Martha Stewart asks migraine experts to recommend the best ways to prevent or relieve headache pain, which afflicts about 30 percent of all women in their 30s.
You may attribute that splitting headache to any number of things — stress, hunger, thirst, sinus infection, PMS, even an out-of-date eyeglasses prescription. But new research suggests that what many people think is just a garden-variety headache is, in fact, a migraine. As it turns out, migraine, which many researchers believe is a genetic disorder, is much more common than most people realize, affecting more than 10 percent of women — with women suffering up to three times more often than men, according to the Migraine Research Foundation. As research improves our understanding of headaches, it also improves both drug and nondrug treatments.
Decoding your headache pain
Be aware that not every pain in your cranium is merely a headache: If profound pain comes on very abruptly — disrupting sleep, balance or mobility — you should seek immediate medical attention or go to the ER, says Dr. Denise Chou, an assistant professor of neurology at Columbia University Medical Center. You want to rule out a structural change that increases pressure in the brain, such as a tumor or aneurysm. Far more common, however, are episodic and persistent headaches. For these, consider seeing a neurologist who focuses entirely on treating them, or a general neurologist with up-to-date headache training — especially if at any point your headaches change in "quality, intensity or frequency," Chou says.
But what makes the pain a migraine? Well, a migraine is a form of primary headache - meaning there's no structural abnormality causing the pain — that's often accompanied by nausea, blurred vision, unusually hot or cold feelings, and a congested, stuffy nose. (That's why it's occasionally misdiagnosed as a sinus infection ... and patients don't get relief from taking antibiotics that were prescribed.)
Migraines frequently come in closely spaced attacks that occur once or more a day for several days in a row. For this reason, they're often misdiagnosed as "cluster headaches," but true cluster headaches are extremely rare and are characterized by intense, searing pain on one side of the face and head. Migraines, on the other hand, usually cause throbbing or pulsating pain around the temples and eyes, and sometimes all over.
The new view
Thanks to new studies, doctors now know that brains prone to migraines are wired in a way that makes them unusually sensitive to stimuli — noise, light, smells, physical touch, changes in sleep and hunger or thirst. When the brain is disrupted by such factors, neuroinflammatory peptides are released, causing pain.
"Migraine actually serves a purpose, which is telling you there may be something hostile in the environment," says Dr. Robert Cowan, a neurologist and director of the headache and facial-pain division at Stanford Hospital and Clinics. Some migraines result from dehydration, for example; others, from moving quickly to a higher altitude. "It's your brain telling you something's wrong," Cowan says. "What do people instinctively do when a migraine hits? Move to dark, quiet, safe places."
There's also recent evidence suggesting that proactively treating migraines is essential for long-term health - especially for women. These headaches afflict about 30 percent of all women in their 30s. "That's huge," says Dr. Christopher Gottschalk, a neurologist and director of the headache and facial-pain program at the Yale School of Medicine. "We don't talk often about conditions that impact one-third of a population, but there it is."
Migraines caused by fluctuating estrogen often subside after menopause — when hormonal levels stabilize. But many women's migraines continue unabated well into middle age. Without treatment, they often become more frequent and severe, with some startling risks and associations, including heart disease. Plus, a subset of women experiencing migraine with aura (fleeting visual or sensory symptoms preceding the headache) have a significantly increased lifetime risk of stroke — as high as that for women with diabetes, morbid obesity and hypertension — according to data released in 2013 by the long-running Women's Health Study.
Track your triggers
Fortunately, a variety of effective medications (including over-the-counter anti-inflammatories as well as prescription triptans) can abort migraines or abate their symptoms after they start. What's more, self-care and lifestyle steps — such as keeping a daily log of sleep, meal schedule and exercise to track possible correlations to headaches — can significantly reduce the frequency and magnitude of migraine attacks, Cowan says.
For years, the conventional wisdom cautioned migraine sufferers away from some perceived triggers like red wine, aged cheese and chocolate. Stress, too, was considered taboo - even though a 2013 Dutch study showed no direct link between migraine attacks and external stressors, such as work pressures. Yet according to Cowan — who suffers from migraines himself — it's increasingly clear that the pain is often caused by a combination of multiple factors, rather than a single problematic insult to the nervous system.
Of course, it's impossible to avoid every aspect of modern life known to set off migraines — the long list includes fluorescent lights, too much (or not enough!) caffeine, perfume and disrupted sleep. But as Cowan says, it helps to "pay attention to your life. For instance, I know that sometimes red wine will give me a headache, so if I've had a bad night's sleep, I'll probably skip wine with dinner. If I'm going to a loud rock concert tonight, I might want to take a preventive medication. The most important thing is not to live in denial about migraines," he says. "The people who do best are those who take the lifestyle modifications seriously."
Haven't got time for the pain?
With migraines, an ounce of prevention seems to be worth a lot more than a pound of cure.
Take a break from your computer. Dr.Robert Cowan, who treats many office workers with chronic migraines, suggests "setting a reminder on your computer to walk around every hour, get a drink of water." Eyes get a break from intense lighting, the body rehydrates, and neck and shoulder muscles, which are controlled by nerves that can trigger headaches, relax.
Stave off menstrual migraines. To prevent menstrual migraines, Dr. Denise Chou often tells her patients to consider the over-the-counter anti-inflammatory naproxen (often sold as Aleve), which appears to be the most effective. "I recommend taking it prophylactically, starting a day or two before your period starts, and continuing for up to a week."
Fight the urge to push through it. Too often, Dr. Christopher Gottschalk says, people try to fend off a headache with more movement. "But one of the characteristic features of migraine is that physical activity worsens the pain because your nerves become sensitized." His advice: "Take your medicine early. Don't wait till you're throwing up in the dark."
Waylay worrying and retrain your brain. Cognitive-behavioral therapy can help people reduce headaches by learning to quiet their own worried reaction to pain, which can make it worse. Cowan says you can learn to resist alarm signals. If you're bothered by bright sunlight, for example, it's possible "to retrain yourself to understand, Well, I won't get a headache if I wear sunglasses and a floppy hat, " he says.