The truth about migraines

Woman holds hand to head in dark room with her eyes closed

One in ten people in the United States have migraines, and women are three times as likely as men to suffer from them. Migraines are also one of the top ten complaints people have when they visit their health care provider.

We talked to Juliette Preston, M.D., a neurologist at OHSU and one of the only headache specialists in Portland with specialized training in headache medicine. Dr. Preston directs the OHSU Headache Center, a multi-disciplinary clinic focused on helping people with severe headaches and migraines.

OHSU’s Headache Center

Along with Dr. Preston and other neurologists, the clinic includes an oral-facial specialist who helps patients with jaw pain, an acupuncturist, and four infusion centers across town for treating patients quickly and effectively.

The infusion centers are especially helpful for migraine patients. If you have a migraine and your medicine isn’t working, an IV infusion containing Depakote and magnesium works great. But you may have to sit in the ER for 8 hours to get one. OHSU Headache Center patients can call and get set up at the infusion center closest to them within an hour.

Busting Myths

We asked Dr. Preston for the truth about migraines and she delivered. Below are her responses to eight common beliefs about migraines, half of which she confirmed and half of which she busted.

Myth #1: Aura + intense headache = migraine

A severe headache, with or without aura, is the most common type of migraine, but there are other types too. It’s important to understand what makes a migraine headache different from other headaches. Most headaches people have are tension headaches. These are usually mild, affect both sides of the brain, feel like pressure, and don’t cause nausea or sensitivity to light and sound. 80 percent of us will have a headache like this within a year.

Migraines, though, are usually just on one side of the brain and are much more intense. They throb, often cause nausea or sensitivity to light and sound, and last at least four hours without treatment.

That said, not all migraines cause pain. Some cause what we think of as aura, without a headache following. This type usually lasts about an hour.

Another type of migraine, called vestibular migraine, makes you feel like you’re on a boat and unable to steady yourself. This type of migraine is not always followed by head pain.

Myth #2: Migraine aura is always visual

Aura is defined as any neurological symptom that resolves within an hour, and the truth is only 20 percent of people who get migraines have visual aura (such as wiggly lines in your vision, a big circle of light, or temporary vision loss). There are two other types of migraine aura:

  • Language aura – This type of aura can include word-finding difficulty, slurring your speech, or you can have word salad, where you say things that don’t make sense.
  • Motor aura – This type of aura may include one-sided weakness, dragging your feet, or your face looking droopy on one side.

Myth #3: You need an MRI or brain scan to diagnose migraines

The vast majority of patients don’t need a brain scan. There are a few exceptions:

  • Late onset – If you never had headaches and suddenly develop them at 50 or 60, then we will do a brain scan.
  • Sudden change in symptoms – If your migraine changes suddenly and you’re having symptoms you never had before.
  • Children – For kids, we’re more likely to do a brain scan to rule out other potential problems.

Myth #4: When treating a headache, take the smallest dose of medicine that works

Most people think the less medication the better and, in general, they aren’t wrong. But when it comes to migraines, you have to treat them as soon as possible and aggressively. If you start slow and wait to see if a small dose works, the chances of breaking the headache shrink. Whether you take over the counter medicine like ibuprofen or a specific medication for migraines, take the full dose the moment you sense a migraine starting.

Migraine truths

Truth #1: Prevention is the best treatment

The best way to treat a migraine is to not get one. Stress, poor diet, lack of sleep, dehydration and lack of exercise can all increase how often you have migraines. Other common triggers include chocolate, cured meats and alcohol.

Some triggers, like hormone fluctuations or shifts in the weather, are out of your control, but doing what you can to maintain a healthy lifestyle can make a big difference.

Truth #2: Many non-drug treatment options do work

There is good evidence that a variety of vitamins and minerals help break migraine headaches, including magnesium, vitamin B2 and CoQ10. Studies have also shown that acupuncture can help break headaches.

As far as prevention, biofeedback and relaxation techniques are very effective. Yoga, exercise, meditation and mindfulness are all great ways to help prevent migraines in the first place, but they are unlikely to help once a migraine has already started.

A new non-drug treatment that works really well is called neural modulation. Devices like a Cefaly or a Vagus Nerve Stimulator, when placed on your forehead or neck, send signals to your nerves to break a bad migraine headache. Both devices are available by prescription.

Truth #3: Keeping a headache diary will help

Headache diaries are an important part of treating migraines because, if you don’t keep track of your headaches you tend to underestimate how often they happen. Headache diaries can also help with identifying triggers and making sure that you are using medicine safely and effectively.

Truth #4: Periods do cause migraines

Migraines have many triggers, and one of them is definitely a change of estrogen level. When you ovulate, your estrogen level goes up. This is a possible trigger for women who have migraines. About two days before your period, estrogen levels drop. This is another possible trigger.

This is a very common trigger in women. Women are three times more likely to have migraines than men, and the reason is that women have these hormone cycles. Many women even stop having migraines after menopause when their hormones stop fluctuating.

Many women think their birth control pills cause migraines, but it’s really just the hormone cycle. Birth control pills can actually prevent migraines if you skip the placebo week, eliminating the estrogen fluctuation.