Migraine headaches ( a primary headache syndrome) are a common ailment affecting men and women. They affect almost 10% of the population. Typical migraines are usually throbbing headaches affecting one side associated with sensitivity to light, noise, and may even be accompanied by nausea and vomiting. Unlike common migraines, the classic migraines are associated with auras of flashing lights, dots, sparkles or colored spectra and vision changes. Complicated migraines can also present with neurological symptoms of weakness, tingling, confusion and dizziness. They usually can last hours to days. Most migraines are worse with movement.


Though most headaches are migraines, headaches can be from a variety of causes. It is important to see a physician if you are having frequent headaches that are getting worse to assess any of the other reasons.


Worrisome symptoms with headaches for which immediate medical evaluation is suggested:


Headaches with fever, confusion or seizures, neck stiffness, may be due to brain infections (encephalitis) or brain covering infection (meningitis)


Sudden neurological symptoms – weakness, tingling or numbness, vision loss, speech problems may be due to strokes from bleeding inside the brain (intracranial hemorrhage) or lack of blood supply (ischemic stroke).


Gradually progressive neurological symptoms, weakness, tingling, vision loss, speech changes, etc- brain tumors, venous clots inside the brain.


Sinus headaches, glaucoma or eye strain related headaches.


The above headaches are secondary headaches. Several primary headache syndromes distinct from migraines also exist including:


Cluster headaches: Daily short lasting <1hr headaches with one sided ice pick jabbing headaches associated with nasal stuffiness and tearing occurring in 2-4 week clusters few times per year.


Exertional headaches with exercise or intercourse


Occipital neuralgia with neck discomfort and retro-orbital headaches due to whiplash injury, concussions.


Postural headaches with headaches on sitting or standing and disappearing on lying down due to spontaneous spinal fluid leaks or post spinal tap or epidural procedures.


Treatment of Migraines:


Talk to your primary physician. (click here for family medicine/ internal medicine physicians in your area)


Neurology consultation is helpful. (click here for neurologists in your area).


Consider imaging either Cat Scan (computed tomography or CT brain) or MRI (Magnetic Resonance Imaging) brain imaging.  (click here to find out imaging facilities/ imaging costs in your area). Blood tests ( Lyme titers, Sedimentation rate in older patients, etc) (click for lab facilities and costs of testing).  Rarely spinal tap or lumbar puncture is needed for excluding brain infection if fever or confusion exists.


Observe the tips listed below


Your physician can prescribe the following medications based on individual needs:


For migraine attacks multiple medications are available including OTC medications – ibuprofen or Tylenol, Excedrin, sumatriptan ( imitrex) tablets, sprays or injections ( sumavel dose pro), rizatriptan (maxalt or maxalt MLT), eletriptan( relpax), frovatriptan, zolmitriptan ( zomig), Migranal, diclofenac (cambia), pain medications or steroids, etc. Antinausea medications such as promethazine ( phenergan tablets or suppositories), metoclopromide IV ( Reglan IV) are also helpful.


For migraine preventative therapy multiple medications exist that must be used daily or frequently including Nortriptyline ( Pamelor) , Amitriptyline ( Elavil), Topamax ( Topiramate), Inderal ( Propranolol), Verapamil (Calan), Valproic acid ( Depakote), Butterbur, Magnesium supplementation and even quarterly botulinum toxin ( Botox) injections. 


 Tips for migraine headaches:


Avoid caffeinated beverages, switch to decaffeinated products if possible. Use caffeine only during an attack.


Avoid sleep deprivation, fasting, dehydration, heat and temperature extremes.


Avoid light or sensory overload during a migraine attack if possible. Sleeping is usually helpful.


Consider butterbur a herbal root extract that is alkaloid pyrizolidine free and OTC twice a day if headaches occur more than weekly. ( Recently recommended by AAN - American Academy of Neurology in guidelines for migraine management)


Magnesium supplementation in vitamin tablets.


Watch out for food triggers including MSG, cheese, cured meats, wines, coke, chocolate, caffeine, and others that may cause your headaches.


Avoid regular or daily use of OTC medications such as Ibuprufen/ acetaminophen/ Excedrin/ triptans or other abortive medications due to the risk of rebound headaches. 


Talk to your physician for options for abortive therapy and prophylactic or preventative therapy if the headaches are frequent.