Migraine headaches

Originally Published: January 27, 1995 - Last Updated / Reviewed On: August 1, 2008
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My wife has terrible migraine headaches. She has tried caffeine, vitamins, and Motrin. Motrin works occasionally. Any suggestions?

—Low tolerance

Dear Low tolerance,

There are three major types of headaches: tension (most common), vascular, and organic (rarest of the three and associated with an underlying medical condition, such as a tumor, infection, disease, or hemorrhage). Migraines fall under the vascular headache category, being caused by constriction and then dilation of blood vessels in the head. Migraines are severe headaches, lasting from several minutes to several days, often accompanied by light and noise sensitivity, nausea, possible vomiting, and sometimes disturbances of vision (known as auras, which include flashing lights and blind spots). According to the Journal of the American Medical Association (JAMA) Migraine Information Center, migraines affect approximately twenty-six million Americans, nearly 75 percent of whom are women. Occasionally, people experience only a single migraine; more typically, however, they have recurrent episodes at varying intervals.

Migraines seem to run in families. It is believed that migraines can be caused by biochemical changes in the brain, particularly a low level of the neurotransmitter serotonin. People with migraines do not have enough serotonin to quiet the body's response to various triggers, such as:

  • certain foods
  • strong smells
  • excessive hunger
  • changes in altitude, weather, or temperature
  • bright lights
  • rising or dropping stress levels
  • sleep difficulties
  • depression
  • extreme noise
  • in some women, hormonal fluctuations, particularly estrogen, that accompany menstruation, birth control pills, pregnancy, and estrogen replacement therapy

Migraines come in two types: common and classic. In common migraines, which affect about 80 percent of people with migraines, the pain of the headache develops slowly, sometimes mounting to a throbbing pain that is made worse by the slightest movement or noise. The pain is often, but not always, on one side of the head, and usually occurs with nausea and sometimes vomiting (many recover after they have vomited). The difference between common and classic migraines is the classic variety are accompanied by auras. Most people find that they recover more quickly from a migraine if they can sleep in a darkened, quiet room and use an ice pack.

The best-known way to prevent migraine headaches is to avoid any known triggers. Triggers can be different for different individuals, however individuals can often identify the triggers that affect them. Keeping a careful diary can help pinpoint triggers, including certain foods or ingredients, such as:

  • alcoholic beverages (often those containing sulfites, such as red wine)
  • aged cheeses (because they have tyramine)
  • chocolate
  • citrus fruits
  • fermented products
  • monosodium glutamate (MSG)
  • preserved meats (due to nitrates and nitrites)
  • possibly aspartame

These foods may need to be limited or cut out of the eating plan as they have been implicated in setting off migraines in many people. Managing stress levels, treating any underlying depression, quitting smoking (if already a smoker), limiting salt and caffeine intake, and following regular eating, exercise, and sleep schedules can also help. Not having enough sleep or oversleeping is a common cause of migraines. Try getting up at the same time each day. If it's the weekend, regardless of bedtime, arise at the usual time anyway, have something to eat, wash up, and then go back to bed or take a nap later on in the day. Relaxation, physical therapy, and massage can help the migraine-affected as well.

If making lifestyle changes is not enough in managing migraine episodes, then the person may need to see a health care provider to discuss more powerful treatment options, including trying different medications or alternating between two or more meds depending on the type of migraine s/he has. Follow directions carefully and avoid overmedicating and overusing  pain relievers (i.e. chronic or daily use), which could lead to rebound headaches as the last dose leaves the system.

Much progress has been made recently in the field of migraine therapy. Powerful new drug offerings have made a dramatic difference in improving the quality of life of many people who have acute or chronic migraines. One such medication group is the triptans (e.g., sumatriptan, naratriptan, rizatriptan, and zolmitriptan), which are available in several forms and doses. Depending on a person's medical history and what drugs and supplements s/he is currently taking, a health care provider will determine which medications may work best.

Considering there are more migraine treatment options than ever before, your wife could benefit from seeing a health care provider to get a proper diagnosis and to discuss her prescription possibilities. She can work with her provider in coming up with a migraine management plan that'll meet her needs and be effective for her. If she is a student at Columbia, she can make an appointment by calling x4-2284 or logging on to Open Communicator.

For more information about migraines, check out:

National Headache Foundation

American Council for Headache Education (ACHE)

Best of luck as you and your wife explore the sources of her migraines. Hopefully she'll find some lasting relief soon.