What Really Causes Migraines — And How to Treat Them

June is Migraine and Headache Awareness Month. Here’s what you need to know

Got a headache? You’re not alone. According to the National Headache Foundation, 47 percent of all adults in the U.S. experience headaches annually. But headaches in general, and migraine — the most ferocious type of headache — in particular are poorly recognized and inadequately treated, the NHF says. So now that you’ve gone red for heart disease in April, the NHF wants you to go purple for Migraine and Headache Awareness this June.

More than three million Americans miss work or school, are not able to perform daily chores, or cannot attend family or social activities because of chronic migraine, the NHF says. Women are three times more likely to experience migraine than men.

Migraines cause intense pulsing or throbbing pain in one area of the head. They often come in multiple attacks (at least five that last four to 72 hours, by one definition), and include additional symptoms such as nausea and/or vomiting, or sensitivity to both light and sound. About one-fifth of all migraine sufferers can predict the onset of a migraine because it is preceded by an “aura” of flashing lights, zigzag lines, or a temporary loss of vision.

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dr. Uri Napchan
Dr. Uri Napchan of Middletown Medical’s Headache Center

There are many possible triggers of migraine — stress, anxiety, hormonal changes during the menstrual cycle, and diet — but no known cure, says Dr. Uri Napchan, medical director of Middletown Medical’s Headache Center. But there are medications for preventing and treating migraine. “One thing I use is Botox — Botulinum toxin A,” Dr. Napchan says, noting that it has been shown to be effective in prevention of chronic migraine. Other medications, originally developed for epilepsy, depression, or high blood pressure, can be extremely effective in treating migraine. Behavioral changes in diet, sleep, and weight, along with stress-management strategies, such as exercise, relaxation techniques, biofeedback mechanisms, and others, also may reduce the number and severity of migraine attacks.

In 2014, an external nerve-stimulation device, called Cefaly, earned FDA approval. It’s a headband with battery-powered electrodes that stimulate branches of the trigeminal nerve, which has been associated with migraine. “This is a promising non-medical approach that can decrease the severity of headaches,” Dr. Napchan says. And supplements like magnesium, coenzyme Q10, vitamin B12, riboflavin, feverfew, and butterbur may help, too. “I also find that acupuncture, melatonin, and homeopathic medicines with capsaicin are effective for some patients,” he says. “Every patient is different, so it’s usually not just one solution. Usually we try a multitude of options.”

In the near future, scientists should have a better understanding of the genetic causes of migraine. In 2010, a team of researchers found a common mutation in the gene that controls an important potassium ion channel; these channels keep nerve cells at rest, and mutations lead to overactive and overly pain-sensitive cells. And a drug to regulate a protein called CGRP, which has been found in excess in migraine sufferers, is “in the pipeline,” Dr. Napchan says. “That’s not approved yet, but it looks promising.”

In the meantime, support your fellow headache sufferers and Go Purple this month. Learn more at the NHF Web site, www.headaches.org.

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