Migraine vs. Komodo Dragon: A Battle of Headache Proportions
If a headache is like an iguana, migraines are like a Komodo dragon. They’re bigger, badder, and hurt a lot when they attack you. Migraines are very common, affecting about a billion people every year [1]. Unlike Komodo dragons, they affect people in every country, and the number of people who experience an attack increases yearly. Migraines are classified as primary headaches (not caused by another underlying condition) that come with at least two of the following criteria: [2]
- Pulsing or throbbing
- Predominantly affecting one side of the head
- Pain that is moderate to severe
- Worsened by or requires avoiding normal activity
Additionally, migraine headaches are accompanied by one or both of these symptoms:
- Nausea and/or vomiting
- Sensitivity to light and/or sound
On the MedEvidence! Podcast [3], Dr. Stephen Toenjes explains that not all of these symptoms are necessary to diagnose a migraine. “The person does not need to have nausea. You don't need to have light and sound sensitivity. As a matter of fact, it's even possible to have a migraine and have no pain.” Additionally, many people experience an aura, which is a disturbance of our senses, speech, muscles, and/or vision (kinda like a Komodo dragon bite) that often precedes a migraine.
Migraine Frequency: Episodic vs. Chronic
Migraines can be differentiated by how often you get them.
Episodic migraines occur for fewer than fifteen days a month [2]. This could be very few per year, all the way to every few days. Episodic migraines can get better (called remission), stay the same, or get worse. Much like venomous lizards, a few migraines are bad news but if you get too many you have a real problem.
Chronic migraines are frequent or constant migraines (with or without aura) that occur for 15 or more days a month. That’s half the days of every month being a headache day. Chronic migraine is somewhat rare, but the definition changed around 2018, which makes exact numbers difficult to come by [4]. Like all migraines, chronic migraines primarily affect women. Around 25% of chronic migraine sufferers go into remission each year and are downgraded to an episodic migraine classification. The other 75% of people with chronic migraines either have stable or worsening migraines and are often dissatisfied with their treatment options [5]. Many find their condition debilitating or disabling [6].
Understanding Migraines
Migraines are complex, and the exact mechanisms are unknown. Several research studies have investigated causes, but since we can’t ethically give people a migraine to compare it to a placebo in a randomized controlled trial, it can be difficult to find definite answers. One theory is that the brain becomes sensitized to pain. Sensitization to pain is when the threshold for pain lowers, making normal things feel painful. When you are sunburned, for instance, your skin is sensitized to pain, which can make things like high fives, lizard claws, and even clothing hurt. This theory states that pain-signaling neurons are sensitized, making you feel pain when there’s no real problem. Some of the risks associated with migraine include: [7]
- Being female
- Genetics
- Obesity
- Metabolic syndrome
- Depression
- Anxiety
- Stress
On top of this, many people have “triggers” that initiate a migraine. These may include specific foods, noises, sleep problems, weather changes, and more.
Treatment options
Targeting Risk Factors
Addressing risk factors like obesity, depression, and stress may help. Additionally, identifying and avoiding triggers can help stop migraines before they start.
Abortive Medications
Abortive medications are designed to rapidly end, or “abort” a migraine. Analgesic medications, like aspirin or ibuprofen, can lower the pain for some people. Others may need migraine-specific medications like triptans or inhaled dihydroergotamine spray. Unfortunately, poorly controlled episodic migraines significantly increase the risks of developing chronic migraines. Overusing these medications (more than 15 days/month of analgesics or more than 10 days/month of triptans) may increase pain sensitization [8, 9]. Ironically, underusing medications for episodic migraine may increase the number of attacks [9]. Clearly, quality care is critical for chronic migraine mitigation.
Preventative Medications
Abortive migraine medications are important, but not the whole story. Preventative medications help stop migraines before they start but require regular use and may have side effects. Randomized clinical trials have found that some preventative treatments, including topiramate, are effective for chronic migraine, though only around one-third of sufferers use them [9]. Botox is another approved option for chronic migraine (not episodic), though its cost can be a barrier for some [10]. There are other treatment options available, with more being investigated through clinical trials [10].
If you are experiencing migraines, talking to an experienced professional is the best way to ensure that care options match your specific needs. With the help of quality care and new medications, we might be able to make migraines as rare as the endangered Komodo dragon.
Staff Writer / Editor Benton Lowey-Ball, BS, BFA
|
Click Below for ENCORE Research Group's Enrolling Studies
|
|
Click Below for Flourish Research's Enrolling Studies
|
[1] Safiri, S., Pourfathi, H., Eagan, A., Mansournia, M. A., Khodayari, M. T., Sullman, M. J., ... & Kolahi, A. A. (2022). Global, regional, and national burden of migraine in 204 countries and territories, 1990 to 2019. Pain, 163(2), e293-e309. https://oce.ovid.com/article/00006396-202202000-00028/HTML
[2] International Headache Society. (2018). 1. Migraine. IHS Classification ICHD-3. https://ichd-3.org/1-migraine/
[3] Koren, M.J. & Toenjes, S. (Hosts). (2024). Two docs talk: Migraines. [Podcast Episode]. In MedEvidence! Truth Behind the Data. MedEvidence. https://medevidence.com/two-docs-talk-migraines
[4] May, A., & Schulte, L. H. (2016). Chronic migraine: risk factors, mechanisms and treatment. Nature Reviews Neurology, 12(8), 455-464. https://www.nature.com/articles/nrneurol.2016.93
[5] Young, N. P., Philpot, L. M., Vierkant, R. A., Rosedahl, J. K., Upadhyaya, S. G., Harris, A., & Ebbert, J. O. (2019). Episodic and chronic migraine in primary care. Headache: The Journal of Head and Face Pain, 59(7), 1042-1051. https://doi.org/10.1111/head.13543
[6] Schürks, M., Rist, P. M., Bigal, M. E., Buring, J. E., Lipton, R. B., & Kurth, T. (2009). Migraine and cardiovascular disease: systematic review and meta-analysis. Bmj, 339. https://www.bmj.com/content/339/bmj.b3914
[7] Amiri, P., Kazeminasab, S., Nejadghaderi, S. A., Mohammadinasab, R., Pourfathi, H., Araj-Khodaei, M., ... & Safiri, S. (2022). Migraine: a review on its history, global epidemiology, risk factors, and comorbidities. Frontiers in neurology, 12, 800605. https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.800605/full
[8] Bigal, M. E., Serrano, D., Buse, D., Scher, A., Stewart, W. F., & Lipton, R. B. (2008). Acute migraine medications and evolution from episodic to chronic migraine: A longitudinal population‐based study. Headache: The Journal of Head and Face Pain, 48(8), 1157-1168. https://doi.org/10.1111/j.1526-4610.2008.01217.x
[9] Mathew, N. T., Kurman, R., & Perez, F. (1990). Drug induced refractory headache‐clinical features and management. Headache: The Journal of Head and Face Pain, 30(10), 634-638. https://doi.org/10.1111/j.1526-4610.1990.hed3010634.x
[10] Lipton, R. B., & Silberstein, S. D. (2015). Episodic and chronic migraine headache: breaking down barriers to optimal treatment and prevention. Headache: The Journal of Head and Face Pain, 55, 103-122. https://doi.org/10.1111/head.12505_2
