9 things doctors want you to know about migraines

If you or someone you know has a migraine, it’s no surprise this can be an incapacitating, painful neurologic condition. According to the Migraine Research Foundation, worldwide, migraine is the sixth most disabling illness.

In the United States, nearly 40 million Americans suffer from migraine, with women three times more likely than men to have this disorder.

Treatment is available to ease pain and prevent attacks—including promising new drugs—but many migraine patients remain untreated. Here, three headache specialists share compelling advice for living with migraine.

1. “Your gender could affect how your migraine is treated.”

"Because migraine is so much more common in women than men, men sometimes have trouble getting diagnosed with this disorder," says Dr. Richard Lipton, MD, director of the Montefiore Headache Center in New York.

About 18% of American women have migraine, compared to 6% of men. “When men go to the doctor, they are less likely to be diagnosed because of the perception that migraine is a woman's disease. Yet, when men do get diagnosed, they are more likely than women to receive good treatment,” says Dr. Lipton.

2. “Many people with migraine don’t receive proper treatment.”

“I think migraine is very under-treated,” says Dr. Lipton. A recent migraine research study in which he participated found that only 25% of migraine patients received a correct diagnosis and appropriate treatment. “For chronic migraine, it’s even worse,” he says. “Just 4.5% of chronic migraine patients were treated according to guidelines.”

Lipton explains: the system “breaks at multiple levels, whether it’s having access to a doctor, getting an accurate diagnosis, or receiving optimal treatment. One problem is that more doctors need to be better educated about migraine.”

3. “Migraine treatment should be multifaceted.”

“Migraine management involves using a lot of different tools,” says Dr. Merle Diamond, MD, managing director of the Diamond Headache Clinic in Chicago. A patient’s “migraine toolbox”—or, comprehensive treatment plan—could include a preventive drug and a drug to take when you get a migraine.

“But to me, some of the most important pieces in the toolbox are figuring out that regular sleep is helpful, not skipping meals is helpful, not over-utilizing analgesics or caffeine is helpful,” she says. Also good to include as part of your toolbox is a headache diary in which you track and identify triggers, Dr. Diamond advises.

4. “A new migraine drug helps better prevent attacks.”

New drugs that block a brain chemical associated with migraines came out in 2018, with others expected to follow. Mark W. Green, MD, a headache specialist at Icahn School of Medicine at Mount Sinai in New York City, says he’s seen a positive response for one drug, Aimovig, in some patients “who never responded to anything I used before.”

Some patients—so-called ‘super responders’—have had migraines all but disappear, he says. “We’re not used to seeing that [type of response].” On average, up to 50% of migraines were prevented in patient studies of Aimovig.

5. “Drugs aren’t the only way to treat migraine.”

Want or need to avoid drugs? Biofeedback can be very effective, according to Dr. Diamond. “I call it ‘mindfulness with a computer.’” “Acupuncture from a qualified provider can also be helpful,” she says.

Another alternative: external nerve stimulators, which you place against your head or neck to deliver electric pulses aimed at disrupting pain pathways. Three types of external stimulators have received FDA approval to treat migraine. “They are really, really safe and have proven effectiveness,” says Dr. Lipton. However, insurance doesn't yet cover these, so cost can be a concern.

6. “Migraine is not ‘just a headache.’”

When Dr. Diamond hears people say this, she says, “It makes me crazy. Migraine is a neurologic disorder. It’s the second-most disabling neurological condition.” Besides head pain, sufferers typically have other symptoms too, such as nausea, vomiting and sensitivity to light and sound.

Even if someone’s migraines aren’t severe or frequent initially, “a lot of migraines can progress,” says Dr. Green. “The more you have, the more you are going to get. Failing to take migraine seriously and undertreating it may be very unsafe,” he warns.

7. “Relaxation can be a bigger migraine trigger than stress.”

Stress is well recognized as a potential trigger for migraine attacks. But, according to Dr. Green, relaxing after stress can be an even greater spark. “I have a lot of college patients who worry about their final exams,” he says.

“Typically, they get through them [without migraines]—and then on the train home they get [a bad one].” Or, patients will tell him they get worse headaches on weekends and vacations than during the work week. “People often find that when they're stressed, they’re protected,” says Dr. Green, “and as soon as they relax—whammo!”

8. “Your migraine is not your fault.”

There’s a misconception among patients sometimes that “If they just did things better, they wouldn’t have so many headaches,” says Dr. Diamond. Yet, a patient can follow all recommendations for avoiding triggers and living healthily—eating well, sleeping well, exercising, and hydrating—and still the migraine attacks occur, she says.

“We have to remember it is a genetic disorder with a sensitive brain.” Too often, there’s “a lot of self-blaming that goes on. I really try to encourage my patients to shift the dialogue because it isn’t helpful.”

9. “Educate yourself about migraine and advocate for better care.”

If your headaches are interfering with your life, you should see your primary doctor—and if you can’t get help, seek out a headache specialist. Dr. Lipton recommends keeping a headache diary for a month to help your doctor uncover possible triggers and trends. Also learn about migraine treatments before visiting the doctor so, as Dr. Lipton advises, you can be “prepared to advocate for yourself.”

Migraine, he says, is a “wonderfully treatable disorder. People who are experiencing disabling migraines should maintain hope and advocate for themselves.” Visit the American Headache Foundation online for a list of specialists.