Is your migraine giving you a big headache?

If you’ve ever had a migraine, you know it’s much worse than the average headache. In fact, symptoms may be so severe that all you can think about is finding a dark, quiet place to lie down.

Among those who experience migraine, women outnumber men by about two or three to one. Twenty-five percent of women experience this type of headache during their lifetimes. Fortunately, there are many effective options that can help keep you from needing that dark, quiet room.

Beyond a normal headache

The pain of a migraine headache may feel dull, deep, intense or throbbing. Any part of your head may be affected, but many people feel the pain on one side, in the temple, or behind an eye or ear. Migraine can also cause nausea, vomiting, sensitivity to light, sound or smell.

Some unique features set migraine apart from other types of headaches. “Premonitory” signs and symptoms precede the headache, by several hours to one or two days. Such signs and symptoms may include fatigue, difficulty concentrating, yawning, neck stiffness, euphoria, depression, dizziness, food cravings or nausea.

About 15 to 20 percent of people with migraine experience visual or other sensory changes, known as aura. Auras typically begin just before the headache and last less than an hour. An aura might include flashing lights or bright spots, zigzag lines, or other visual changes. Occasionally, auras cause temporary numbness or tingling in your fingers or face on one side.

Migraines last from four to 72 hours if untreated. They tend to occur repeatedly over many years, with episodes occurring anywhere from once to twice a year to once or twice a week.

Causes and Triggers

While the cause of migraine isn’t fully understood, both genetic and environmental factors play a role. Migraines often run in families. Genes that control the activities of some brain cells are thought to cause abnormal activity or stimulation of the nerves in the brain. Surges of nerve impulses in the brain trigger the release of substances that cause inflammation. In turn, inflammation stimulates nearby nerves, leading to pain and sensitivity.

A variety of factors and events may trigger migraine attacks, including:

• Stress or the letdown after a stressful or intense time

• Menstruation

• Use of oral contraceptives

• Changes in the weather, high humidity or high altitude

• Going too long without eating

• Lack of sleep or too much sleep

• Bright lights, glare, loud noises or strong odors

• Alcohol

• Caffeine (too much or withdrawal)

• Foods, including chocolates, aged cheeses, cured meats, citrus fruit, fried foods, and items containing monosodium glutamate (MSG) or aspartame.

Migraine may occur more frequently during the transition to menopause, but the condition often improves substantially or disappears after menopause.

Acute treatment

Medications that stop a migraine after it starts are known as acute treatment. All acute migraine medications work best if you take them as soon as your symptoms begin — when the pain is mild or at the first sign of aura. For mild to moderate migraine attacks, over-the-counter medications often work well, including:

• Aspirin

• Ibuprofen

• Acetaminophen

• Naproxen

• Combination pain relievers.

For more severe headaches, your doctor may prescribe:

• Triptans. These work by counteracting certain chemicals in the brain. Many different triptans are available, including almotriptan, eletriptan, frovatirptan, naratriptan, rizatriptan, sumatriptan, and solmitriptan. If one triptan does not work, your doctor may try another.

• Dihydroergotamine (by injection or nasal spray). This older medication acts like triptan but may cause more side effects.

If a debilitating migraine isn’t helped by other medications, your doctor may prescribe an opioid painkiller — one that contains a natural or synthetic narcotic analgesic — as a “rescue” drug. These shouldn’t be taken more than one or two days a week.

If your signs and symptoms include nausea or vomiting, your doctor may also recommend an anti-nausea medication.

Non-drug treatment

While most people with migraines benefit from medications, some non-drug treatments can be effective. Behavioral and lifestyle approaches can be combined with drug treatment and may make your medicine more effective or reduce your need for it.

Non-drug treatments include cognitive behavioral therapy, biofeedback training, and relaxation techniques. It’s also important to maintain healthy lifestyle habits — getting enough sleep, sticking to a regular sleep schedule, eating regular meals, staying physically active, limiting alcohol and caffeine, and managing stress.

Preventive means

Some medications can be taken every day to reduce the frequency, duration or intensity of future migraines. You won’t be able to avoid all attacks, but preventive treatment can reduce your headache burden by one-third to one-half or more. You may want to consider preventive medication if you have frequent migraines that interfere with your daily activities despite acute treatment. Preventive medications may also help if you can’t take acute medications or they don’t work for you, or if you experience intolerable side effects from acute medications.

Preventive medications include:

• Blood pressure medications. Two types of drugs that lower blood pressure — beta blockers and one calcium channel blocker — may also help prevent migraine. Examples include propanolol, timolol, and the calcium channel blocker verapamil.

• Antidepressants. Tricyclics antidepressants, a class of medications for treating depression, may also help with migraine. Examples include amitriptyline and nortriptyline.

• Anti-seizure drugs. Topiramate, gabapentin, and divalproex sodium are used in treating epilepsy but may also help prevent migraine.

• Botulinum toxin. Injections of botulinum toxin type A (Botox) into the scalp muscles can be helpful but need to be repeated every three months.

• Natural products. The herbal products feverfew and butterbur may help prevent migraine, though the benefits haven’t been proved. Supplements of coenzyme Q10 may also be useful for some people.

If you have menstrual migraine, you may be able to prevent attacks by taking a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen or naproxen, or a long-acting triptan, on a daily basis for two to three days before and during your period.

You can prevent some headaches by avoiding your migraine triggers. But just in case, always carry your migraine medication with you.

Have a plan

Although migraine is a chronic condition, you should be able to control your symptoms by working closely with your doctor on how to best manage your migraine.