There are headaches — and then there’s the kind of head pain that makes you want to crawl under the covers and do nothing. If you know what we’re talking about, you’ve likely had a migraine.
Although more than 1 billion people live with migraines worldwide, there’s no cure for the condition. Luckily, there are plenty of ways you can manage — and potentially avoid — migraines and headaches.
We spoke to Dr. Robert Fryer, clinical professor at the Department of Neurology at NYU Grossman School of Medicine, to find out the best ways to manage your headaches at home — and when it might be time to see a doc.
Let’s talk about the differences between headaches and migraines.
We categorize headaches into two main types: primary headache disorders and secondary headache disorders.
A secondary headache disorder is when the headache is caused by some other process going on in the head. For instance, if you have a headache from a sinus infection, and you treat the sinus infection, then the headache will go away.
The other category is primary headache disorders. And that’s where the headache itself is the disease. In this case, you use medicines that directly treat the headache.
The two most common types of primary headaches are tension headaches and migraines. In the neurologist’s office, we don’t really see much in the way of tension headaches because people just take Tylenol and they’re usually fine. It’s really the migraines that are the bad headaches that require workup and treatment.
Are there certain groups that are more susceptible to migraines?
A migraine is a very common disorder. Anywhere from 15% to 20% of the population suffers from migraine. And around three-quarters of them are women.
Before puberty, actually, it’s a little different. It occurs almost equally between boys and girls. In younger kids, it can be slightly more common in boys. But then female hormones that start during puberty definitely drive and can trigger migraines. So, that’s why it becomes a lot more common in women than in men as people get older.
How can a person identify the difference between a migraine and a headache?
A migraine is by definition a moderate to severe headache. So, it’s a kind of headache where it’s hard to do things or, if it’s really bad, you can’t do anything. You just have to lie down in a dark room with a blanket over your head.
But in general, it’s a headache where it’s really hard to get things done and it’s hard to concentrate, hard to work. If you have that a few times, you should definitely get it checked out because there are some very simple things that can be done to make them less bothersome.
What are some of those simple things? How can you address migraine triggers?
There are four main triggers for migraine: hunger, dehydration, stress and lack of sleep. So, I tell people you have to eat regular meals. You’ve got to drink water throughout the day. You have to really do your best to keep a good sleep schedule, and then you have to figure out ways to manage stress.
The next step is that some people with migraines will actually have a specific food that triggers the migraine. It’s not very common, but for some people, for instance, it could be red wine. You’ll have people who drink a glass of red wine and they get a migraine. If you can identify a food trigger, the headaches will actually get a lot better by just eliminating that food.
The best way to identify a food trigger is doing what’s called a headache diary. Whenever you get a headache, you go back and you write down the foods that you ate about five hours before the headaches started. Do that for a few headaches and then you’ll have a good sense as to whether there is a food trigger.
People might think to pop a few Tylenol, like you mentioned, but what are some other options if you feel a headache or migraine coming on?
As someone who ignored their migraines for 30 years or so, I can speak to this pretty well — I would just sometimes take medicine for it and sometimes just ignore it and push through. In general, it’s best to take medicine.
Tylenol, or acetaminophen, is probably the safest but also perhaps less effective than some other options for headache. But if it works for you, stick with it.
Ibuprofen, also known as Motrin or Advil, is an anti-inflammatory. So, that’s usually second on my list to try. Another option is a combination medication such as Excedrin Migraine. And that’s a combination of aspirin, which is an anti-inflammatory, and caffeine. And caffeine can be a pretty strong, abortive medicine for migraine.
You could also take a different anti-inflammatory like naproxen. And that can be pretty effective for some people.
And then there are prescription medicines that can be used. But I only prescribe those if you’ve gone through those other medicines and they don’t seem to work. I find it’s easier to have something at home that you can get over the counter.
Aside from medications, what other treatments are available?
Botox is a newer treatment. It’s a very effective treatment for what we call chronic migraines. Most people have episodic migraines. That’s when you have a horrible headache that lasts for several hours. And then you can go a week or longer before having another one.
Chronic migraines are surprisingly common — as many as 1% of the population has chronic migraines. And that’s defined as at least eight migraines in a month.
These are patients where you think about Botox injections. And those are a series of 31 injections around the face, in the back of the neck or the shoulders, and they’re done every three months. But they’re surprisingly effective for treating chronic migraines.
This interview has been edited for length and clarity.
Robert Fryer, MD, is the clinical professor at the Department of Neurology at NYU Grossman School of Medicine. He is certified by the American Board of Psychiatry and Neurology and specializes in treating migraine, headaches, nerve pain and children.
