Migraine headache is one of the most common medical conditions in the United States — and also one of the most commonly misdiagnosed.
Despite the belief that migraines are rare, statistics estimate that migraine headache affects about 20% of the population. Moreover, because migraines are often missed by physicians or not reported by patients, the actual number is likely much higher.
“Migraine is a common and treatable condition and patients are not alone, although they may feel that way,” says Emily Rubenstein Engel, MD, a Scripps Clinic neurologist specializing in headache medicine, and codirector of the Dalessio Headache Center at Scripps Clinic. “Migraine is the most common cause of recurring severe headaches that bring patients to their doctor.”
While advances are being made to bring relief to people who have migraines, the condition still remains misunderstood. Here are five facts about migraine that might surprise you:
The goal is to treat migraine symptoms right away, and to prevent symptoms by avoiding or changing triggers.
Over-the-counter pain medicines, such as acetaminophen, ibuprofen or aspirin, are often helpful when a migraine is mild. If these treatments do not help or the migraines are frequent, a physician may prescribe medication.
In 2018, the Food and Drug Administration (FDA) approved a new drug, called Aimovig, for the preventive treatment of migraines. Given by monthly injection, Aimovig works by blocking the activity of a molecule that is involved in migraine attacks.
Botox injections are another FDA-approved alternative for chronic migraine prevention. Patients receive 31 injections in specified sites every three months. These preventive approaches work by blocking the release of inflammatory pain chemicals which lead to migraine.
Although sinusitis, or inflammation of the sinuses, is a common diagnosis, it typically doesn’t cause a headache. An actual sinus headache is extremely unusual, and most headaches in the sinus region are really migraines that affect the nerves in that area.
Tension headaches are more common, but are generally not painful enough to need medical attention. In other words, if your headache is bad enough that you need to call the doctor, it is probably a migraine.
You often hear that migraine headache is accompanied by visual disturbances, such as flashing lights or blurry vision, but these auras actually are rare, affecting only about 10% of people with migraine. Similarly, only about 15% of patients vomit. Nausea, however, is a common migraine symptom, as is sensitivity to light and dizziness.
Additionally, not all migraine headaches are one-sided or pulsating. A headache that affects the whole head or feels like a tight band may be a migraine if there are other symptoms, such as nausea and light sensitivity.
Chocolate, cheese, citrus, dairy and other foods have long been blamed for triggering migraine headaches, but they may not be to blame.
“Food triggers, for the most part, are not supported by evidence and in fact some, such as chocolate, have actually been disproven,” says Dr. Engel. “So many patients have been given limited diets to avoid migraine triggers, but they haven’t been told not to go hungry — and ironically, hunger itself is one of the major triggers of migraine.”
Dr. Engel adds that hormones are another significant trigger.
“Hormones are under-recognized and under-addressed, especially among women in perimenopause,” she says. “These patients with migraine often get unusual symptoms, such as dizziness that they didn’t used to have.”
Migraine headaches are divided into two classes: episodic and chronic. Chronic migraine occurs more than 15 days a month; episodic is less frequent.
Because chronic migraine patients have headaches so often, they start to believe it is normal to have some type of headache almost every day. Many take over-the-counter pain relievers daily instead of seeking medical help, so their condition often goes undiagnosed. Also, non-prescription pain relievers aren’t meant to be taken on a regular basis, and doing so can lead to other health problems, such as stroke.
If you have frequent headaches, don’t try to treat them on your own. Talk to your doctor or seek out a headache specialist if your headaches:
- Become more frequent
- Are severe or debilitating
- Interfere with your job or home life
- Do not improve with over-the-counter medicine
- Get worse when you cough or move
“It’s important to know that if you have migraine headaches, you’re not alone and it is treatable,” says Dr. Engel. “Help is out there.”
This content appeared in San Diego Health, a publication in partnership between Scripps and San Diego Magazine that celebrates the healthy spirit of San Diego.