Understanding migraine headaches

St. Joseph’s/Candler Neurologist Dr. Jill Trumble explains symptoms, triggers and treatment for migraines

How common are migraines?

“It is the No. 1 complaint across the country in any doctor’s office. That is how common they are,” says Dr. Jill Trumble, St. Joseph’s/Candler neurologist and neurology medical director of the St. Joseph’s/Candler Movement Disorders Program.

A migraine is a type of throbbing headache typically associated with nausea or vomiting and sensitivity to light and sound. It’s typically unilateral, but can develop on both sides of the head, Dr. Trumble explains. The degree of severity can range in patients from mild to so severe it limits their ability to work or enjoy normal activity.

Anyone can suffer from a migraine, but we know they are more common in women, especially during menstrual years. Some patients eventually stop having migraines, while Dr. Trumble says she has patients in their 70s and 80s who still get migraine headaches.

Experts do not know for certain what causes a migraine. There is some heredity component, as migraines have been shown to run in families, but there’s no evidence a certain gene increases your risk of having migraines.

There are triggers that can cause a migraine, Dr. Trumble says, such as foods containing nitrites and nitrates (pepperoni, hot dogs and certain deli meats, for example). Alcohol can trigger migraine headaches and that’s typically related to dehydration associated with excessive alcohol use.

Dr. Trumble also tells her migraine patients to not skip meals because a drop in blood sugar can cause migraines. She also recommends a protein snack two hours after each meal to keep blood sugar levels balanced.

While migraine patients should be aware of these triggers, they should also know a migraine can happen regardless of these triggers.

“The most common question I’m asked is why they are having these headaches. Unfortunately, there’s no answer for that,” Dr. Trumble says.

Treating migraines

But the good news is advances in medicine have reduced the number of migraines and severity that patients experience. Until about four years ago, the option to treat migraines was with medication intended to treat something else, such as blood pressure or seizures, or anti-depressants.

Now there are multiple medications available specifically to try to prevent migraines or reduce the severity of one. There are three injectable options: Aimovig, Ajovy and Emgality. There’s an infusion option called Vyepti, and now an oral medication called Qulipta.

“Instead of waiting until you get a headache, you use this medication to lessen the frequency and severity of those headaches,” Dr. Trumble says.

Dr. Trumble adds that not every medication will work for 100 percent of people with migraines, and some people may experience side effects. For the three injectable options, you may experience pain or tenderness or hardness at the site of the injection, as well as fever, hives or itching skin, joint pain, stiffness or swelling. If you experience swelling of the eyelids, face, lips, hands or feet, tightness in the chest, trouble swallowing or difficulty breathing, you should seek immediate care. 

Vyepti can cause headache and muscle aches, sore throat, a stuffy or runny nose and tiredness or weakness. If any part of your face, hands or feet swell and if you have trouble breathing or swallowing you should seek immediate care. Finally, Qulipta may cause constipation, nausea, drowsiness and unusual tiredness or weakness. 

Dr. Trumble or your neurologist can help determine the best option for you.

If you suffer chronic migraines, another treatment option is Botox. You must meet certain criteria to be diagnosed with chronic migraines: More than 15 headache days a month, lasting longer than four hours for more than six months, Dr. Trumble explains.  If you have a diagnosis of chronic migraine, Botox injections are a FDA-approved treatment.

Related Article: Can Botox really treat neurological disorders and chronic migraine?

“The biggest thing I want migraine patients to know is now there are these available medications and treatment options,” Dr. Trumble says. “I have patients who for years went to a neurologist and tried different medications and just thought this was something they would have to deal with. The good news now is there are these medications, so even for patients who have gone through the gamut of treatment in the past, just knowing there are new options is a good thing.”