woman laying down suffering from migraine

Understanding and Managing Migraines 

September 13, 2023
Meitel Ben-Dov

Meitel Ben-Dov, MD, Assistant Professor of Neuro-Ophthalmology (in Ophthalmology) at CUIMC

Picture this: a head-splitting pain, a world that's suddenly too bright and too loud, and a stomach that threatens a mutiny. That's a migraine.

Migraines aren't just headaches; they're powerhouses of pain that millions of people grapple with worldwide. To better understand migraines, we sat down with Meital Ben-Dov, MD, Assistant Professor of Neuro-Ophthalmology (in Ophthalmology) at Columbia University Irving Medical Center. She helps us understand the signals, unveils the culprits, and provides tips to help keep you sane while managing these debilitating conditions. Welcome to your migraine survival guide.

Recognizing Migraine Symptoms 

Migraines advance through four stages (not always all): mood shifts, auras (visual/neurological symptoms), diverse headache intensity, light/sound sensitivity, nausea, and fatigue. Spotting these stages enables diagnosis and treatment and may prevent the burden of daily activities interruption. 

Possible Triggers 

Genetic factors and imbalances in brain chemicals, particularly serotonin, alongside an array of triggers that might surprise you—such as specific foods (like aged cheeses, processed meats, chocolate, caffeine, alcohol, MSG, artificial sweeteners, smoked foods, citrus fruits, bananas, and avocados), hormonal fluctuations, stress, and sensory stimuli—can all contribute to the onset of migraines. Furthermore, weather fluctuations and medication usage have also been identified as potential factors. 

Treatment Options to Help Manage Migraines

Addressing migraines involves three crucial steps: 

  1. Lifestyle Adjustments: Incorporate stress management, ensure sufficient sleep (which may include addressing snoring or obstructive sleep apnea), avoid night shifts or work during nighttime, and consider dietary modifications to avoid certain trigger foods. 
  2. Acute-Phase Medications:  Treating migraines early leads to better results. For mild migraines, over-the-counter NSAIDs or acetaminophen can provide relief. When attacks include vomiting/nausea, antiemetic medication (such as metoclopramide or prochlorperazine), usually combined (but also sometimes used alone) with non-oral migraine medication, should be employed. More severe cases might require prescription options, including: 

    Triptans: They constrict blood vessels and block pain pathways in the brainstem. They work better when combined with NSAIDs than when used alone. 
    Ergotamine Medications: Some are combined with caffeine; they constrict blood vessels and help treat pain. 
    Oral CGRP Antagonists: These medicines regulate a substance called CGRP, which seems to affect how migraine pain is transmitted in the head. We use these when the patient does not respond sufficiently to triptans or when there are contraindications, such as in the case of a patient with cardiovascular disease. 
  3. Preventive Treatment: When migraines occur at least four times per month, last for at least 12 hours, and lead to significant problems in daily life or lower your overall well-being, we typically look towards prevention. Options for prevention include Beta-blockers, antidepressants, antiepileptic drugs, and CGRP antagonists(injections/oral), which can provide relief.

It's essential to consult your neurologist, who can tailor treatment to your medical history. Some options include combining treatments, such as using beta-blockers for hypertension and migraines.

Beyond medication, keeping a detailed diary noting symptoms, sleep changes, menstrual cycles, ovulation, and food consumption can be invaluable. One patient in our clinic, plagued by years of migraines, started a diary. He discovered a hidden pattern among its pages—the snack he enjoyed on tough days was the trigger. Bid farewell to the snack, and the migraines bid farewell too. A simple diary became his compass to relief, proving that answers often lie in life's little details. 

Implementing healthy sleep patterns, adhering to regular meal schedules, engaging in consistent aerobic exercises, and effectively managing factors that trigger migraines are also critical strategic tools.

What Not to Do for Your Migraines

It's important to exercise caution and moderation when using acute headache treatments such as analgesics, triptans, and ergots. Overreliance on these medications can lead to complications. Additionally, you should avoid using opioids and barbiturates. These substances not only increase the risk of developing chronic daily headaches but may also impede the efficacy of other preventive therapies. This cautious approach ensures the best possible outcomes for migraine management. 

Remember, migraines vary significantly from person to person. Seeking medical guidance ensures precise diagnosis and individualized management, enhancing overall well-being and quality.