Am I Having a Headache or a Migraine? And More Migraine Questions, Answered
It’s time to finally get a handle on your migraine.
Last summer, Becky Welter-Nolan, a 32-year-old director of an arts organization who suffers from chronic migraine attacks, arrived at a pain management clinic in Halifax, prepped to receive a barrage of Botox-loaded needles all over her head, neck and shoulders. And it wasn’t because she wanted to look younger.
Botox injections are one of the newer prevention therapies for chronic migraine, a neurological disorder that affects millions of Canadians.
Botox — a protein called onabotulinum toxin A, the same stuff used to fill lines and wrinkles — can work for chronic migraine due to its effect on muscles and impact on brain mechanisms. Because she feels the migraine all over her head and neck, Welter-Nolan had to receive 32 injections. “The most terrifying part was signing off on the potential side-effects, which, if they missed with one of the needles near my eyebrow, for example, could have left me with a droopy eye for the next three months,” she says. “I thought, ‘Like, that’s all I need!’” But Welter-Nolan was willing to try just about anything to help her better manage the debilitating migraine attack she deals with at least once a week.
“In Canada, we estimate there are about three and a half, maybe closer to five million people with migraine,” says Dr. Christine Lay, a neurologist and director of the Centre for Headache at Women’s College Hospital in Toronto. “And of course, migraine affects women three times more than men.”
Is my headache a migraine?
“There are 300 different types of headaches,” says Lay. And they each have distinguishing characteristics. Sinus headaches are caused by an infection or allergic reaction that’s creating inflammation in the sinus and triggering pain and pressure in the cheeks and head. Cluster headaches typically occur on just one side of the head, around the eye, and are incredibly painful. (They’ve been described as the sensation of having a hot poker driven into one’s eye and are statistically experienced by men more often than women.) There are also exertional headaches that can be triggered by a bad cough or even a fantastically good orgasm. (Yes, you read that right. It’s called a coital headache.)
Tension headaches are the most common, characterized by a dull ache on one or both sides of your head, and/or tightening in the back of your neck. A walk outdoors, a round of meditation or some over-the-counter medication usually takes care of them. By and large, they’re not a big deal, says Lay. “There is a subset of this headache type called a chronic daily tension headache, which obviously is more disabling because it occurs every day, but by definition a tension headache is rarely bothersome and often doesn’t even need treatment,” she says.
The second most common type of headache comes with a migraine attack, and as every person living with migraine knows, it’s so much more than just a really bad headache. In fact, a headache is considered just one aspect of a migraine attack. “With migraine, there are neurobiological brain changes going on for 12 to 24 hours before the headache arrives,” says Lay.
Migraine is actually considered a brain disorder. A person’s predisposition to migraine is likely the result of the brain’s reaction to a complex intersection of causes, including genetics, hormonal fluctuations and environmental factors.
(Related: 6 Effective Pressure Points for Headaches)
Sure, a migraine can involve a painful throbbing on one or both sides of the head, but it comes with a wide range of other symptoms too, from sensitivity to light and noise to nausea and vomiting. Attacks tend to last for at least four hours but can go on for days, and they can be incapacitating. Some people also experience aura, which can include an array of visual or sensory disruptions, including blind spots, flashes of light, and tingling or numbness in the hands and face.
“The other part of migraine is this neurobiology — the brain chemical changes that go on in the 12 to 24 hours before the headache actually shows,” says Lay. During this period, some people experience what’s called a prodrome. Classic symptoms of this early migraine stage include excessive yawning, fatigue, food cravings and even feelings of sadness. In the other extreme, some women actually experience a great big boost of energy.
Understanding your triggers
When the migraine hits a day later, it’s all too easy to blame it on exhaustion from yesterday’s baking marathon or epic closet clean-out when, in fact, that activity was simply a clue that a migraine attack was brewing. Same goes for that chocolate bar you just had to have last night. “Some patients will say, ‘I ate chocolate, and it gave me a headache,’ but what we think might be happening is the chocolate craving was part of the neurobiology of the migraine coming,” says Lay. Understanding this prodromal phase can be helpful for gaining clarity on your migraine and your triggers, she says.
“It’s taken me a really long time to understand it.” says Welter-Nolan. Over the years, she’s tried acupuncture, naturopathy, elimination diets to pinpoint possible food triggers and much more. For many women, figuring out what’s triggering their migraine can be a lengthy and frustrating process — and that can easily turn into feelings of personal failure. “It’s not something you’ve done or something you’re responsible for doing to yourself. I see a lot of women engaging in that type of shame-based thinking about their pain,” says Welter-Nolan.
The confusion and frustration stems from the fact that triggers are varied and individual. A migraine attack can be triggered by stress, for example — or even the relief after a very stressful event, like a job interview or closing a house purchase. (That’s called a post-stress letdown migraine.) Another common culprit is poor sleep, which, by the way, includes getting only not enough hours of sleep but also poor-quality sleep or even too much sleep. One of the biggest traps is trying to catch up on zzzs over the weekend, says Lay. (Sleeping in changes your usual breakfast timing or means you might skip the morning stretch or meditation you usually do Monday to Friday, for example, which can throw off your system and lead to a whopping headache.) For other women, loud noises, changes in barometric pressure, bright lights, strong smells, skipping meals and too much (or too little) caffeine can all potentially jump-start a migraine.
The hormonal roller coaster of womanhood is also to blame for many a migraine. Basically, any time estrogen levels change drastically, like right before your period, you could be at risk of developing a doozie. This is also why during pregnancy, when estrogen stays high and stable, people with migraine typically won’t experience an attack.
(Related: 12 Foods That Can Make Your Headaches Worse)
“The most important thing is to get the right diagnosis,” says Lay. “Once we know it’s migraine, there are lifestyle factors, there are herbals and vitamins, and pharmacological therapies,” she says. “There’s a lot we can do to help.”
The lifestyle factors — maintaining a consistent sleep schedule, staying hydrated, eating well, getting enough exercise and staying on top of stress with mindfulness or meditation — might not sound like a huge deal, but it’s actually a big task to manage, says Welter-Nolan. “Managing migraine is like trying to live in peak health all of the time, so that when you get a migraine, it doesn’t affect you as much,” she says. “But staying on top of it all is basically like having a part-time job.”
In addition to top-notch self-care, a number of vitamins and supplements can be helpful when it comes to managing headaches and migraine. Backed by solid research, magnesium citrate, vitamin D, vitamin B2 (known as riboflavin) and coenzyme Q10 have been shown to minimize the frequency and severity of head-throbbing attacks. An herb called butterbur has been proven to reduce the number of migraine attacks, and the American Academy of Neurology even endorsed its use in 2012 but then did an about-face on this recommendation in 2015, due to concerns about possible liver damage. If you’re considering trying butterbur, talk to your doctor to ensure it’s safe for you.
When it comes to acute therapies (also known as remedies that will get you through a migraine), over-the-counter pain relievers are typical and effective go-tos. But beware of using them more than once a week on a regular basis, because you could end up with what doctors call “medication overuse headaches,” a common subtype that can become a vicious cycle. There’s also a range of prescription meds designed for on-the-spot migraine treatment, including anti-inflammatories and a specific class called triptans. One new type of drug used to prevent migraine blocks a protein called calcitonin gene-related peptide (CGRP), which is now believed to be a primary brain chemical involved in starting and perpetuating a migraine attack. And although it’s crucial to be able to manage a migraine in the moment, Welter-Nolan stresses the magnitude of having the ability to prevent or minimize your migraine attacks. “Otherwise, how are you going to be able to live your life effectively?” she says.
Prevention therapies include daily medication (which is mostly borrowed high blood pressure or antidepressant drugs that also work on migraine, but not perfectly, of course), gene therapy, injectable alternatives (like Botox, CGRP medication or occipital nerve blocks like Marcaine) and drug-free wearable devices such as CEFALY (which works by sending tiny electrical impulses to a key cranial nerve). “These devices are a great option for someone who hasn’t had enough of a result from drugs, or a pregnant woman who can’t take medications or someone who can’t take the medications because of certain health conditions,” says Lay. All told, there are a lot of options when it comes to managing migraine attacks. “The important thing is to realize that you don’t have to suffer,” she says.
“What I wish I had known when I was younger is that it’s not my fault,” says Welter-Nolan.
“I wish somebody had told me sooner that it’s a disease, that it’s genetic, that it’s not something I did to myself,” she says. “And that it’s important for you to take care of yourself — but it’s also important to give yourself a break.”