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Staying Healthy: Migraine, it's all in your head

'Migraine is not fatal but it can affect your quality of life'
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The day that I pitched a story about migraines for Staying Healthy during our staff meeting, I had one of my own brewing, coincidentally.

As I explained my idea while occasionally massaging my left temple -- usually the focal point for the worst of the pain that I'll feel -- I knew I wasn't the only person who has suffered with migraines at work.

Migraines are, in fact, the third most common medical disorder in the world, so the odds are good that many workplaces have at least one employee who suffers from migraines. According to the American Migraine Foundation, more than 36 million Americans have migraines -- more than the number who have diabetes and asthma combined.

And while migraines are estimated to cost American business more than $29 billion in lost time and lost work productivity, they take an incalculable toll on one's quality of life. Dr. Charlene Hu, a migraine specialist at Stanford Health Care-ValleyCare, said she has seen this in many of her patients.

"Migraine is not fatal but it can affect your quality of life. I see so many so often, affecting the quality of the life for the family," Hu said.

So what makes a migraine different from a regular headache? "Migraine has this unique presentation compared to other headaches or such a tension headache," Hu said.

Migraine headaches can take over someone's life for several days. For me, they start with what I describe as a mental fog that hinders my concentration even before the onset of actual pain. They're comparable to a hangover but worse (in my opinion). Headaches are still annoying and painful, but much more tolerable and don't typically hang around until the next day or after like a migraine does.

Usually mine lasts about 24 to 36 hours, a period of time during which I try to sleep as long as possible, and avoid any bright lights and screen time. Maybe this is TMI, but nausea and vomiting are also common among migraine sufferers -- possibly due to serotonin levels.

Relief often only comes in the form of deep sleep or over-the-counter medication. Sometimes I'll experience a lingering throbbing sensation in my temples the day after. Hu said these are all common symptoms, though each migraine patient's profile is unique.

I am fortunate, though, because mine could be more frequent and worrisome (2020 was by far the worst year that I've ever experienced so many, simply due to the stress -- the top trigger for migraines, according to Hu).

Migraines aren't generally a link to other conditions, but Hu said "there is a small risk for the patient who has migraine aura, a slight risk for stroke."

"Specifically if the migraine involves aura and the patient is a smoker, and takes birth control," Hu said. "All three in combination put them at even higher risk for a stroke. I think that might be the only one in terms of risk with any other medical conditions from the migraine."

Migraines are much more common in women, who Hu also said "tend to have more severe headaches because women tend to have more triggers."

"We're not sure of the cause of migraines; it's a complicated area," Hu said. "What we know for sure is that it's a genetic condition, that's the most common."

According to Johns Hopkins Medicine, serotonin and estrogen level changes are believed to be responsible for triggering migraines, as well as general vascular system changes. Women are also more likely to have migraines than men because of fluctuating estrogen levels, which affect women only and naturally vary throughout their life cycles.

Hu said migraines typically occur anywhere from the teenage years (when hormone fluctuations also start to happen) until someone is in their 40s or 50s. Once women finish menopause, Hu said their migraines usually improve.

While the causes of migraines are still unknown, Hu said there's a long list of documented triggers, with emotional stress taking the No. 1 spot, followed by hormone changes.

Other triggers for migraines are unique to each individual but Hu said they can include weather changes (a thunderstorm may have actually triggered my very first migraine), strong or very bright lights, sleep disturbances, alcohol, smoke, exercise, and all sorts of food, including red wine, chocolate and cheese.

For patients who have a migraine more than four days out of every 30 days, Hu will "start them on preventative headache treatment to stop the headache instead of chasing it." Migraines that are less frequent and more mild can be treated by taking over the counter medication such as Tylenol or Motrin. Severe migraines may be treated with Imitex or something else more powerful.

"There's a whole group of meds we use for acute migraine attacks, and the key pain medication for migraine is very important. You have to catch it early -- that is very, very important," Hu said.

There are many very effective treatments existing, Hu said, so people don't have to suffer and should be able to find something that works for them.

"All of those pain medications that are over-the-counter, for the most part they work, but the migraine -- if you don't control them -- they tend to become more severe more often," Hu said. "The beauty of the preventive way is you would not have a headache."

Take it from me -- when it comes to migraines, it's always worth the ounce of prevention to save a pound of cure.

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