Frequently Asked Questions

Frequently Asked Questions about Migraine

Not too sure about what migraines are? Just started having them?

Over the past decade of taking care of patients with migraine, I’ve found certain questions emerge time and again, particularly amongst folks who have just started having them for the first time. Some of these will crop up in our initial conversation, others will inevitably occur as soon as our visit is over. So to help ensure my patients aren’t left twisting in the wind, I’ve compiled a list of answers to the most frequently asked questions about migraines that I’ll share with you here.

Q: What are migraines?

A: Migraines are a temporary change in brain physiology that occurs in normal brains in response to certain triggers. These changes in brain physiology can result in multiple symptoms, the most notable of which is usually a headache. The headaches are often intense, though they may not always be so. Other symptoms may include sensitivity to bright lights or noise, nausea, vomiting, dizziness, visual disturbances, numbness, tingling, and even in some cases disruption of speech or movement.

Q: What’s causing them?

A: Migraines are primarily triggered by dietary, lifestyle, and hormonal factors. With rare exception, it is never any one thing that causes a migraine attack, but is rather the culmination of many different factors that “flip” the brain’s migraine switch. Identifying your own most powerful triggers is a critical step in taking control over your migraines, as the best way to treat them is to prevent them from coming in the first place. Because there are so many potential contributing factors, however, identifying your triggers can be challenging. To assist you with this, I’ve designed a “trigger tracker” worksheet that can assist you greatly in this process.

Q: Do I need an MRI of my brain?

A: MRIs are typically done in specific circumstances in which the cause of your headaches is somewhat uncertain, and your doctor feels it necessary to exclude other possible causes of headache. In most cases of migraines, however, MRIs are not necessary. It is extremely rare for headaches, particularly those with characteristics of migraine, to be caused by something abnormal in the brain (that could be seen on an MRI).

Q: But this pain is really bad. Doesn’t that mean that something is very wrong?

A: Migraines are often times very severe (in fact, the official diagnostic criteria for migraines requires that they be severe). For those experiencing them for the first time, the intensity of the pain can feel very scary. In this case, it feels like there must be something very wrong inside your head. Yet, the vast majority of severe headaches are from migraine, which as stated above isn’t associated with an abnormal pathology (like tumors, aneurysms, etc.) in the brain, but rather is the brain’s response to certain environmental and biological triggers.

In the case of migraine, the head pain is not the result of something wrong inside the head. Rather, it’s the result of the part of the brain that senses head pain being switched on by the migraine process. It’s like the fire alarm going off because someone pulled it, not because there’s a fire.

A: What should I do when I get one?

Q: It’s important to have an effective strategy for migraine relief, and be ready to employ that strategy whenever needed. Fortunately, medications to relieve a migraine attack have improved greatly over the past couple of decades, so there are many options. For some, over the counter remedies work well. For others, only prescription medications will work. Your ultimate goal, which is usually achievable, is to find a strategy (usually with the help of your doctor) that works to relieve the majority of your migraine headaches within 1 to 2 hours. Of course, this requires that you keep your medication with you at all times.

Q: How can I keep them from coming on?

A: Preventing migraines from occurring in the first place is the ultimate goal of migraine treatment. In some cases, prescription medications that your doctor can prescribe can help a bit, but the most powerful results come from changes in diet and lifestyle that only you can make.

Identifying your own most significant triggers is thus an important step in preventing migraines. This can be tricky to do, as there are so many possible factors that can influence your migraine risk. The trigger tracker worksheet can help you do this efficiently and effectively.

The single best lifestyle change you can make to prevent migraines is to return to the nutrient dense, low-toxin diet of our ancestors. In my personal and professional experience, no other migraine-prevention strategy even comes close. And not only will making this change dramatically reduce migraine frequency, it will also reduce your risk of developing a whole host of chronic illnesses, from Diabetes to Rheumatoid Arthritis.

Q: How do I know if it’s a sinus headaches?

A: Numerous studies have shown that almost all headaches that have been diagnosed as “sinus headaches” (either by patients or their doctors) are actually just misdiagnosed migraines. Migraines often cause pain in the front of the head, and in the area adjacent to the nose. When pain occurs in these regions, it is natural to assume that it’s coming from the sinuses. Most of the time, however, this is not the case. Furthermore, migraines themselves may cause sinus drainage and congestion.

It is true that infection and inflammation in the sinuses (aka “sinusitis”) can cause pressure and pain in the sinus regions. However, this condition is often associated with other signs of infection like fever and malaise, as well as colored nasal discharge.

Q: I’ve never had migraines before – is it unusual for them to start out of the blue?

A: Everyone is capable of experiencing a migraine, though how easily they’re triggered varies from one person to the next. Because of this fact, migraines can occur at any time in a person’s life. Usually this is because something new has occurred that has shifted the balance towards migraine (head injury, change in job or lifestyle, pregnancy, menopause, etc.), but at times there may be no clear explanation.

Q: My brain MRI is normal. How can that be?

A: Since migraines occur in structurally normal brains, we expect the brain to look normal on an MRI when the cause of a headache is migraine. Very rarely, headaches can be caused by abnormalities in the brain like tumors or aneurysms. If abnormalities like this are seen on an MRI scan, then the diagnosis is no longer migraine.

Q: My headaches are not always the same. How do I know if it’s a migraine?

A: Migraines come in many different shapes and sizes, and the character of migraine pain and the associated symptoms may vary a lot between one headache and the next. Some may be very intense, some may be mild. Some may be associated with exquisite sensitivity to bright lights and loud sounds, nausea and vomiting. Others may not. Some may hurt in the front, some may hurt in the back.

The truth is, most headaches folks experience are migraine headaches. Those who experience them in their most classic form (severe, one-sided headaches with nausea, vomiting, sensitivity to lights and sounds, etc.) are usually correctly diagnosed as migraines. Those who don’t often end up getting diagnosed (sometimes with self-diagnosis) with something else (sinus or tension headaches, usually).

Chances are, if you’re reading this FAQ, most every headache you experience is a migraine.

Q: Do migraines run in families?

A: While it is true that having a first degree relative with migraines will increase your risk of having them, it is not a necessary condition. As stated, migraines are the product of many different factors, and your personal genetics are only one. The DNA you inherit may render you more or less susceptible to migraines, but alone are not enough to cause or prevent them. Other factors are still necessary to trigger a migraine headache. Migraines can happen to anyone, regardless if there’s a history of other family members experiencing them.

Q: Is stress a factor?

A: Yes, indeed. Our body’s stress response – which involves, among other things, a massive surge in adrenaline – evolved to help us in times of mortal danger. When this occurs in response to something that threatens our survival, that response is beneficial. When it occurs day in and day out in response to imagined threats (excessive worry and anxiety, etc.), however, it causes us harm. One of the ways it causes harm is to increase our chances of triggering a migraine.

In these cases, it is not the events in our life that produces the stress response, but how we choose to think about them. Understanding how to control and minimize harmful, stress-provoking thoughts is thus another key to preventing migraines.

Q: Are there any natural remedies I can take?

A: Yes, there are a few natural remedies that have been shown in clinical studies to reduce the frequency of migraines. You can try any one of them by themselves, or you can try them in combination. Given that they are very low risk and associated with few side effects, I encourage anyone suffering from migraines to give them a try. They are easiest to find at health food stores, or can be ordered online. These are:

1. Magnesium – 400 mg daily

2. Butterbur – 75 mg twice a day.

3. Vitamin B2 (Riboflavin) – 400 mg daily.

Another option is Migrelief, a supplement that combines Magnesium and vitamin B2 (along with Feverfew, another natural remedy for which the evidence is not as strong) into one pill.

Q: What about Botox for migraines?

A: Most people are surprised to learn that Botox wasn’t originally developed in the name of beauty. Botox was first developed in the mid 1990s as a treatment for spasmodic disorders of the facial muscles. Since that time, it’s therapeutic uses have expanded, and it is now used effectively to treat a number of other conditions, including chronic migraines. I have had many patients who’ve experienced great results with Botox, many of whom had suffered with daily or near daily migraines for several years that had never responded to prescription preventative medications.

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