Q and A with Dr. Merle Diamond, president and managing director of Diamond Headache Clinic, and board member of the National Headache Foundation
What causes headache?
Headache is due to traction, pulling, or pressure on any pain-sensitive structure in the brain. We divide headaches into two different categories, including primary/benign (tension-type, migraine, cluster) and secondary (organically caused). Depending on the cause and symptoms, every type of headache falls into one of these two categories. A person can also experience more than one type of headache, such as migraine with tension-type headache.
What causes migraine?
Migraine disease is usually an inherited headache disorder caused by a hypersensitive nervous system that is sensitive to change. Migraine is believed to occur due to chemical reactions in the brain, starting with a dull ache that turns to a constant throbbing and pulsating pain in the head temples. In addition to pain, migraine can result in a combination of nausea, vomiting, and aura that proceeds the head pain of a migraine. Aura can include having trouble focusing, seeing flashes of light, tingling in the face or hands, and a change in the sense of smell, taste, or touch.
Dehydration, hunger, poor posture, and weather changes can also trigger migraine.
There are over 300 types of headache disorders and migraine is one of them! Some of the other more types include:
- Tension: These typically start in the neck or back of the head and creep forward. Most people have experienced a tension headache at some point in their life and it is the most common type of headache. Tension headache can be caused by poor posture, eye strain, stress, and hunger. These can be chronic or infrequent.
- Sinus: These are common when you are sick or suffer from allergies. The head pain felt during this type of headache is caused by inflammation in the sinus passage and the pain usually presents in the forehead, brow bone, cheeks, and behind the eyes and nose. Due to their throbbing nature, these are often confused with migraine.
- Cluster: A headache that’s sadly known as the suicide headache because of the relentless and frequent intense pain. These are caused by dilation in the blood vessels of the brain due to a release of serotonin and histamines. Physical exertion, bright lights, and altitude can be triggers as well as exposure to high levels of toxic chemicals.
- Menstrual: Only affecting women who are menstruating, this headache is caused by the sudden drop in estrogen. Many women experience a headache before the onset of their menstruation at some point in their life.
Headache disorders come in many forms and it’s very important to seek medical attention from a doctor or specialist if you’re head pain is frequent or brought on with no apparent cause. Migraine is severe, disabling, recurrent, and due to a hypersensitive nervous system. A migraine can occur with or without aura and the intense throbbing usually occurs on one side of the head, however, it can consume the whole head. It can be easy to dismiss migraine as “just another headache” which makes it very important to consult a doctor. Headache medicine is a specialty and people can use the National Headache Foundation’s locater tool to find a specialist near them.
What makes someone prone to develop migraine disease?
Migraine is usually inherited and more than 12% of the adult population in the United States experience migraine. Migraine is most common between the ages of 18 and 44, and it runs in families – about 90% of people who have migraine have a family history of the disease. Additionally, women are three times more likely to have migraine than men That said, anyone, can develop a migraine. Episodic migraine is categorized as 0-14 headache days per month and chronic migraine is 15 or more headache days per month. A migraine can be triggered by a variety of things such as emotional triggers (stress, depression, anxiety), physical causes (lack of sleep, poor posture, overexertion), and hunger. Chronic migraine is most likely to be caused by chemical imbalances and hormonal changes.
What are some of the ways you can relieve migraine pain?
Migraine is most effectively relieved with the help of a doctor and an individual treatment plan with various pain-management techniques. There are very specific medications that have been developed that can help once the migraine starts. Triptans have been on market since 1992 and work by shrinking blood vessels and alleviating symptoms of migraine including pain, nausea, and sensitivity to visual and audio cues. Triptans are unsafe for those at risk of heart disease. More recently available, gepants block pain transmissions of migraine in the brain instead of shrinking blood vessels. Non-prescription relief options include moving into a dark and quiet room, taking over-the-counter pain relief medications, or trying acupuncture, Botox, psychological intervention, physical and recreational therapy, never blocks, and massage therapy.
Is there anything you can do to lessen the risk of developing a migraine?
Patients with migraine tend to have a very sensitive nervous system which is irritated by change. Maintaining a regular sleep schedule, not skipping meals, and being well hydrated can all be helpful. Avoiding triggers such as tyramine-rich foods and weather changes helps. There are also preventative oral medications migraine patients can take with a prescription. If you think you have migraine disease or are concerned about your headache you can visit the National Headache Foundation’s provider finder to find a healthcare provider in your area.