A migraine is often misunderstood as just “a bad headache,” but this assumption couldn't be further from the truth. Migraines are a complex neurological disorder, far more debilitating than a typical headache, with a significant impact on patients' quality of life. For some, the pain is relentless and pounding, and it comes with a slew of other symptoms that make day-to-day functioning a challenge. Moreover, the struggle of enduring migraines is often worsened by the feeling of having an invisible disorder and of being doubted.
Migraines often come with throbbing or pulsating pain in the head, lasting anywhere from 4 hours to 3 days. But the headache is only one part of the experience. Those afflicted often experience muscle rigidity, nausea, vomiting, and sensitivity to light (photophobia), sound (phonophobia), and strong odors like perfume or gasoline. During a migraine attack, individuals may struggle with concentration and mood changes. Post-migraine, lingering fatigue is common and can last from several hours to a full day.
Some individuals experience visual disturbances also known as auras that can appear as zigzag lines, flashing lights, or temporary vision loss either before or during a migraine. The relative risk of ischemic stroke is significantly higher in individuals having migraines with aura and the use of combined hormonal contraception containing estrogen further increases this risk in women.
Migraines are one of the leading causes of disability, affecting approximately 15% of the global population. The exact cause of migraines remains elusive, but researchers suspect it involves abnormal brain activity affecting nerve signals, chemicals, and blood vessels. There's also a genetic component—if one parent has migraines, the chances of inheriting them are around 40%; if both parents are affected, the likelihood rises to 75%. Various triggers can provoke migraines, including stress, sleep disruptions, certain foods, alcohol, physical activity, high altitudes, and even changes in the weather. Caffeine can also be a trigger, but in small amounts, it may help during an attack. While a little caffeine at the onset of a migraine can provide relief for some, excessive or frequent consumption is linked to more frequent attacks. As for the chocolate trigger debate, the jury’s still out. Chocolate may or may not trigger migraines in some, but it’s probably not the worst idea to cut back on it regardless.
Diagnosing migraines is not simple because there is no definitive test, and it's mostly a process of elimination. Physicians rely on detailed patient history and symptom patterns to distinguish migraines from other types of headaches.
Migraine treatment can be classified as acute (abortive) or preventive (prophylactic). Patients with frequent, severe migraines often need both. A preventive medication is deemed effective if it reduces the frequency of attacks or migraine days by at least 50% within 3 months, although it may take 2 to 6 months to assess its full effect.
Common preventive medications include antiepileptic drugs, antidepressants, beta-blockers, calcium channel blockers, serotonin antagonists, and NSAIDs. The choice of medication depends on its effectiveness, side effects, patient preference, and any existing health conditions. The selected drug should have the best risk-to-benefit ratio for the individual and, where possible, take advantage of the drug’s side effect profile. For example, tertiary tricyclic antidepressants with sedative properties can be beneficial for patients with insomnia when taken at bedtime. Supplements such as Vitamin B, magnesium, and melatonin are also used as preventive treatments; however, more solid evidence from randomized placebo-controlled clinical trials is needed to support their effectiveness.
For acute migraine attacks, NSAIDs or triptans can relieve pain by constricting blood vessels and blocking pain signals, especially when taken early. However, they may not provide lasting relief, as migraines can return. It is also important to note that triptans are contraindicated in individuals with severe vascular conditions or untreated vascular risk factors.
Then there’s Botox—yes, the same one used to smooth out wrinkles. Botox injections have been found to reduce the frequency and severity of migraines. However, data supporting its clinical use is still limited. Unlike aesthetic injections in the face, Botox for migraine relief is typically administered in the upper to middle areas of the head.
And of course, there are alternative treatments like acupuncture, reflexology, aromatherapy, and even the somewhat dubious daith piercing (which involves puncturing an inner part of the ear). The science backing these methods is shaky at best, but people in the depths of migraine misery will try anything for relief.
Recent advancements in migraine treatment hold promise, even though there is no cure yet. Neuromodulation, which uses electrical devices to stimulate nerves, is emerging as a potential option for both acute and chronic migraines, targeting the trigeminal and vagus nerves to reduce attack intensity. Non-invasive methods are particularly appealing due to their minimal side effects, making them suitable for patients who struggle with medication tolerability. Additionally, a new class of drugs known as calcitonin gene-related peptide (CGRP) antagonists—such as erenumab, fremanezumab, eptinezumab, and galcanezumab—has been approved for migraine prevention. Other therapies like lasmiditan, ubrogepant, and rimegepant offer new options for acute relief, although some studies suggest that triptans remain much more effective. While these developments are encouraging, further research is needed to determine their long-term effectiveness and tolerability.
Aside from therapeutic treatments, lifestyle changes play a significant role in migraine management. For many, keeping a migraine diary helps identify and avoid triggers. Proper sleep hygiene, regular meals, staying hydrated, and stress management can also lessen the frequency and intensity of attacks. That said, no amount of "self-care" will magically eliminate migraines, and it’s important not to imply that people can control these debilitating episodes simply by meditating or eating better.
Living with migraines means constantly navigating an unpredictable terrain. Those affected may seem fine one day and utterly incapacitated the next. The impact on mental health cannot be understated—depression, anxiety, and frustration often accompany the physical pain. Migraines may not be visible, but their effects on individuals’ lives are very real.
Finally, my anecdotal experience with severe migraines. I’ve had them for a couple of years, and they’ve been a challenge in many areas of life, including studies, work, and socializing. The biggest issue is the time lost to hours of pain, making it impossible to carry out daily activities. Life goes on, though, and despite wishing I could pause everything until the migraine passes, I still have to manage at least some tasks. As with any condition, treatments vary in effectiveness from person to person. While none of the treatments I’ve tried have significantly reduced my migraines, I remain hopeful.
Hosna Akhgary is a BSc candidate at Ď㽶ĘÓƵ, majoring in Pharmacology.
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