Millions of Americans live with undiagnosed migraines and severe headaches. New therapies can help
Headache sufferers know the feeling well: the sudden pain in that certain spot, the throbbing sensation, the need to get away from noise and light. Then the questions start: do I have to take off work? Can I make it to my kid’s soccer game? How long will this headache last?
Neurologist Sarah Benish, MD, is a member of the M Health Fairview Headache Care program. There are many kinds of headaches—including tension headaches, cluster headaches, migraines, sinus headaches and more. Benish partners with patients to help them understand the source of their headaches, identify prevention techniques and develop a treatment plan. She also serves as an associate professor in the Department of Neurology at the University of Minnesota Medical School.
We asked her to answer some frequently asked questions about migraines and headaches for National Migraine & Headache Awareness Month this June. Scroll down to read more.
Find customized headache solutions, specialized care and the latest treatments through the M Health Fairview Headache Care program.
What causes headaches—and why do some people get them while others don’t?
Whether you experience headaches or not, you can thank your parents. Genes play an important role in determining your likelihood of headaches. Past head trauma and injuries or infections that impact the brain can also increase the risk of chronic or severe headaches.
Headaches can also be caused by diet, dehydration, stress levels, sleep deprivation, caffeine withdrawal, certain medications, or hormones. Any person can get a headache from these triggers. People who are more susceptible to headaches may experience them more frequently or with greater severity.
Changes to temperature and atmospheric pressure can also lead to headaches, which is why many people experience headaches in the spring and fall.
Because triggers and symptoms differ for everyone, Benish encourages each person to track their headaches. Knowing your triggers can be a helpful starting point if you choose to seek medical care.
How can I treat headaches at home?
Benish recommends staying hydrated (even if you feel nauseous), staying away from noise or taking a short nap. Some of these may not be realistic with a busy schedule, so many people also use over-the-counter medications.
Medicines like ibuprofen (Advil), acetaminophen (Tylenol) or Excedrin can help relieve headache symptoms. But those medications should be used carefully and with moderation, Benish said. Frequent or prolonged use of some over-the-counter headache medications can contribute to heart or kidney problems. The brain also gets used to these quickly. Over time, their effect will wear off and possibly cause more headaches.
If you are using them, it’s important to inform your primary care doctor, Benish said. Your doctor can advise if these options are right for you. Benish recommends that people never take over-the-counter medicines more than two days a week. If you do, it’s worth seeing a doctor to discuss a different care option.
What about migraines?
Migraines are a leading cause of disability worldwide, impacting nearly one in four U.S. households. They’re severe headaches accompanied by other symptoms. These can include light or sound sensitivity, nausea or vomiting. Migraines are usually associated with a throbbing sensation and may have warning signs – including vision changes or tingling in the hands and feet. Symptoms last at least four hours and can persist for up to three days.
The M Health Fairview Headache Care program was founded in 2019 to help the millions of adults nationwide who suffer from chronic migraines and severe headaches.
Though migraines aren’t fully understood, experts believe they are caused when the pain fibers on the brain turn on and create pain signals. The pain fibers turn on when they interact with two peptides, calcitonin gene-related peptide (CGRP) and Substance P (the ‘p’ stands for pain). These peptides are thought to turn nerve fibers in the body on or off, resulting in symptoms of migraines. They dilate blood vessels, which causes throbbing. They also change how our stomach moves, causing nausea and vomiting. The signals even interact with receptors in our eyes, creating sensitivity to light.
Other types of headaches involve different processes, but it is believed CGRP may still play a role triggering pain.
What are the treatment options for chronic migraines?
As headache research continues to advance, drugs are being developed to target headaches in new ways. In 2018, the Food and Drug Administration approved Monoclonal Antibody Injections to treat chronic migraines. The injections are self-administered every month. The drugs block CGRP and prevent it from triggering the signals that cause migraines. Benish believes these injections could be a game-changer for treating chronic migraines.
Botox is another option. Clinical trials have shown that Botox injections can reduce the number and severity of migraines in patients with a chronic migraine diagnosis. Experts believe Botox may have an anti-inflammatory effect that stops the release of CGRP and Substance P. Botox treatments for chronic migraines involve a series of injections on the head and neck, repeated every 12 weeks.
Triptans are a common class of medication for migraines, but many people are unable to use them due to high blood pressure or certain side effects. Gepants, a new group of acute migraine medications, also target CGRP but have milder side effects. People can take them and often continue to work through a migraine. Patients who have tried triptans in the past and need a different solution can talk with their doctor about this new option.
All three of these emerging treatments are available through the M Health Fairview Headache Care program. Our specialists can also provide referrals to treatment options like physical therapy or chiropractic care for tension headaches and acupuncture for migraines.
When should I seek help for my headaches?
While there is no cure for headaches, M Health Fairview experts, including neurologists and physiatrists, can help people identify solutions that lessen their severity and frequency. Patients don’t need a doctor’s referral to make an appointment, though it’s best to check with your insurance to find out if you need one for coverage.
Occasionally, headaches can be a sign of another medical issue. Consider making an appointment if you experience any of the following:
- Headaches accompanied by neurologic symptoms, like numbness, dizziness, or weakness
- New or different headaches you’ve never had before, especially after age 50
- Headaches that awaken you from sleep
- Headaches accompanied by a fever
- Worsening headaches over time
- Headaches that happen only when you’re in a certain position (for example, lying down)
- Headaches that happen only with bearing down, coughing, or sneezing
- Someone experiencing a headache that comes on suddenly, where the pain goes from one to 10 in under a minute, should go to the emergency department
Are headaches interrupting the life you want to live? Do you have to miss work or cancel social plans because of headaches or migraines? If so, the M Health Fairview Headache Care team can work with you to discuss the right treatment options, backed by leading-edge science.
