Migraine Headaches

Migraine Headaches Overview

There are many different types of headaches. Although not all headaches are the same, they all share at least one thing in common — they cause pain. But many headaches also cause other unwanted symptoms, including nausea and vomiting. This article addresses the most common headache symptoms associated with the different types of headaches.

Tension Headaches

People with tension headaches commonly report these symptoms:

  • Episodic Tension Headaches (occur less than 15 days per month
  • Pain is mild to moderate, constant band-like pain or pressure
  • Pain affects the front, top or sides of the head
  • Pain usually begins gradually, and often occurs in the middle of the day
  • Pain may last from 30 minutes to several days
  • Chronic Tension Headaches (occur more than 15 days per month)
  • Pain may vary in intensity throughout the day, but the pain is almost always present
  • Pain comes and goes over a prolonged period of time

Associated Symptoms of Tension Headaches include:

  • Headache upon awakening
  • Difficulty falling asleep and staying asleep
  • Chronic fatigue
  • Irritability
  • Disturbed concentration
  • Mild sensitivity to light or noise
  • General muscle aching

Migraines

The symptoms of migraine headaches can occur in various combinations and include:

  • Moderate to severe pain (often described as pounding, throbbing pain) that can affect the whole head, or can shift from one side of the head to the other
  • Sensitivity to light, noise or odors
  • Blurred vision
  • Nausea or vomiting, stomach upset, abdominal pain
  • Loss of appetite
  • Sensations of being very warm or cold
  • Paleness
  • Fatigue
  • Dizziness
  • Fever (rare)
  • Bright flashing dots or lights, blind spots, wavy or jagged lines (aura)

Cluster Headaches

Intense one-sided pain described as having a burning or piercing quality that is throbbing or constant
Pain is located behind one eye or in the eye region, without changing sides.
Pain lasts a short time, generally 30 to 90 minutes (but can last for three hours); the headache will disappear, only to recur later that day (most sufferers get one to three headaches and some up to eight per day during a cluster period).
Headaches occur very regularly, generally at the same time each day, and they often awaken the person at the same time during the night.

Sinus Headaches

Deep and constant pain in the cheekbones, forehead or bridge of the nose
The pain usually intensifies with sudden head movement or straining and usually occurs with other sinus symptoms, such as nasal discharge, feeling of fullness in the ears, fever, and facial swelling.

Migraine Headache Symptoms

Symptoms vary from person to person and from migraine to migraine. Five phases can often be identified:

  • Prodrome: A variety of warnings can come before a migraine. These may consist of a change in mood (for example, feeling “high,” irritable, or depressed) or a subtle change of sensation (for example, a funny taste or smell). Fatigue and muscle tension are also common. In some people, food cravings, constipation, and yawning may precede a migraine.
  • Aura: This is commonly a visual disturbance that precedes the headache phase. Some migraine sufferers develop blind spots (called scotomas); see geometric patterns or flashing, colorful lights; or lose vision on one side (hemianopsia).
  • Headache: Migraine pain usually appears on one side of the head. Sometimes a migraine occur on both sides. Throbbing pain may be present. Most people with migraine headaches feel nauseated, and some vomit. Most also become sensitive to light (photophobia) and sound (phonophobia) during a migraine.This phase may last 4-72 hours.
  • Headache termination: Even if untreated, the pain usually goes away with sleep.
  • Postdrome: Other signs of the migraine (for example, inability to eat, problems with concentration, or fatigue) may linger after the pain has disappeared.

Migraines and several other headache disorders are a real source of pain, but most of the time, they’re not signs that you have a serious medical problem. But when you have new symptoms or problems that are more severe than normal, it’s worth talking to your doctor.

Know your personal headache symptoms — what’s normal for you and what’s not, and when you need emergency help.

The following headache symptoms mean you should get medical help right away:

A sudden, new, severe headache that comes with:

  • Weakness, dizziness, sudden loss of balance or falling, numbness or tingling, or can’t move your body
  • Trouble with speech, confusion, seizures, personality changes, or inappropriate behavior
  • Blurry vision, double vision, or blind spots
  • Fever, shortness of breath, a stiff neck, or rash
  • Headache pain that wakes you up at night
  • Severe nausea and vomiting
  • Headaches that happen after a head injury or accident
  • A new type of headache that starts for the first time after age 55
  • Have headaches that are triggered by coughing, bending, sexual activity or other intense physical activity
  • Have a history of headaches but have noticed a recent change in your symptoms or pattern of attacks

These migraine or headache symptoms don’t need urgent care, but you should let your doctor know if you:

  • Have three or more headaches per week
  • Have headaches that keep getting worse and won’t go away
  • Need to take a pain reliever every day or almost every day for your headaches
  • Need more than two to three doses of over-the-counter medications per week to feel better
  • Have headaches that interfere with your family, work or social life

In some people, certain foods and drinks — or components they contain — can trigger a migraine. One well-accepted migraine trigger is tyramine.

Tyramine is a substance found naturally in some foods. It’s especially found in aged and fermented foods, such as:

  • Aged cheeses
  • Smoked fish
  • Cured meats
  • Some types of beer

Also, foods high in protein may contain more tyramine if:

They have been stored for a long time
They have not been kept cold enough

How Scientists Found a Link Between Tyramine and Headaches

Experts have long known that tyramine can be harmful to people’s health in some cases. Discoveries they made since the 1950s help explain how this ingredient can trigger migraine pain.

Because of its chemical structure, tyramineis called a monoamine. An enzyme in our bodies that breaks down monoamines is called monoamine oxidase (MAO). The enzyme helps process tyramine.

In the 1950s, anti-depression drugs that inhibit MAO went on the market. These drugs, which are still used today, are called monoamine oxidase inhibitors.

Soon after these drugs became available, some people began developing problems when they ate foods containing tyramine while they were taking these drugs. They had headaches as well as high blood pressure.

People taking these drugs can’t break down tyramine properly. As a result, tyramine can get into the bloodstream and raise blood pressure. That’s why people taking these drugs are supposed to limit the foods they eat that contain tyramine.

In the late 1960s, researchers began suspecting that tyramine could also play a role in migraines. One researcher noted that some people with migraines who also had a deficiency of MAO had headaches after they ate foods containing tyramine.

Migraine Research

In a 2010 study, headache researchers talked to 200 people with migraines about factors that triggered their headaches. Eighteen percent reported that their diet could trigger attacks. The specific foods that came up most often included cheese and hot dogs.

Another study from the same year included 126 people who had migraine with an “aura.” It also found that cheese triggered migraines in some people.

Experts are still trying to understand how tyramine can trigger migraines. One explanation is that tyramine can cause nerve cells in your brain to release the chemical norepinephrine. Having higher levels of tyramine in your system — along with an unusual level of brain chemicals — can cause changes in the brain that lead to headaches.

Foods That Contain Tyramine

Here are examples of especially tyramine-rich foods:

  • Aged chicken liver
  • Aged cheese
  • Beer on tap
  • Meats that have been fermented or air-dried, such as summer sausage
  • Red wine
  • Sauerkraut
  • Soy sauce

Other foods that may contain tyramine include:

  • Sauces containing fish or shrimp
  • Miso soup
  • Yeast extract

How to Check if Tyramine May Be Triggering Your Migraine

Keeping a “headache diary” for several months can help you and your doctor determine whether tyramine or some other trigger may be linked to your migraines. Take note of the time and date that a migraine begins. Then answer these questions:

  • How exactly does the migraine feel?
  • If you’re a woman, where does the migraine episode fall in your menstrual cycle?
  • What have you eaten recently?
  • Have you been exposed to other common headache triggers, such as a change in altitude, change in temperature, strong smells, bright lights, loud noises, changes in sleep habits, or unusual stress?

It’s worth remembering that headaches may not begin for 24 hours after you eat certain trigger foods. As a result, including the foods you’ve eaten during the past day or two may help you learn if tyramine could be linked to your migraines.

If you get migraines, one thing’s certain: You want to find a way to stop them. While you feel a migraine in your head, one cause may reside in your mouth and jaw.

You have two temporomandibular joints (TMJs) that connect the sides of your jaw to your skull. They help you open and close your mouth when you talk, eat, and yawn. Pain that starts in those joints or the muscles around them can travel to your skull and lead to a migraine.

Causes

Many things can cause jaw pain. One possibility is that you clench your jaw or grind your teeth. You might clench your jaw throughout the day when you feel stressed. Or you may grind your teeth together at night while you sleep. You may not be aware that you do either of these things.

Signs that you clench your jaw or grind your teeth include:

  • Your teeth are flat, broken, chipped, or loose
  • Your teeth feel more sensitive
  • You have pain or soreness in your jaw or face
  • Your jaw feels tired or tight
  • You have an earache, but there’s no problem with your ears

Another cause of TMJ pain that can lead to a migraine is an issue with your bite. This can happen if you’re missing a tooth or your teeth don’t line up right. A problem with your bite may mean that the muscles in your jaw have to work harder to bring your upper and lower teeth together. Over time, that can become painful.

If you chew gum often, that can lead to TMJ pain, too. Lots of chewing strains your jaw. It’s like lifting a weight over and over again. As a result, you can have pain and soreness in your jaw.

Treatment

If an issue with your TMJ is causing your migraines, your headaches probably will get better when you treat that problem. Your dentist will be able to check your teeth, jaw, and muscles to see what’s causing your pain.

If you grind or clench your teeth, he might recommend a mouth guard that fits over your upper or lower teeth and keeps them apart while you sleep so you can’t grind them together.

These devices are available over the counter. But they can make your problem worse. If they don’t fit well, they can make you clench your teeth even more. It’s much better to have a dentist fit you for a custom mouth guard.

If your teeth don’t line up the way they should, your dentist may suggest dental treatments to correct your bite. This might include crowns, braces, or oral surgery.

Some people grind or clench their teeth because of stress. If you think this may be the case for you, some things, like exercise, therapy, or meditation, can help you manage it.

Other lifestyle changes can make a difference, too:

  • Don’t chew on your fingernails, lips, cheeks, or other objects like pens
  • Use a hands-free device when you talk on the phone to keep pressure off your head and jaw
  • Don’t chew gum
  • Stay away from sticky or crunchy foods that make your jaw work harder
  • Cut food like hamburgers or apples into smaller pieces so you don’t have to take big bites
  • Try to relax your jaw and keep your upper and lower teeth apart during the day

With migraine, one of the best things you can do is learn your personal triggers that bring on the pain. Red wine, caffeine withdrawal, stress, and skipped meals are among the common culprits.

The first step is to track your migraine symptoms in a diary. Note what you were doing before and when your headache came on. What were you eating? How much sleep did you get the night before? Did anything stressful or important happen that day? These are key clues.

Learn Your Triggers

When you look at your diary, you might find that these things tend to lead to a migraine:

  • Stress
  • Menstrual periods
  • Changes in your normal sleep pattern
  • Extreme fatigue
  • Certain foods and drinks
  • Too much caffeine or withdrawal from it
  • Skipping meals or fasting
  • Changes in the weather
  • Exercise
  • Smoking
  • Bright, flickering lights
  • Certain smells

7 Steps to Avoid Your Triggers

Watch what you eat and drink​:​ If you get a headache, write down the foods and drinks you had before it started. If you see a pattern over time, stay away from that item.
Eat regularly. Don’t skip meals.

Curb the caffeine​:​ Too much, in any food or drink, can cause migraines. But cutting back suddenly may also cause them. So try to slowly ease off caffeine if it seems to be one of your headache triggers.

Be careful with exercise​:​ Everyone needs regular physical activity. It’s a key part of being healthy. But it can trigger headaches for some people. If you’re one of them, you can still work out. Ask your doctor what would help.

Get regular shut-eye​: ​If your sleep habits get thrown off, or if you’re very tired, that can make a migraine more likely.

Downsize your stress​:​ There are many ways to do it. You could exercise, meditate, pray, spend time with people you love, and do things you enjoy. If you can change some of the things that make you tense, set up a plan for that. Counseling and stress management classes are great to try, too. You can also look into biofeedback, where you learn how to influence certain things (like your heart rate and breathing) to calm down stress.

Keep up your energy​:​ Eat on a regular schedule, and don’t let yourself get dehydrated.

What to Look for in Foods

These things are migraine triggers for some people:

  • Foods that have tyramine in them, such as aged cheeses (like blue cheese or Parmesan), soy, smoked fish, and Chianti wine
  • Alcohol, especially red wine
  • Caffeine, which is in coffee, chocolate, tea, colas, and other sodas
  • Foods made with nitrates, such as pepperoni, hot dogs, and lunchmeats
  • Bread and other baked goods
  • Dried fruits
  • Potato chips
  • Pizza, peanuts, and chicken livers

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