There is headache — and then there are those headaches that just make you want to crawl under the covers and do nothing. If you know what we're talking about, you've probably experienced a migraine.
More than 1 billion people migraine There is no cure for this condition in the world. Luckily, there are many ways you can manage and sometimes avoid migraines and headaches.
We listened to the story Dr. Robert FryerWe spoke to Jonathan Myers, MD, clinical professor of neurology at NYU Grossman School of Medicine, about the best ways to control headaches at home and when it's time to see a doctor.
Let's talk about the difference between a headache and a migraine.
Headaches are classified into two main types: primary headache disorders and secondary headache disorders.
A secondary headache disorder is when the headache is caused by some other process going on in your head. For example, if you have a headache due to a sinus infection, treating the sinus infection will make the headache go away.
The other category is primary headache disorders, where the headache itself is the illness. In these cases, medications are used to treat the headache directly.
The two most common types of primary headaches are tension headaches and migraines. Tension headaches are not seen often in neurology offices because patients usually just take Tylenol and it goes away. Any severe headache that requires evaluation and treatment is actually a migraine.
Are there certain groups of people who are more susceptible to migraines?
Migraines are extremely common: they affect 15 to 20 percent of the population, and about three-quarters of these people are women.
Before puberty, it's actually a little different. Boys and girls are affected about equally. In younger children, it's slightly more common in boys. But the female hormones that start happening at puberty definitely trigger migraines, so as we get older, it becomes more common in women than in men.
How can you tell the difference between a migraine and a headache?
A migraine is, by definition, a moderate to severe headache — one that makes it hard to do anything, or in its worst cases, stops you from doing anything at all, except lie down in a dark room with a blanket over your head.
But generally, it's a headache that makes it very difficult to get things done, makes it difficult to concentrate and work, and if you have a few episodes like this, you should definitely get it checked out, because there are some very simple things you can do to help alleviate the symptoms.
What are those simple things, and how can you address your migraine triggers?
There are four main triggers for migraines: hunger, dehydration, stress and lack of sleep, so I encourage people to eat regular meals, drink water throughout the day, stick to a good sleep schedule and find ways to manage stress.
The next step is that some people who have migraines have certain foods that trigger them. It's not very common, but for some people, red wine, for example, may be the culprit. For some people, drinking a glass of red wine can give them a migraine. Once you identify the food trigger, just eliminating that food can actually improve the headache quite a bit.
The best way to identify food triggers is to keep what's called a headache diary. When a headache hits, go back and write down the foods you ate about five hours before the headache started. Do this for a few headaches and you'll get a clear idea of whether you have any food triggers.
Like you said, some people might consider popping a few Tylenol pills, but if a headache or migraine is coming on, what other options do they have?
I know this as someone who has ignored migraines for about 30 years. Sometimes I took medicine, sometimes I ignored them and just put up with them. In general, it's best to take medicine.
Tylenol, or acetaminophen, is probably the safest, but may be less effective than other options for headaches. But if it works, keep using it.
Ibuprofen, also known as Motrin or Advil, is an anti-inflammatory drug, so it's usually second on my list of medications to try. Another option is a combination medication such as Excedrin-Mygrain, which is a combination of aspirin, an anti-inflammatory drug, and caffeine. Caffeine is a very powerful pain-relieving drug for migraines.
You can also take another anti-inflammatory drug like naproxen, which can be quite effective for some people.
And prescription medications are available, but only if you've tried other medications and they don't seem to work – I find it easier to have over-the-counter ones at home.
What treatments are there other than medication?
Botox is a new treatment that is very effective for a condition called chronic migraine. Most people suffer from episodic migraines, which are severe headaches that last for a few hours. After that, it can take a week or more before the next headache occurs.
Chronic migraines are surprisingly common, with 1% of the population suffering from them, and are defined as having at least eight migraines per month.
These patients could consider Botox injections, a series of 31 injections around the face, back of the neck and shoulders given every three months, which are incredibly effective in treating chronic migraines.
This interview has been edited for length and clarity.
Robert Fryer, MDis a Clinical Professor in the Department of Neurology at the New York University Grossman School of Medicine. He is board certified by the American Board of Psychiatry and Neurology and specializes in the treatment of migraines, headaches, nerve pain, and pediatric disorders.
