If you have migraine headaches or other severe headaches, talking to your doctor or a headache specialist is the first step to getting treatment and feeling better. But one doctor’s visit might not be enough to clear up all of your uncertainty around your headache condition.
That’s why we asked our medical advisors some of the most common questions their headache patients ask, so you don’t have to wait any longer to get the answers you need.
Migraine expert and Cove medical advisor Dr. Philip Bain says that many of his patients want to know why they’re suffering from severe headaches.
And let’s face it. If you get extreme headaches, you know how painful and isolating they are, and how easy it is to feel hopeless when your treatments aren’t working. It’s reasonable to wonder why migraines are happening to you.
“Migraine is a very common disorder,” says Dr. Bain, “12% of the general population suffers from them. 18% of women get them.”
Doctors aren’t certain what causes migraines, but they do know there could be a genetic component and that women are more likely to suffer from migraines. Your migraine could be triggered by your lifestyle too. Stress, diet choices, alcohol and caffeine intake, irregular sleep, weather changes, and other things can be related to your migraines.
When it comes to other types of headaches, they can be triggered by a variety of things too. Tension headaches, for example, might be caused by grinding your teeth, straining your eyes, and more.
Know that, whatever the cause, you’re not alone, and talking to your doctor will take you closer to a treatment that makes you feel better.
In other words, what the heck is happening when I get a migraine? What causes my symptoms?
The thing is, though scientists have identified many of the triggers that can bring on a migraine and know who is at higher risk to get them, they still aren’t 100% sure exactly what happens in your body when you experience a migraine.
Researchers used to think they were a result of changes in blood flow, but according to a physician at Johns Hopkins, it’s more complicated. Now, scientists believe that migraines are caused by nerves firing throughout your brain and causing “cortical spreading depression.” This wave of nerve activity leads to changes in your brain’s blood vessels and inflammation, which gives you a headache.
Even though we have a lot to learn about migraines and other headache types, the good news is that doctors have treatment options that work.
Not all patients experience migraines exactly the same way, and no two people will notice the same warning signs that a migraine is coming. For example, your attack might start with visual aura (or other visual disturbances, like flashing lights), nausea, sensitivity to lights and sounds, brain fog, or the pain may simply gradually set in.
Whatever your first migraine symptoms are, how do you know when to take your acute medication?
Migraine expert and Cove medical advisor, Dr. Sara Crystal notes that, “oftentimes, patients wait to take acute treatments, sometimes holding out to see if the headache will resolve on its own.”
But that may not be the best strategy. “The earlier one treats a migraine,” says Dr. Crystal, “the more likely it is to respond to medication, so I don’t recommend waiting to treat.”
What does that mean if you have several options for migraine treatment to choose from?
Dr. Crystal suggests that, if the migraine feels mild (or if you tend to get less intense migraines), start with an anti-inflammatory like Naproxen. If your headache feels moderate or severe, start with your triptan treatment, like sumatriptan. Also, if you typically get an aura that is followed by headache pain, go ahead and take a triptan when your aura comes on. (However, Dr. Crystal recommends that if you take injectable triptans, “which are metabolized quickly,” wait to take until the pain starts.) And, if you experience nausea with your migraines, she suggests taking an antiemetic (a.k.a anti-nausea medication).
“All of these are okay to mix,” says Dr. Crystal, “so if you take naproxen and the pain persists, take sumatriptan.”
For Dr. Crystal, it’s important that you talk with your doctor about how soon you’ll start to see an improvement. “I explain to patients that improvement is a gradual process—your migraines didn’t begin overnight and they likely won’t be fixed overnight either.”
She lets patients know how long they should expect to wait to start to feel the effects of their treatment. With preventive medications, she says that “it can take several weeks at an effective dose to improve, and it may take a few weeks to gradually reach the effective dose in order minimize side effects.”
Make sure to check with your doctor, since your specific treatment may come with its own timeline.
This is an important question to ask. You may have heard about medication overuse headaches, or “rebound headaches,” as a possible result of taking too much migraine medication.
Dr. Crystal notes that, “neurologists have long advised patients to limit the use of certain acute medications (including triptans) to avoid rebound headaches.”
However, a 2017 study in Neurology challenged our understanding of medication overuse headaches, calling out a lack of evidence that overusing medication actually causes frequent headaches. That, coupled with the fact that stopping the medications doesn’t stop the headaches for most patients, calls some of these long-standing notions into questions, says Dr. Crystal.
Still, medications that have opiates and caffeine do cause rebound headache if you use them too often, “so I definitely advise using these sparingly, if at all,” Dr. Crystal says.
Dr. Crystal adds, “I hear from a number of patients who experience rebound headaches with frequent triptan use,” so, to be on the safe side, she advises, “limiting their use to two days per week on average.” To avoid overusing triptans, she prescribes over-the-counter NSAIDs for mild or moderate migraines (which don’t cause rebound), and saving triptans for severe headaches.
Dr. Bain goes on to add that “a good rule of thumb is that if you’re having to use your acute medication more than two days a week, you should speak to your doctor to see if a preventative strategy is right for you.
Typically, migraines last 4-72 hours, but what if your migraine goes on for longer than three days?
When that happens, you’re experiencing a type of migraine called status migrainosus.
Status migrainosus is incredibly frustrating, to say the least, since it can seem to get better only to come back on after a break. It can be caused by overusing medication, but it can also be triggered by other factors, like weather changes, hormones, illnesses (such as the flu or a sinus infection), stress, and traumas (such as sinus, tooth or jaw surgeries, or head and neck trauma), states the National Headache Foundation.
Dr. Crystal says that if you’re experiencing status migrainosus, “You may need treatment aimed at breaking a headache cycle, such as steroids, anti-inflammatories, anti-nausea medications like metoclopramide, and injectable medications.”
To get help and identify the right treatment to break your migraine, you’ll need to see your doctor.
Sometimes the pain of a migraine can feel unbearable, and you might wonder if it’s dangerous or becoming an emergency.
Dr. Crystal notes that you need to go to the emergency room immediately if you have a very “severe headache that comes on suddenly, known as thunderclap onset,” or if your headache has “new neurological symptoms, or fever and neck stiffness.”
That said, she adds that, “the ER is not the ideal place for a migraineur,” since you’ll be dealing with a long wait in a noisy environment, and lots of bright lights. “If your neurologist offers IV treatments in the office and you can avoid the ER, that is ideal.”
A quick internet search will reveal infinite migraine home remedies and natural treatments that sufferers swear by, but where do you start?
Dr. Crystal recommends a few supplements that have been known to be helpful:
“Magnesium probably as the most evidence of effectiveness,” she notes. And there are ways to get magnesium other than taking a supplement. Dr. Crystal recommends eating foods rich in magnesium, such as greens, nuts and seeds.
As a rule of thumb, bake sure to talk to your doctor before starting a treatment, even if it’s considered homeopathic.
Just because a treatment is “natural” or unregulated by the FDA doesn’t necessarily mean it’s totally safe.
Dr. Crystal notes butterbur as one example. It’s “a natural product shown to be effective for migraine prevention,” she says, “but it contains a compound that can cause liver toxicity, so it’s very important to use a reliable brand that properly extracts the dangerous compound.”
Other natural treatments may not be recommended for you if you have other conditions or are pregnant, so make sure to talk to your doctor before taking something for your headaches.
We investigated common alternative treatments for migraines, to give you guidance on what might work and what to avoid.
With all of your options for migraine treatment, how do you know if you should avoid taking certain ones at the same time?
As Dr. Crystal mentioned, it’s usually safe to combine naproxen, triptans, and anti-nausea medications. That said, “you should avoid mixing two different triptans (such as sumatriptan and rizatriptan) within 24 hours, and do not take dihydroergotamine (DHE, Migranal) within 24 hours of a triptan.”
She also notes that a general best practice to avoid mixing two different types of anti-inflammatories in a 24-hour window.
(Here’s what to do if you’ve maxed out on your treatment doses and it’s still not working.)
To make your migraine treatment more effective, or while you’re waiting for it to kick in, Dr. Crystal suggests a few lifestyle changes you can make to start feeling better:
To learn more about what’s bringing on your migraines, read up on common migraine triggers. We researched the best home remedies for migraines, so read up for more ideas on lifestyle changes that could be helpful.
The information provided in this article is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon the content provided in this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.
Sumatriptan and rizatriptan are oral medications indicated for the acute treatment of migraine with or without aura in adults and not for the prophylactic therapy of migraine attacks or for the treatment of cluster headache. Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using either of these drugs while you are pregnant. Tell your doctor if you are breast-feeding. Call your doctor right away if you have chest, throat, neck, or jaw tightness, pain, pressure, or heaviness; break out in a cold sweat; shortness of breath; a fast heartbeat; a heartbeat that does not feel normal; or very bad dizziness or passing out. Very bad and sometimes deadly brain blood vessel problems like stroke have rarely happened with this drug. Call your doctor right away if you have weakness on 1 side of the body, trouble speaking or thinking, change in balance, drooping on 1 side of the face, or change in eyesight. You can read more about sumatriptan’s side effects, warnings, and precautions here. Full prescribing information for sumatriptan is available here. You can read more about Rizatriptan side effects, warnings, and precautions here. Full prescribing information for rizatriptan is available here. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch: https://www.fda.gov/Safety/MedWatch/default.htm or call 1-800-FDA-1088.
Naproxen is an oral medications used to ease pain, swelling, and fever. This drug may raise the chance of heart and blood vessel side effects like heart attack and stroke. If these happen, they can be deadly. The risk of these side effects may be greater if you have heart disease or risks for heart disease. However, the risk may also be raised in people who do not have heart disease or risks for heart disease. The risk of these health problems can happen as soon as the first weeks of using this drug and may be greater with higher doses or with long-term use. This drug may raise the chance of very bad and sometimes deadly stomach or bowel side effects like ulcers or bleeding. The risk is greater in older people. The risk is also greater in people who have had stomach or bowel ulcers or bleeding before. These problems may occur without warning signs. If you are pregnant or you get pregnant while taking this drug, call your doctor right away. Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby. You can read more about naproxen’s side effects, warnings, and precautions here. Full prescribing information for naproxen is available here. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch: https://www.fda.gov/Safety/MedWatch/default.htm or call 1-800-FDA-1088.