by Naziyath Vijayan, M.D.

About the Author

Dr. Naziyath Vijayan is a neurologist with UC Davis Medical Center in Sacramento.

Other Resources

American Headache Society Web site

Migraine sufferer

For people who get regular migraines, headaches are never far from their thoughts. Although not life-threatening, migraine headaches can be devastating for the 18 percent of women and 6 percent of men who suffer from them, at least while they last.

A migraine is usually described as a one-sided and throbbing headache, often located behind or around the eye and accompanied by exquisite sensitivity to lights and noise. Nausea and vomiting is common. In 25 percent of sufferers, attacks are preceded by an “aura,” which typically consists of visual phenomena, such as flashing lights, blind spots or loss of vision.

Current thinking is that migraine headaches are caused by a genetically inherited abnormality. For an attack to occur, something triggers a change in the brain, which excites serotonin-containing nerve cells and causes them to transmit impulses to the blood vessels. The inflammation and dilation of blood vessels cause the throbbing, pulsing pain.

With increasing knowledge about the mechanisms of migraines, new medications are rapidly being developed, and many choices are now available. 

Triggers differ between individuals. Hormones are a common culprit: many women get headaches associated with their monthly periods or when using oral contraceptives or hormone replacement therapy. Sometimes specific foods like chocolate, cheese or alcohol, or food additives like sulfites, nitrates or MSG trigger an attack. General stress like losing a good night’s sleep, missing meals, or windy or humid weather can also bring one on.

With increasing knowledge about the mechanisms of migraines, new medications are rapidly being developed, and many choices are now available. Sometimes combinations of different classes of drugs are useful. Medications that specifically target nausea and vomiting can be added if this is a predominant symptom of an attack. It’s important to work closely with a doctor to find the right medication for you. Some medications cause intolerable side effects, such as drowsiness, or may not be used safely if certain medical conditions are also present.

New routes of delivery offer further improvement. Medications that can be administered by holding it under the tongue, by nasal spray, by rectal suppository, or by injection are fast acting and are good options for people whose headaches come on rapidly. They are also useful for sufferers who can’t take oral medications because of vomiting during attacks. Doctors can administer even faster-acting medications directly into the bloodstream during a severe attack.

Common Migraine Triggers

  • Hormones, like a woman’s monthly period, oral contraceptives or hormone replacement therapy
  • Specific foods like chocolate, cheese or alcohol
  • Food additives like sulfites, nitrates or MSG
  • General stress
  • Missing meals
  • Windy or humid weather

Some medications can actually precipitate headaches when people withdraw from them. If you find yourself using medications more than a couple times a week, you may be getting “rebound” headaches caused by the medications themselves. In general, for attacks that occur more than a few times a month, I recommend a prophylactic medication that can safely be taken regularly to prevent attacks. 

A lot of attention in the popular media has been paid to using Botox injections against migraines. Unfortunately, there is not enough evidence at this point for me to recommend this therapy, and the FDA has not approved it for migraine treatment. I also would not recommend the herb, feverfew. It was recently reviewed in the scientific literature with unimpressive results. I know of no over-the-counter herbal therapies that are known to be as effective as FDA-approved medications.

Migraine sufferers have a higher incidence of depression and anxiety than the general population. The neurotransmitter, serotonin, is implicated in both migraines and mood disturbances. Depressed mood, decreased interest in life, or anxiety are not symptoms of migraine. If such mood disturbances are a part of your life between headaches, consult your doctor. Your moods and your headaches may benefit considerably by specific treatment targeted towards the underlying mood disturbance.

Not all bad headaches are migraines. It is possible, but unusual, for migraines to initially start in someone over age 40. Anyone who experiences a first severe headache or a regular migraine sufferer who comes down with a “worst-ever” headache should be evaluated promptly by a doctor. Other warning signs of a dangerous headache include accompanying memory loss or thinking difficulties, clumsiness, fever, stiff neck, or visual changes lasting longer than one hour.

For a wealth of information about headaches and their treatments, check out the Web site of the American Headache Society at And talk to your doctor if you have unrelieved migraines. You’ll be surprised at the number of options now available.