Pain Relief for Migraine Headaches
Headaches, depending on the cause, can range in severity from being a mild sensation of discomfort to acute pain. They are very common, with about 4% of the world’s adult population experiencing headaches 15 days or more in a month. For mild headache pain, relaxation techniques, some caffeine, adequate rest and/or basic over-the-counter medicines may be used to reduce or eliminate discomfort. In some cases, pain symptoms from headaches can escalate into an acute or chronic condition such as migraine or cluster headaches. They can also be a symptom of a serious underlying condition.
Primary versus Secondary Headaches
Headaches vary in a number of ways, including intensity, location, frequency, and cause. They are classified into two main categories: Primary and Secondary. A primary headache is when the headache itself is the main problem. It is not a symptom of an underlying disease or condition. A secondary headache is caused by another condition that triggers pain-sensitive areas in the neck and head.
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While the pain from primary headaches can be disabling, the headaches are not dangerous, as they are not a symptom of a more serious condition. The brain cannot feel pain, so the pain associated with primary headache actually comes from inflammation in and around the neck and head, including nerves, blood vessels, and muscles.
There are several categories of primary headaches. Some of the most common types of primary headaches include:
- Cluster headache
- Migraine headache
- Tension headache
- Hypnic headache
At The PainSmith, we primarily treat patients suffering from cluster or migraine headaches, but do manage all types of headache pain.
A cluster headache is a type of headache which is relatively short-lived (compared with migraine) lasting usually between 20 minutes and two hours. It is always one-sided and is associated with symptoms such as a stuffy nose on one side, tearing, an enlarged pupil, or a droopy lid. The headaches tend to occur several to many times a day for a period of days to weeks, and then disappear for a variable amount of time, usually weeks to months.
A migraine is a type of headache that can cause severe “piercing”, “throbbing”, “pulsing”, or “stabbing” pain, typically concentrated on one side of the head. It may also cause nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can last for a few hours to days, and for many, the pain is so severe that it interferes with daily activities. About 12% of all Americans suffer from migraines, and women are about three times more likely than men to experience migraines.
What are the different types of migraines?
There are several types of migraines:
- Migraine with aura (complicated migraine): Around 15% to 20% of people with migraine headaches experience an aura (visual symptoms indicating a migraine is coming).
- Migraine without aura (common migraine): This type of migraine headache strikes without the warning an aura may provide.
- Migraine without head pain: “Silent migraine” or “acephalgic migraine,” includes the aura symptoms but not the headache that usually follows.
- Hemiplegic migraine: This type of migraine causes temporary paralysis (hemiplegia) or neurological or sensory changes on one side of the body. The onset of the headache may be associated with temporary numbness, extreme weakness on one side of the body, a tingling sensation, a loss of sensation and dizziness or vision changes. It may or not include head pain.
- Retinal migraine (ocular migraine): Temporary, partial or complete loss of vision in one of the eyes, along with a dull ache behind the eye that may spread to the rest of your head. The vision loss may only last a minute, or as long as months. Retinal migraines should be reported to a healthcare provider as it could be a sign of a more serious issue.
- Chronic migraine: A chronic migraine is when a migraine occurs at least 15 days per month. The symptoms and the severity of the pain may change frequently.
- Migraine with brainstem aura. This type of migraine causes vertigo, slurred speech, double vision or loss of balance before the headache. The pain may be centered in the back of the head. The symptoms usually occur suddenly and may also include the inability to speak properly, ringing in the ears and vomiting.
- Status migrainosus. This is a rare and severe type of migraine that can last longer than 72 hours. The headache pain and nausea can be severe. Certain medications, or medication withdrawal can cause this type of migraine.
Migraines can progress through four stages: prodrome, aura, attack and post-drome. Not everyone who has migraines goes through all stages.
One or two days before a migraine, there may be subtle changes in the body including:
- Mood changes
- Food cravings
- Neck stiffness
- Increased urination
- Fluid retention
For some people, an “aura” might occur before or during migraines. Auras are symptoms of the nervous system (usually visual) but can also include other disturbances. Symptoms may begin gradually, build up over several minutes and can last up to 60 minutes.
Examples of migraine auras include:
- Visual phenomena, such as seeing various shapes, bright spots or flashes of light
- Vision loss
- Pins and needles sensations in an arm or leg
- Weakness or numbness in the face or one side of the body
- Difficulty speaking
A migraine usually lasts from 4 to 72 hours if untreated. The frequency of migraines varies from person to person. Migraines might occur rarely or happen several times a month.
During a migraine, there may be:
- Pain, typically concentrated on one side of the head, on possibly on both sides
- Pain that throbs or pulses
- Sensitivity to light, sound, and sometimes smell and touch
- Nausea and vomiting
After a migraine attack, many people feel drained, confused and washed out for up to 24 hours. Some people report feeling elated. A sudden head movement may briefly bring on the pain again.
What causes migraines?
Although the causes of migraines aren’t fully understood, genetics and environmental factors do appear to play a role.
Changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway, might be involved. So might imbalances in brain chemicals — including serotonin, which helps regulate pain in your nervous system.
Researchers are studying the role of serotonin in migraines. Other neurotransmitters play a role in the pain of migraine, including calcitonin gene-related peptide (CGRP).
Migraines can be triggered by a number of factors including:
- Hormonal changes in women. Fluctuations in estrogen, such as before or during menstrual periods, pregnancy and menopause, seem to trigger headaches in many women.
- Hormonal medications, such as oral contraceptives, also can worsen migraines. Some women, however, find that their migraines occur less often when taking these medications.
- Other Medications. Vasodilators, such as nitroglycerin, can aggravate migraines.
- Foods. Aged cheeses and salty and processed foods might trigger migraines. Skipping meals can also be a trigger.
- Drinks. Especially alcohol, specifically wine, drinks with a high amount of caffeine, such as coffee or energy drinks.
- Stress. Stress at work or home can cause migraines.
- Sensory stimuli. Bright or flashing lights, and loud sounds can induce migraines. Strong smells — such as perfume, paint thinner, secondhand smoke and others — can trigger migraines in some people.
- Sleep changes. A lack of sleep or too much sleep can trigger migraines in some people.
- Physical factors. Intense physical exertion, including sexual activity, might provoke migraines.
- Weather changes. A change of weather or barometric pressure can bring on a migraine.
Several factors may increase the likelihood of having migraines, including:
- Family history. If you have a family member that suffers from migraines, then it is more likely that you will experience them too.
- Age. Migraines can start at any age, although they most commonly start to occur during adolescence. They tend to peak during your 30s, and gradually become less severe and less frequent as you age.
- Sex. Women are three times more likely than men to have migraines.
- Hormonal changes. For women who experience migraines, the headaches may begin just before or shortly after the onset of menstruation. They may also change during pregnancy or menopause. Migraines generally improve after menopause.
Who should I see about chronic migraine pain?
Often, headaches are triggered suddenly but also subside just as quickly. In some cases, simple over-the-counter medication, rest, and home remedies may be sufficient to address and reduce pain symptoms and discomfort.
Discuss symptoms with a primary care provider first. They can diagnose migraine headaches and discuss treatment options. A referral to a neurologist or pain medicine physician may be required.
Migraine and cluster headaches are chronic. They cannot be cured, but they can be managed. There are two main medication treatment approaches: abortive and preventive.
- Abortive medications are most effective when taken at the first sign of a migraine, while the pain is mild. By interrupting the headache process, abortive medications help eliminate or decrease migraine symptoms, including pain, nausea, light sensitivity, etc. Some abortive medications work by constricting blood vessels, relieving the throbbing pain.
- Preventive (prophylactic) medications may be prescribed for severe headaches occuring more than four times a month that significantly interfere with normal activities. Preventive medications can reduce the frequency and severity of the headaches. The medications are taken on a regular, daily basis to help prevent migraines.
However, taking painkillers too often can trigger serious medication-overuse headaches. Medication-overuse headaches occur when medications stop relieving pain and begin to actually cause headaches. More pain medication is then required, which continues the cycle.The highest risk seems to come from aspirin, acetaminophen and caffeine combinations (i.e. Excedrin). Overuse headaches may also occur if when taking aspirin or ibuprofen for more than 14 days a month, or triptans, sumatriptan (Imitrex, Tosymra) or rizatriptan (Maxalt, Maxalt-MLT) for more than nine days in a month.
If you are not responding to pain relieving medications, or if they are causing more headaches, you may want to consider alternative treatments. At The PainSmith, we have several different options to help manage your migraine pain.
Botulinum Toxin (Botox)
- The injectables used by aesthetic surgeons and dermatologists to minimize facial wrinkles, can also be used to treat migraines.
- Licensed medical professionals inject botulinum toxin around pain fibers that are involved in headaches. It enters the nerve endings around the injection and blocks the release of chemicals involved in pain transmission.
- The treatments are approved for select people age 18 and older who experience 15 or more migraine days per month.
- It may take four weeks or more after treatment before you see a reduction in the frequency of your migraines, and more than one set of injections may be needed.
- We offer a procedure called a nerve block to stop the pain of an acute migraine attack. This quick, outpatient procedure is used as an abortive treatment, which is one that is offered during a pain episode, when you are in need of immediate relief.
- Small amounts of numbing medicine such as lidocaine or bupivacaine are injected into the base of the skull to block pain signals from the nerves. Pain may be relieved within a few minutes, and the effects of the procedure can last weeks to months.
- A nerve block is a temporary treatment for severe pain. It may be recommended when other medications do not relieve symptoms or when other treatments are contraindicated.
- Nerve blocks are performed on an as-needed basis. Your doctor can determine whether this is an appropriate treatment for your symptoms.
- RFA provides migraine relief by means of direct intervention on nerve clusters believed to cause headaches.
- An RFA probe is inserted and uses radio waves to create an electric current, which in turn heats up the nerve endings and essentially incapacitate them.
- RFA is similar to nerve block applications; blocks are frequently applied to determine if a patient is a good candidate for RFA.
- RFA is a mid-term therapeutic solution for migraine patients whose headaches are thought to originate from their necks. The nerves are not permanently disabled; they tend to regenerate after a while.
- Three quarters of patients who undergo RFA report complete relief that lasts about a year.
Every patient is different and not all treatments will be successful in reducing or eliminating migraine pain. Dr. Smith will complete a comprehensive consultation with migraine patients to determine the best course of treatment.
Suffering from migraine headaches can make it impossible to go to work, school or enjoy other daily activities. Fortunately, there are some ways to manage and prevent migraines, keep them from ruling your life.