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By Melissa Tennen, HealthAtoZ writer
When a migraine starts, Lisa Roll feels like someone is stabbing her in the left side of her head. And then, that attack plunges deep and her body begins to scream.
"There are times when I can't even stand my clothes touching my body. That's how sensitive my skin feels. Sometimes I can't even stand the pressure of my glasses on my face," Roll says.
"Some migraines are really bad and some are not so bad. Usually, they don't affect me too badly unless I move the wrong way. I can't turn my head when I am having one. If I do, that's when the pain is excruciating."
Roll, 57, has had a lifetime to get to know her beast. Not getting enough sleep or eating often enough during the day can incite an attack. When one hits, she steadies herself, gets very quiet to help block the pain, and keeps going in her job and her life.
Not routine headaches
Much more than just a bad headache, migraine attacks are symptoms of a brain disorder affecting 28 million Americans, making these attacks the most common kind of chronic headaches. Migraines consume the whole body, causing symptoms such as nausea, sensitivity to light, and a heightened sense of touch and smell. Some people vomit.
"I look at it as a disease with episodes of pain. These people are very susceptible to headaches just like people with diabetes are at risk for high blood sugar," says Lisa Mannix, M.D., spokeswoman for the National Headache Foundation (NHF) and a Cincinnati-based neurologist specializing in headache treatments.
But many sufferers do not get the help they need. About half of migraine sufferers aren't getting the right treatment or even seeing a doctor, Mannix says. And of the 28 million who suffer, 11 million have moderately to severely debilitating headaches, according to NHF. That means they might need to retreat to bed for a few hours or a few days.
Having chronic migraines can seriously disrupt your life, affecting how well you do your job, the time you spend with family and the quality of your friendships. Attacks may happen every day or once every few years. Women are three times more likely to be migraine sufferers.
"Over time, migraines may become more difficult to treat. The longer you suffer without treatment, the more headaches you'll get," Mannix says. "In some people with migraines, there may be permanent changes in the brain stem."
During an attack, blood vessels in the brain expand and become inflamed. Although these vessels are in the scalp, skull and surface of the brain, the pain feels like it is coming from inside the head, particularly behind the eyes. This leads doctors to misdiagnose the pain as a sinus headache. Mannix says about 90 percent of people diagnosed with recurrent sinus headaches are actually suffering from migraines.
Less than one-third of sufferers have what is known as "aura." They may see light flashes, blind spots, zigzag lines and shimmering lights and may even have vision loss and numbness before the head pain and other symptoms start.
The pain of a migraine attack usually lasts between four and 72 hours. The typical sufferer might have two attacks a month, although the frequency of attacks may change throughout a person's life.
Migraines do not have a cure. But they can be controlled and the attacks can be less crippling. Treatment has improved tremendously throughout the past 10 years, Mannix says.
"People suffering from migraines are often dismissed by doctors as not being able to handle stress or that they have depression," says Michael John Coleman, executive director of the Migraine Awareness Group: A National Understanding for Migraineurs, which is a nonprofit public education organization. "Some just give up on getting medical help because they just haven't been diagnosed correctly, getting the right medication, or past inappropriate care."
The lack of a lab test for migraines is one of the reasons many sufferers don't get clear diagnosis.
Where do they come from?
Researchers aren't sure why migraines happen. But they have theories. Here's the most common. Migraine sufferers have a nervous system that is more sensitive than other people's. This overly sensitive system means the brain is more sensitive to your environment. This means that triggers, which include changes in sleep, weather and hormones, can set off migraines. These changes excite the brain, which activate blood vessels on the brain's surface. These dilated, or swollen, vessels are surrounded by chemicals, causing inflammation. This creates the pounding pain associated with migraines.
Triggers for attacks include:
- Red wine
- Food additives such as MSG
- Aged cheese
- Fasting
- Sleep deprivation
- Perfumes
- Changes in weather
- Stress
- Menstruation
One thing is clear, that the faulty mechanism is hereditary, passed down through parents who had it or passed it on from previous generations.
Make an appointment with your doctor and start a journal of your attacks that includes:
- Time of day
- Severity of the attack
- Duration
- Symptoms
- The site and feel of head pain
- Changes before the attack, such as with sleep and eating
Your doctor will want to rule out any other problems. Having a journal certainly helps. But you should get a physical exam and neurological tests and scans that look for other causes.
Coping with migraines
Someone living with migraines should try two approaches: preventing the attacks and dealing with them when they come on. There are medications that are taken every day to reduce the number of attacks and severity, and there are lifestyle changes one can make that help too. There are other medications to treat the symptoms of an attack as it begins.
Knowing your triggers and making lifestyle changes can help prevent some attacks. No matter how hard you try, you won't be able to prevent all attacks. Exercise can help because it releases endorphins, which are natural pain relievers. Something as simple as a walk can help relieve stress and give you more refreshing sleep. Relaxation techniques such as biofeedback might help, too.
Preventive medications include certain anticonvulsants, beta-blockers and antidepressants. Hormone therapy may help with migraines linked to menstrual cycles. "Abortive" medications (the ones used to deal with the symptoms of an attack) include over-the-counter analgesics, such as aspirin or acetaminophen, for mild to moderate attacks. Medication should be taken as soon as possible. But be careful. Taking analgesics more than three times a week raises the risk of rebound headaches. And there is some concern that too frequent use of acetaminophen may be associated with high blood pressure.
NSAIDs (non-steroidal anti-inflammatory drugs) might help by relieving pain and inflammation. Over-the-counter versions are ibuprofen and naproxen.
A class of drugs called triptans are often prescribed and are best taken at the first sign of a migraine. They may stop the process that causes the pain, nausea, and other symptoms. Triptans affect two of the brain's serotonin receptors, which, in turn, narrow the dilated blood vessels in the brain and block the release of painful inflammation chemicals. Before you take triptans, tell your doctor about all the medicines you take, especially any medicines for depression.
"The communication between the doctor and the patient is so important to get the right diagnosis and treatment," Mannix says.
 A word about NSAIDs
NSAIDs (nonsteroidal anti-inflammatory drugs) are commonly taken to reduce pain and swelling, although they are not for everyone. Ibuprofen, naproxen and aspirin are all NSAIDs. Talk to your doctor about whether taking NSAIDs is safe for you, especially if you:
COX-2 inhibitors
Recent information suggests that the COX-2 inhibitor celecoxib (Celebrex®) may increase the risk of heart attack and stroke. Related drugs, rofecoxib (Vioxx®) and valdecoxib (Bextra®), were removed from the market because of the risks of heart, stomach and skin problems. Ask your doctor if celecoxib is safe for you.
Antidepressants
Children, teens and adults being treated with antidepressants, particularly anyone being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed - either increased or decreased. Bring up your concerns immediately with a doctor.
This article was reviewed and updated June 2007.
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