Decoding Migraines: Science, Symptoms, Solutions and Support

Migraines are more than just headaches—they’re a full-body experience that can throw your life off balance. If you’ve ever been sidelined by intense pain, sensitivity to light and sound, dizziness or nausea, you’re not alone. This National Migraine and Headache Awareness Month, we’re shedding light on the debilitating condition with insights from Natalie Fortin, FNP, at Sinai Hospital’s Headache Clinic.

Science: Distinguishing Migraines from Headaches

Migraines and headaches, while often conflated, are distinct conditions with different characteristics. Headaches, which can be classified as primary or secondary, are generally limited to pain in the head or neck area.

• Primary Headaches, such as tension headaches, cluster headaches and migraines, are standalone medical issues.
• Secondary Headaches result from underlying medical conditions like sinus infections, concussions or severe head injuries.

Most of us have experienced the discomfort of a headache, whether it’s sharp, localized pain, throbbing or a dull ache. Unfortunately, some of us know the severity of a migraine.

“Migraine is a neurological disease that goes beyond head pain,” Natalie explains. Migraines can last 4 to 72 hours and include severe pain, sensitivity to light and sound, dizziness, nausea and more.  

Symptoms: Recognizing Migraine Causes, Triggers and Physical Manifestations

Migraines result from complex interactions between blood vessels, nerves, neurochemicals and musculature. The causes, triggers and symptoms of migraines can be as varied as the internal systems involved.

Causes: Genetics, hormonal changes and head trauma can contribute to migraines, but often, there is no apparent cause.  

Triggers: Common migraine triggers can include weather changes, sleep quality, certain foods, smells and bright lights.  

Symptoms: Migraines typically unfold in stages:

• Prodrome: Occurs hours or even days before an attack, with symptoms such as mood changes, food cravings, neck stiffness and increased thirst or urination.
• Aura: Typically lasts 20-60 minutes and includes visual disturbances like flashing lights, blind spots or zigzag patterns, and sometimes sensory, speech or motor symptoms.
• Attack: The main phase of the migraine, often characterized by intense head pain, nausea, vomiting and extreme sensitivity to light, sound and sometimes smell.
• Postdrome: Following the attack, this “migraine hangover” can last up to a day and involve fatigue, confusion, moodiness, dizziness and continued sensory sensitivity.

Chronic migraine sufferers experience 15 or more headache days a month, while episodic migraine sufferers have fewer.

Solutions: Managing Your Migraine

First and foremost, Natalie emphasizes, “Your migraines are not your fault. They are not the result of anything you’re doing or not doing.” Many triggers are beyond an individual’s control. The key is to develop strategies to manage environmental factors, reducing susceptibility to or impact of biological or unpreventable ones.

General recommendations include:

• Hydration: Drink plenty of water.
• Diet: Increase intake of fruits and vegetables, minimize refined sugars and fatty foods and avoid caffeine entirely.
• Exercise: Engage in purposeful movement.
• Sleep: Ensure adequate rest.

Migraine medications have historically included anti-seizure, antidepressant and blood pressure medications. However, Natalie highlights a few newer treatment options that are seeing success:

• CGRP Monoclonal Antibodies: Injectable or infusion treatments like AJOVY, VYEPTI, Emgality and Aimovig block CGRP, a protein involved in migraine mechanisms.
• Gepants: Oral medications like Nurtec ODT and QULIPTA block CGRP receptors, reducing the occurrence and severity of migraines.
• Botox: Used to prevent headache flares in chronic migraine sufferers, administered through injections around the head and neck. Dr. Santiago Mazuera at Sinai Hospital’s Headache Clinic specializes in this treatment.  

Most patients benefit from a combination of acute and preventive medication.

Support: Navigating Conversations with Your Provider

As a migraine patient herself, Natalie empathizes with the complexities of diagnosis and treatment. “Just because you can’t see a problem on an MRI, doesn’t mean what you’re experiencing isn’t real,” she says.

To make the most of your conversations with a healthcare provider, she recommends:

• Keeping a Headache Diary: Document the number of headaches you have, their symptoms and severity, any medications taken and the effectiveness of those medications. Format it however you like—physical journals, index cards, calendars, mobile apps and more all work.
• Asking Questions: Keep a list of questions between appointments to ensure all important topics are covered.
• Connecting with Specialists: Sinai Hospital’s Headache Clinic has access to specialists in physical medicine and rehabilitation, physical therapy and health psychology. Ask your provider about them!

If you or a loved one are struggling with migraines or severe headaches, don’t hesitate to seek help. Meet our providers or schedule an appointment here!