Pain in the Head: Treating and Preventing Migraines

Published on: November 06, 2020

While medical professionals haven’t discovered the underlying cause of migraines there are treatments and prevention methods to help sufferers manage their daily lives.  

By Neuroscience Center Bumrungrad International Hospital  

Many people experience this painful, pumping feeling in the head: a pulsating headache in one half of the head, lasting from a few hours to three or many days.  

As if the pain is not enough, the headache may be accompanied by nausea, vomiting and sensitivity to light, sound or smell.  

These recurrent headaches, which are moderate to severe, can be diagnosed as a medical condition called migraine. And while a regular headache can disappear with a walk or physical activity, a migraine is usually made worse if the sufferer tries to be active and move.    

What causes migraines?

To this day the underlying causes of migraines are not known. However, they are believed to be a mixture of environmental and genetic factors. Migraines run in families and in about two-thirds of cases, family members are affected. In more rare cases migraines occur due to a single gene defect.  

Once it was even assumed that migraines are more common in highly intelligent people. But a migraine is no indication of intelligence. However, some psychological conditions are associated with migraines, including depression, anxiety and bipolar disorder. Additionally, many biological events or triggers can cause migraines.  

What happens in the brain when you have a migraine?

Migraines are believed to be a neurovascular disorder. This means the condition is most likely relating to blood vessels and blood nerves in the brain. Evidence supports a mechanism that starts within a part of the brain and then spreads via blood vessels and nerves.  

Some studies say that blood vessels play the key role while another theory suggests more complex, abnormal brain processes are the principal cause of a migraine.  

Who is most likely to suffer from migraines?

Migraines are two to three times more common in women than men. Young children usually don’t suffer from migraines. The condition usually develops during the teenage or middle-age years. Overall, migraine headaches are the second most common type of headache behind tension-type headaches.  

Is it possible to treat migraines successfully?

There is no miracle cure to heal migraines. Chronic migraines, however, can be controlled by adequate self-care and proper medication. Additionally, it is common for symptoms to subside as the patient ages.

The treatment of migraines has made great strides over the years and can be divided into two categories:

  1. During acute migraine attacks, pain medication, such as paracetamol and non-steroid anti-inflammatories (NSAIDs) is given. Such medication is given as early as possible after symptoms occur. Active substances will be activated in the bloodstream directly.

  2. If a patient suffers from frequent or very severe migraine attacks, it is advised to take medication daily to prevent migraines. More than two attacks per month are considered to be a severe migraine.

  Additionally, medicines for reducing nausea and vomiting can be prescribed, including antidepressant and appetite-stimulating medication.  

Migraine attacks that occur during menstruation are a special case. Patients are usually prescribed NSAID medication which should be consumed two to three days before menstruation commences until four to five days after menstruation stops.  

What are treatment options for migraines?

 In general, however, neurologists consider three main aspects of treatment:  

  1. Trigger avoidance
  2. Acute symptomatic control
  3. Prevention

Trigger avoidance

 There are five different types of migraine triggers: emotional, physical, dietary, environmental and medical triggers.  

Emotional triggers can be stress, anxiety, tension, shock, depression and excitement.  

Physical triggers can be tiredness, poor-quality sleep, shift work, poor posture, neck or shoulder tension, jet lag, low blood sugar and strenuous exercise (if a person is not used to it).  

Dietary triggers can be missed, delayed or irregular meals, dehydration, alcohol, caffeine products (such as coffee and tea), specific foods (such as chocolate and citrus fruits). Foods containing the substance tyramine such as cured meats, yeast extracts, pickled herrings, smoked fish (like smoked salmon) and certain cheeses (such as cheddar, stilton and camembert) may also trigger migraines.  

It is also advisable to consume foods that have been stored at room temperature rather than being refrigerated or frozen, since the latter can lead to increased levels of tyramine.  

Environmental triggers can be bright lights, flickering screens, smoking or smoky rooms, loud noises, changes in climate (such as changes in humidity or very cold temperatures), strong smells and a stuffy atmosphere.  

Medical triggers can include sleeping tablets, contraceptive pills and hormone replacement therapy (HRT) which is sometimes used to relieve symptoms associated with menopause and andropause.  

Acute symptomatic control

 Medications for acute symptomatic control are more effective if used earlier in an attack. The frequent use of such medications, however, may result in medication overuse headaches, in which the headaches become even more severe and more frequent. Due to these concerns, doctors carefully weigh up which medications to prescribe and in what dosage.  

Recommended initial treatment for those with mild to moderate migraines usually consists of simple analgesics, such as NSAIDs or the combination of paracetamol, aspirin and caffeine.  

Triptans such as sumatriptan are effective for both pain and nausea in up to 75 percent of migraine sufferers.  

In the most severe cases, older medications such as ergotamine and dihydroergotamine are prescribed. However, these medicines can cause vasospasm (narrowing of arteries) and are contraindicated in people with coronary artery disease.  


Prevention is recommended in those who have migraine headaches more than two days a week and who cannot tolerate the medications used to treat acute attacks. Preventive treatment is also advised for patients with severe attacks that are not easily controlled.  

The goal of preventive treatment is to reduce the frequency, painfulness and duration of migraines while increasing the effectiveness of abortive therapy. Another reason for prevention is to avoid medication overuse headaches.  

Preventive treatment of migraines includes medications, nutritional supplements, lifestyle alterations and in rare cases, surgery. Recommended lifestyle changes consist of stopping tobacco use and receding behaviors that interfere with sleep.  

How long does treatment take?

The length of treatment depends on how strong and how often the patient suffers from migraine attacks. Generally, it’s recommended to try six months of prevention medications in cases of strong and regular attacks. In milder cases, pain medication for each attack may be sufficient enough together with long-term trigger factors avoidance and lifestyle changes. Keep in mind though that it may take several weeks before migraine symptoms begin to improve after the first intake of prevention medications.  

Avoiding specific triggers such as stress or certain types of food may help reduce the patient’s risk of experiencing migraines. It also helps to maintain a healthy lifestyle, including regular exercise, sleep and meals as well as ensuring to stay hydrated and limiting the intake of caffeine and alcohol.  

Alternative therapies

 In addition to the methods listed, alternative therapies can also be used. Acupuncture has shown to have a small effect in reducing the number of migraines. Patients must be aware of sham acupuncture where needles are placed randomly or do not penetrate the skin.  

Tentative evidence also supports the use of stress reduction techniques such as cognitive behavioral therapy, biofeedback and relaxation techniques.  

Additionally, regular physical exercise may decrease the frequency and severity of migraines.  

Among alternative medicines, there is tentative evidence that coenzyme Q10 may reduce migraine frequency. Furthermore, melatonin may be added for the prevention and treatment of migraines. Study results are inconclusive. It is assumed that improved sleep and anti-inflammatory properties might have a direct impact on migraine easing.  

There are even medical devices, such as biofeedback and neurostimulators, which are said to offer some advantages in migraine prevention.

A final recommendation

 Aside from proper medical treatment, these common rules are recommended for easing and preventing migraines:

  • Identify and avoid factors that trigger migraine headaches
  • Get plenty of rest and have a healthy sleep pattern
  • Exercise regularly without overexerting
  • Try not to smoke 
  • Try avoiding caffeinated beverages such as coffee, tea, soda and energy drinks.

  Images supplied by the author.

The views expressed in the articles in this magazine are not necessarily those of BAMBI committee members and we assume no responsibility for them or their effects. BAMBI News welcomes volunteer contributors to our magazine. Please contact