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Migraine Facts and Helpful Treatments

Military personnel receiving treatment for headaches Lt. Col. (Dr.) Chester Barton, 374th Ear Nose and Throat Clinic otolaryngologist, administers Botox shots to Master Sgt. Danira Estrada, 374th Logistics Readiness Squadron section chief at Yokota Air Base, Japan. Botox shots treat migraines by relaxing muscles that cause pain (Photo by: Airman 1st Class Elizabeth Baker, 374th Airlift Wing Public Affairs).

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Migraine headaches feel like an attack on your brain and body that can send you to lie in a dark room in total stillness to ward off symptoms.

What are migraines? "Migraine is a disabling neurological disease in which headaches are associated with neurological symptoms that may differ from individual to individual," said Navy Lt. Cmdr. (Dr.) Cristina Cruzcrespo, chief of Neurology at Womack Army Medical Center in Fort Bragg, North Carolina. "The exact cause is unknown, but it is believed that genetics and environment play a role. Migraine may also run in families," she explained.

If you've ever had a migraine, you may describe it as a heavy, throbbing, pounding, or pulsating pain that prohibits your usual activities, Cruzcrespo said. The migraine may start on one side of your head and move to the front or the back, she explained.

Some people experience prodrome symptoms that "occur before the migraine by several hours or days," Cruzcrespo said. "Typical symptoms are extreme tiredness, yawning, irritability, mood changes, neck discomfort, difficulty concentrating, and food cravings."

"Some people experience aura, which are warning signs occurring minutes before a headache," she said. "Typical aura includes vision changes - such as blurry vision, seeing flashes of light, blind spots, shapes or bright spots - tingling, numbness in the extremities, or difficulty speaking."

During a migraine, the headache, which can be moderate or severe, can worsen with physical activities, Cruzcrespo said. "You may feel nausea and/or experience vomiting, and you may experience sensitivity to light, noise and/or smells."

Migraine sufferers also can experience a "migraine hangover," she said. "The symptoms include fatigue, body aches, trouble concentrating, or dizziness."

Migraines can last from four hours to several days. Yet all migraines include all the phases. The symptoms vary from person to person, Cruzcrespo noted.

Some people just experience aura but not headache, or nausea and vomiting without headache, said Ann Scher, who holds a doctorate in epidemiology and serves as the director of Epidemiology and Statistics at the Uniformed Services University's Department of Preventive Medicine and Biostatistics, in Bethesda, Maryland.

Who Gets Migraines?

Scher said migraine starts about equally in prevalence in boys and girls, but by adulthood, about 18 percent of women get migraines versus 6 percent of men. That is a ratio of three-to-one. "There are theories as to why women continue to get more migraines than men, but no definitive answer," Scher said.

Twenty-five to 30 percent of migraine sufferers get aura, she noted.

There are 39 million American men, women, and children with migraines, which means 17 percent of the U.S. population will be diagnosed with migraines at some point during their lives. However, that number is an underestimate, Scher said, because not everyone gets a diagnosis of migraine.

Migraine ranks second among the world's causes of disability-adjusted life years (behind back pain) due to the number of migraines experienced over a lifetime and is the first-ranked disability among young women, according to a recently published 2019 "Global Burden of Disease" study from the World Health Organization.

Military personnel wearing a face mask receiving treatment for headaches
Air Force Col. Kirsten Aguilar, Joint Base Elmendorf-Richardson and 673d Air Base Wing commander, participates in a Cephaly treatment during a 673d Medical Operations Squadron immersion tour at JBER, Alaska. A Cephaly device uses electrical impulses that treat and prevent migraine headaches without the use of medication or its side effects (Photo by: Senior Airman Crystal Jenkins, Joint Base Elmendorf-Richardson Public Affairs).

Treatment & Triggers

Communication is key to helping to control migraines, said Michael Oshinsky, who holds a doctorate of neuroscience and serves as the program director for pain and migraine at the National Institute of Neurological Disorders and Stroke. "Make sure you communicate with your physician that you have migraines. Migraine is very manageable if you build a plan that works for the individual."

That plan may indicate the use of over-the-counter medications, prescription oral drugs, monthly infusions, or neuromodulation through devices aimed at nerves that trigger migraine symptoms. Field kits for active-duty service members should be tailored to the regimen of treatment and prevention of migraines that works for every individual. "It's got to be the right plan for the individual and should be figured out before they are deployed," Oshinsky said.

The number one trigger for migraine is stress, Oshinsky said, adding, another trigger is strong emotional experiences - be they happy or sad - because of the significant changes in neurotransmitters within the brain.

Oshinsky also said that certain behaviors trigger migraines but noted that some of these factors cannot be controlled during a deployment. All migraine patients should:

  • Keep well hydrated
  • Go to bed and rise at the same hours each day
  • Don't skip meals
  • Watch out for hormonal changes

Bright lights (sunlight, computer screens, or fluorescent lamps) also can be a trigger, Cruzcrespo said.

There are many oral drugs to prevent migraines that need to be taken daily. They include three different drug classes: anti-seizure medications, beta-blockers (blood pressure medications), and antidepressants (depression and/or anxiety medications), Cruzcrespo said.

"Abortive medications are prescribed to be taken at the onset of headaches or aura," she said. These agents include an ergotamine derivative, nonsteroidal anti-inflammatories such as ibuprofen, acetaminophen, "triptans," calcitonin gene-related peptide inhibitors called "gepants," and the immunologics, which are administered subcutaneously once a month or quarterly via an infusion in the provider's office.

Said Cruzcrespo: "Some procedures can be performed at the physician's office to prevent headaches or as adjunctive treatment." Botox injections for headache are performed quarterly for prevention. "Other procedures are performed more frequently, including peripheral nerve blocks, trigger point injections, and sphenopalatine ganglion block (SPG block)," she said.

There are also rescue medications (tranquilizers and sedatives) for a breakthrough migraine while on medication. Breakthrough migraines should be factored into your treatment plan, Oshinsky said.

Additionally, there are new treatments that use neuromodulation of various nerves to treat migraine, he said. These devices include single-pulse transcranial magnetic stimulation, external non-invasive vagus nerve stimulator, external trigeminal nerve stimulation, and an electrical stimulation arm patch that stimulates another nerve that can create migraine.

Other, nonmedical treatments may include yoga, mindfulness, and meditation, Scher said.

"It's important for anybody who's having headaches that interfere with their lives to see a doctor, preferably a neurologist or headache disorder specialist, because there are treatments for migraine that might be effective for that individual," she advised.

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