a journal listing what you ate, what stresses you were under, activities you participated in, environmental changes and anything else that might help you pinpoint what causes your migraines.
Journaling can also help you beginning learning triggers—sensory warnings like flashes of light, blind spots or a tingling in arms or legs that precede a migraine.
Finding the right medication can help reduce the frequency and severity of migraine headaches though it may take some trial and error to find the right one. Meds are more effective with lifestyle changes such as good eating habits.
“Importantly, if you’re over 55 and the worse headache you ever had just came on, proceed to the Emergency Room,” says Tuncay. “Don’t put it off.”