Ask Dr. Darria: What Causes Migraines?

Ask Dr. Darria: What Causes Migraines?

Sometimes I get a migraine when it storms, but the weather has been so unpredictable that by the time I realize a migraine is underway it’s too late to stop it. Is there any way to prevent migraines when they can be so sudden?

Migraines. For the 12 percent of the population (17 percent of females) that suffer from these, you know I’m not just referring to any old headache. I’ve dealt with migraines since childhood, but through identifying my triggers (and occasional medication when needed!), I’ve gotten control of them—it’s no longer the other way around.

Unfortunately, I consistently see patients in the ER that are suffering from an intractable migraine—and just desperate for anything to alleviate the pain—so I wanted to share with you some of the tricks and treatments I’ve picked up along the way.

Everyone has different triggers—sleep deprivation, red wine, menstruation or sudden weather changes. Identifying your triggers is the first step to avoiding them. You can start by keeping a migraine journal and watch for patterns, then take some preventive steps.

Some data suggests that 75mg of butterbur root, taken twice daily, may prevent migraines; however, it may have side effects, so talk with your doctor before trying it. Other over-the-counter (OTC) therapies such as coenzyme Q10, feverfew, riboflavin and magnesium have conflicting data, so for now I don’t recommend these. Biofeedback (which teaches you how to control your heart rate, breathing and blood pressure), relaxation techniques (especially if stress is a trigger!) and even acupuncture may help.

Suppose you try these natural remedies but they’re still not enough? One thing many of my migraine-suffering patients don’t realize is that some prescription medications, including propranolol, amitriptyline, valproate and others don’t just treat headaches but can PREVENT them, too. This can be a more reliable way to stop migraines before they start.

If you haven’t tried the preventive route, what can you take once the head-pounding pain starts? Standard OTC medications such as ibuprofen (which decreases the inflammation) or Excedrin Migraine (acetaminophen, aspirin and caffeine combined) are adequate for most people. But if you find yourself needing these medications so frequently that it disrupts your work and your life—say, two or more times per week, regularly—it’s time to talk to your primary doctor about prescription medications that stop or prevent migraine pain. Medications that stop pain could include sumatriptan, dihydroergotamine or some combination of prescription and OTC meds. This treatment can be extremely effective, especially when taken RIGHT as the headache STARTS.

One note of caution: AVOID narcotics. Not only may they create dependence and even addiction, as an ER doctor I see many patients who have been given narcotics (Percocet, Vicodin, hydrocodone) for their headaches or for other medical conditions. These meds can actually cause “rebound headaches,” meaning that as soon as it wears off, your headache comes back—even worse.

If you don’t see significant improvement after a couple of months, no matter which course you take (treatment to prevent or stop migraines), I recommend that you consult a specialist—a doctor certified in headache medicine. You’ll want to be sure to share your migraines journal to help your physician give you the best treatment possible. These resources can help you find a specialist in your area:

Medically reviewed in March 2020.

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