The Role of Stress
Although stress is often the culprit in tension headaches, Lavin says, "Stress can certainly precipitate migraines." Since women are most likely to get migraines between the ages of 15 and 55, and that's also the time in their lives when they are juggling careers, children, and marriage, the role of stress cannot be ignored.
The stress-migraine link is further supported by a 1999 article in the journal Headache. In the report, Dr. Randolph W. Evans of the University of Texas at Houston described migraine patients who linked their headaches to crying. Nothing happened when they cried from happiness, cutting onions, or in response to a movie, but tears of sadness or frustration inevitably led to a migraine attack. Many stress-induced migraine sufferers report relief by changing jobs, committing to a regular exercise regimen, establishing regular bedtimes, and practicing yoga or stress reduction.
In addition to reducing stress, there are two paths to migraine treatment, prevention and pain relief, and most people employ both techniques. One form of prevention is to simply avoid migraine triggers whenever possible. For some people, that means cutting red meat, chocolate, and coffee from their diets. Others avoid flying in airplanes because their migraines are triggered by drastic changes in altitude and barometric pressure. Migraineurs can also take preventative medications like Topiramate and Depakote—drugs that are also used to treat epileptic seizures and depression.
Just as each patient reacts to unique migraine triggers, individuals respond differently to a variety of headache treatments. Lavin says, "Aspirin works for some people. For other people you need more potent medications." Most doctors recommend patients try over-the-counter remedies such as Ibuprofen and acetaminophen first, but those don't always help. Some people react well to drugs known as ergotamines which constrict the blood vessels in the brain and reduce a migraine's signature throbbing pain.
A new class of drugs called triptans came on the scene about 12 years ago to the relief of many migraineurs. Triptans, marketed under names like Imitrex and Zomig and only available by prescription, also constrict blood vessels, as well as behave like the chemical serotonin to calm inflamed nerve endings in the brain, effectively halting an attack before it can run its course. Triptans work so well for some people, that instead of being sidelined for hours or days by a migraine, they are up and back to work in as little as an hour.