Harpreet Sandhu, MD, is a neurologist and clinical neurophysiologist with HonorHealth Neurology. She also completed a second fellowship in integrative medicine, to help provide her patients with additional therapeutic options and resources. She shares her knowledge of headaches and migraines in this Q&A.
Q: What are some of the most common causes of migraine headaches, and how can someone determine what triggers their headaches?
A: About 75% of patients report at least one known trigger for an acute migraine attack. Typical migraine triggers include stress, hormonal changes in women, missing meals, lack of sleep or sleep disturbances and weather. Certain foods like chocolate, cheese, MSG and alcohol are common triggers, as are certain odors and lights. Hereditary and environmental factors also play a role, especially in women, and can run in families.
Everyone has different triggers, which is why tracking your migraines with a migraine journal is an important strategy toward personalizing your treatment plan.
Q: How can someone tell the difference between a headache and a migraine?
A: Migraine headaches are a specific class of headaches with defined diagnostic criteria. Migraine without aura is the most common type, accounting for approximately 75% of cases. They are episodic, severe, recurrent attacks typically associated with noise and light sensitivity and nausea.
The International Classification of Headache Disorders (ICHD-3) criteria for migraine without aura include:
- At least five headache attacks lasting four to 72 hours with at least two of the four following characteristics: unilateral location, pulsating quality, moderate or severe pain intensity, or aggravation by or causing avoidance of routine physical activity
- At least one of the following: nausea, vomiting or both, photophobia (light sensitivity), or phonophobia (noise sensitivity)
Q: Are there things people can do to prevent headaches, or lessen their severity if they feel one coming on?
A: Try applying ice to your head or resting in a dark, quiet room. Sleep can also offer some relief. Many integrative medicine approaches can also be used as nonpharmacological treatment options or as adjunctive therapy, including relaxation therapy or cognitive behavioral therapy, biofeedback, acupressure/acupuncture, meditation, yoga and massage therapy.
Q: Can nutrition or exercise habits make a difference in headache prevention?
A: Absolutely. Headaches can be prevented by maintaining hydration, regular sleep and meal schedules, aerobic exercise and stress management. Keeping a migraine journal may help identify behavioral, environmental or food-related triggers. I also recommend you quit smoking and limit your caffeine intake, which are known triggers. Supplements like magnesium and riboflavin may also help prevent migraines in some people.
Q: When should someone consider seeing a doctor for headaches?
A: When headaches are becoming more frequent, more severe and more debilitating to where they are affecting quality of life or aren’t responding to treatment, make an appointment to see your doctor. Other indications include new onset headache after 50 years of age, changes in pattern or new features associated with headaches such as speech changes, numbness, weakness or vision loss, fever, stiff neck or mood/personality changes.
Q: If someone suffers from persistent headaches, what are some treatment options?
A: There are many treatment options for prevention and acute rescue treatment. Choosing the appropriate treatment is based on multiple factors, including other medical issues, current medication usage, lifestyle factors and personal preferences. You’ll want to have an open and informative discussion with your doctor and work together to create an effective treatment plan.
Dr. Sandhu treats headaches and many other conditions at HonorHealth Neurology. Other areas of expertise include neurophysiology, electromyography, neuromuscular medicine, epilepsy, multiple sclerosis, movement disorders, dementia and cerebrovascular disease.