Migraine Myths

Migraine affects 12 % of the world’s population. It is present in 25 % of women and 6% of men. It is a chronic, episodic neurologic disorder that makes 91% of persons disabled and unable to function when in the midst of a migraine.

For women, migraine is their most common medical problem, more common than hypertension, arthritis, overweight, and diabetes. In spite of all that is written, everyone’s migraine is specific and different to themselves.

Although there are a number of books, magazine articles, webinars, lectures, podcasts, and YouTube videos on the subject, there is still a lot of wrong thinking about migraine. Migraine is poorly understood by persons without migraine and there is a lot of misunderstanding. What are thesemigraine myths?

Confused about what migraine really is? Read my article, “What is Migraine?” on my website, www.doctormigraine.com

This is an article by Britt Talley Daniel MD, retired member of the American Academy of Neurology, Migraine textbook author, Podcaster, YouTube video producer, and Blogger.

Migraine Myths:

Migraines are easily treated by over-the counter-drugs.

Alas, no, that is wrong and unfortunately the majority of persons with migraine, or about 70% of them, have never had a diagnosis of migraine made by a doctor nor given a prescription for migraine treatment.

Therefore, over the counter drugs are the only viable options for many persons with migraine. They are denied taking one of the 30-year-old triptans, which work the best for migraine treatment, especially if taken at the onset of a migraine.

Read my Mini book on Migraine-Click Here

Rare migraineurs have their migraine headache eliminated by using an over-the-counter drug, like Excedrin, Advil, or Aleve. The real problem for many is that they will treat their continuing migraine headache with Excedrin for too long and develop medication overuse headache.

The number one diagnosis for a person who sees a headache doctor is medication overuse headache.

Migraines are not easily treated by over-the-counter drugs.

Read my article on “Do Prescription Drugs For Migraine Work Better Than Over-The -Counter Drugs” on my website, wwwdoctormigraine.com

Persons with migraine can just ignore their headaches and get on with their lives.

Migraine is the second cause of disability in the world. It is the first cause of disability for young women. This is the reality of how serious a medical problem migraine is. Affected victims have severe headaches which throb and sensitivity to light and sound.

Migraine is made worse by being up and about and persons with migraine want to lie down in a quiet, dark room. Migraine turns on the nausea/vomit center in the brain so that affected persons feel sick at their stomach, truly a miserable human feeling and they spend time leaning over their commodes vomiting all stomach foodstuffs, then bile, then they have dry heaves.

All these symptoms are very limiting, rather terrible medical symptoms.

Persons with migraine can not ignore their headache and get on with their lives.

If you have a bad migraine, you should miss work or school, or childcare and just stay home.

The luxury of just staying home, lying in bed, and doing nothing is not available to most adults who have responsibilities and things they just have to do. Many of them just drag themselves to the office to work, although their performance is poor, or go to the grocery store and shop, because their families need to eat, or get in long pick-up lines at school to retrieve their children.

Migraine is three times more prevalent in women than in men and it is usually the women of the world who attend to the responsibilities mentioned above. Only their worst migraines disable women and compel them to get their husbands to take them to the ER for acute treatment.

Migraine patients hang on and do what is expected of them, even while suffering terrible symptoms and distress.

Migraines just last a few hours or a day.

The International Classification of Headache Disorders states that an individual migraine may last 4 to 72 hours. 72 hours is 3 days. Persons with a diagnosis of chronic migraine have, by definition fifteen or more headache days per month, eight of which have migraine features.

Most of those with chronic migraine are overtreating with headache medication and also have medication overuse headache with daily headaches for months or years.

As a headache doctor I have seen many patients with chronic migraine who had daily headaches for years. This comment plugs into the reality of migraine treatment in the US, 70% of migraine patients have never had a diagnosis or modern headache treatment and so all that is left to these unfortunate persons is to use over the counter drugs, or else search the internet for treatment, which is often supplements or diets that are ineffective.

 Despite its prevalence, many people still do not understand the reality of migraine and what it is like to live with the condition, and this lack of understanding can unfortunately give way to misconceptions or assumptions that are not just inaccurate, but hurtful. Living with a lifelong disease can already be incredibly difficult to manage. But add on the stigmas and misunderstandings surrounding the condition and navigating life as a migraineur can become even tougher.

Read my article on “Medication Overuse Headache” on my website, www.doctormigraine.com.

All migraines are the same.

No, just like all persons differ from one to another. Some migraines only appear as Abdominal migraine in children or teenagers who have rare or no headache but significant GI symptoms of nausea and vomiting. Children with abdominal migraine outgrow their GI symptoms by their early twenty’s but many of them just go on to having regular migraines during their adult lives.

Some persons have plain old, what used to be called, “Common Migraine” which is now called Migraine without aura and these persons have typical migraine features. Others may have what used to be called “Classical Migraine” but is now referred to as Migraine with aura. These persons usually have a premonitory visual aura of seeing zig zag lines, spots or holes in their vision that is followed by a typical migraine headache.

Some Migraine with aura patients may have one arm/face same side numbness or trouble talking, called aphasia.

Seventy percent of women with migraine may experience their headache 2 days before or during menstruation. Some migraineurs have early morning or middle of the night migraine occurrence, while some have trouble and attacks with exercise or during sex.

Some have a migraine event with barometric pressure change, and others with eating certain foods such as cheese, chocolate, or MSG. Although the relationship of migraine attack to food and alcohol are difficult and with some questionable veracity. There is a lot written about alcohol but the most common alcohol drink aggravating migraine is red wine.

Some persons with migraine have terrific motion sickness, which may not be so bad for other migraine patients.

Some migraine patients have “let down” headaches on the weekend or on holiday, while others have headache with stress or recent freedom from stress.

All the variables mentioned above comment on how migraines are not the same. Migraine is a complicated, multifaceted neurological problem with many different symptoms and possible migraine event scenarios.

Making lifestyle changes will cure migraine.

It is true that most all migraine patients will fare better with their headaches if they are do the migraine lifestyle. This incorporates aerobic exercise, normal sleep schedule, avoiding migraine triggers, like red wine, if that is a personal trigger, decreasing stress as much as possible, avoiding daily caffeine and limiting headache medication to no more than 2 days a week.

However, migraine treatment is just not that easy and many migraineurs still need help, often specialist migraine doctor help along with medication trials of acute and preventive medication to get their headaches under control.

Read my article on “Lifestyles For Migraine Prevention” on my website, www.doctormigraine.com.

Migraine is just a headache.

This comment might have come from one of those “I never had a headache in my life” persons who are not very sympathetic to migraine suffers in their life and have no idea of what migraine is really like. Give them one bad headache and they will know the truth.

Migraine is a psychological problem.

Well, migraine is comorbid, a term that means exists along with, many psychiatric syndromes. Migraine and depression are 50% comorbid, while migraine and panic disorder and generalized anxiety disorder are 40% comorbid. Migraine is also common with bipolar disorder.

But migraine and these conditions are not caused one to another. Migraine and these psychiatric illnesses are related by genes and family and since the number one lifestyle issue driving migraine is stress, then the natural stress of depression or anxiety can drive migraine.

Read my article “Migraine and Depression”, on my website, www.doctormigraine.com.

Headache is the only symptom of migraine.

The normal lay concept of migraine is that it is a headache related medical problem, but then some persons with migraine may have motion sickness in the back seat of a car and not have a headache. Some persons with migraine with aura may have a visual attack in mid to later life and not have headache with it.

With a migraine headache there may be nausea, vomiting, dizziness, confusion, vertigo, photophobia, sonophobia, osmophobia, tiredness, need to sleep or lie down, irritability, flickering zig zag visual aura, numbness of one arm and same side cheek and tongue, aphasia, lightheadedness, and fainting.

This is a large gamut of symptoms related to migraine.

All Migraines Come with Auras

Twenty to thirty percent of persons with migraine have a migraine headache with aura, but the remaining eighty to seventy percent who have migraine and headache without aura do not.

Some persons experience a visual aura without headache. They would be classed as having migraine with aura. The classical case is a postmenopausal woman past 50 years old.

This used to be called “migraine sine hemicrania” where sine is Latin for “without” and hemicrania refers to the migraine headache part, but ICDH-3 calls this” Typical aura without headache.” This is also called “silent” migraine and “acephalic” migraine.

Read my article, “Migraine With Aura” on my website, www.doctormigraine.com.

If You Do not Get a Headache, You Don’t Have a Migraine

No, not true-as mentioned above, migraine with aura persons may just have the aura with no headache.

Only Women Get Migraines

Women have migraine three times more often than men and the findings there are that 25% of women have migraine, while 6% of men have migraine. The reason for this difference is not fully understood but may relate to estrogen/menstruation/pregnancy issues.

I have personally seen many men with migraine and for them, like for all, migraine occurrence is a genetic, family issue.

Only Adults Get Migraines

No, Abdominal migraine in children and teenagers is considered to be a type of migraine (and the majority do develop plain old migraine when older.)  Also, many children and teenagers have migraine. There are rare reports of infants with migraine in the literature.

Read my article on “Abdominal Migraine” on my website, www.doctormigraine.com.

All Migraines Are Caused by Stress

Stress is the major trigger or lifestyle issue for migraine causation. But stress is not the only issue.

List of Common Migraine Triggers:

Stress/nervous excitement

Freedom from stress—letdown/weekend/holiday headache

Menstruation with fluctuating estrogen levels

Elevated estrogen level from birth control pill or treatment of postmenopausal women

Hypoglycemia from fasting

Barometric weather change

Motion sickness

Mountain sickness/decompression illness

Insomnia

Over-sleeping or napping

Nocturnal end of a dream headache

Fragrances

Flashing/flickering/fluorescent light

Dietary factors

Heat/sun/workout headache

Intercourse/Orgasm

Overuse of analgesics

Head injury/concussion/post-concussion

Fever

Caffeine withdrawal

Wine/beer/alcohol/hangover headache

Brain freeze/ice cream headache

Toothache/grinding with TMJ syndrome

Prolonged overexertion

There Are No Treatments for Migraines

Of course, there are treatments for migraine and they have existed since antiquity. Current treatment comments would be:

Do the Migraine lifestyle

Use a fast-acting triptan at migraine onset, like sumatriptan or zolmitriptan. Triptans are generic and covered by most major insurance plans. Triptans are still the best acute therapy drugs for migraine, but they do not work for 20-30% of persons and other drugs may be tried here, such as Timolol eyedrops, DHE nasal sprays, Nurtec ODT, Elyxyb, Qulipta, Trudhesa, or Reyvow.

If migraines occur more than 3-4 times per month or with a previous event of medication overuse headache, or personal preference-insurance requires failing 1-2 of the older, cheaper, generic drugs-amitriptyline, Inderal, Depakote, topiramate. If these drugs fail then doctor may order one of the CGRP drugs, such as Aimovig, Ajovy, or Emgality.

Diet Changes Always Prevent Migraines

Results on diets for migraine are specious and more research is needed. As a general, rule the treatment of Migraine triggered by food is clinically identifying the specific food that causes headache for that person and then avoiding eating it.

Treatment for this is still an uncertain medical situation and trial and error identification of the food that triggers migraine for that person and then avoiding consuming that food trigger is the best approach.

Read my big book on Migraine-Click Here

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Although this site provides information about various medical conditions, the reader is directed to his own treating physician for medical treatment.

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All the best.

Britt Talley Daniel MD