One of the most under-treated and misunderstood forms of pain is also one that’s fairly common: migraine headaches. They can cause crippling pain and women are two-to-three times more likely to get them than men. ideastream intern Katie Broida continues our special coverage of the "Body in Pain.”
Often the pain from migraines is so bad, so debilitating, that people with them need to lie down in a dark room and stay there for hours…or days. That’s a frightening prospect for Lynn Yuronich, a young mother in Grafton, Ohio.
YURONICH: “I live in terror, especially with the baby. You can’t take care of children. You can’t do anything but lay there. He’s ten months old. It’s not like I can just tell him to go to his room and close the door.”
Migraines vary a lot between individuals, but they are all different from ordinary headaches, not only in their severity, but also in where they are located. Tension headaches, the most common kind of headache, are in the back of the head and neck, or in a band completely circling the head around the forehead. Migraines, on the other hand, tend to be in the front half of the head in the face around the eyes and nose.
Lots of things can trigger a migraine, like certain foods such as red wine or chocolate, or changes in weather, or stress is a big one too. However, these are not the causes of migraine attacks. In fact, doctors don’t know with any certainty what causes them. Lynn Yuronich’s migraines are usually tied to her menstrual cycle,
YURONICH: “The majority are hormonal. I mean, stress can affect it – caffeine withdrawal, absolutely. If I allow a regular headache to linger too long it can trigger into a migraine.”
Once the migraine starts, it has two phases:
First is the constriction phase. Nerves in the brain discharge and send out chemicals that cause inflammation. These chemicals also tell the arteries supplying blood to the scalp and brain to constrict.
This reduced blood flow is painless, but can lead to auras, which are dizziness, odd changes in vision, and other symptoms. Migraine patients can use auras as a warning that a migraine is coming.
The second phase is dilation. Constricted arteries in the brain suddenly become swollen with blood, and the sensitive blood vessels swell and stretch to twice their normal size. Stretched arteries combined with inflammation can be excruciating. There are throbs and pulses, and then the light sensitivity and nausea kick in. These feelings can last anywhere from 4 hours to 3 days.
YURONICH: “It gets to the point where I mean, I describe it as an ice pick driven through your brain almost. The lights, I turn the lights way down or I turn them off. And it kind of just progresses usually to the point where I’m throwing up. I have to tell you, throwing up is horrible because I know how blindingly painful it’s going to be to do so. But then I usually take my medication and in two hours I’ll be hazy, but ok.”
To treat migraines, headache specialists frequently try a class of drugs known as “triptans.” One type of those worked for Lynn Yuronich.
Finding the right migraine medication is notoriously tricky, and most people have to go through a painful experimentation phase with as many as dozen medications before they find one that works. One thing migraine sufferers shouldn’t do is simply double down with common, over-the-counter pain pills. Taking too much of any pain medication can cause migraines to increase.
Dr Stewart Tepper is a neurologist and researcher at the Cleveland Clinic.
Dr Tepper: “Yeah, it’s very hard because if a person is taking too much medicine inadvertently, and has daily headache, and they try to stop the medicine – they’re going to get the worst headache of their life because they’re basically in withdrawal at that point.”
Another thing about migraines is that more people have them than know it. Dr Tepper led a study on migraines in 14 different countries, and they found that 94% of people coming to their doctor with bad headaches actually had migraines.
Dr TEPPER : “What happens in people is a misconception that they have tension headaches when they have migraines. And in that study when we looked at people who are complaining to their doctors about their headaches, If the patient told the doctor that they thought they had tension headaches, 85 or 90% of the time, it turned out to be migraine.”
The bottom line for recurring head pain? See a headache specialist.