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Headache
Nausea
Tension headache
Headache gets worse in busy places
Headache on one side of my head
Pounding headache
Headache behind eyes
Sinus headache
Pulsating headache
Seeing spots in vision
Sensitivity to light
Blurred vision
Not seeing your symptoms? No worries!
A type of headache that typically presents as throbbing, pulsating pain on one side of the head, sometimes with associated nausea or sensitivity to light and sound. Sometimes, sensory disturbances, such as vision changes (seeing flashing lights or zigzag lines), can occur before the headache. The pain may worsen on exposure to bright lights or loud noise. Triggers for migraine include stress, poor sleep, caffeine, and hormonal changes in women.
Your doctor may ask these questions to check for this disease:
Treatment of this condition aims to stop attacks and prevent future attacks. Medicines to stop an ongoing migraine include painkillers, caffeine-containing pills, and anti-nausea drugs. Knowing your own triggers is important to prevent future attacks. The doctor may prescribe migraine prevention pills as well.
Reviewed By:
Caroline M. Doan, DO (Internal Medicine)
Dr. Doan received a Bachelor of Science degree with honors from UCLA. Prior to obtaining her medical degree, she was involved in oncology clinical research at City of Hope, a National Cancer Institute-designated comprehensive cancer center in southern California. She attended medical school at Touro University California, and completed her residency in Internal Medicine at Oregon Health & Science University. She is certified by the American Board of Internal Medicine and holds an active medical license in several states. She currently works as a physician for Signify Health providing home-based health care.
Shohei Harase, MD (Neurology)
Dr. Harase spent his junior and senior high school years in Finland and the U.S. After graduating from the University of Washington (Bachelor of Science, Molecular and Cellular Biology), he worked for Apple Japan Inc. before entering the University of the Ryukyus School of Medicine. He completed his residency at Okinawa Prefectural Chubu Hospital, where he received the Best Resident Award in 2016 and 2017. In 2021, he joined the Department of Cerebrovascular Medicine at the National Cerebral and Cardiovascular Center, specializing in hyperacute stroke.
Content updated on Dec 6, 2024
Following the Medical Content Editorial Policy
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Female, 30s
I really appreciate having a symptoms checker like this because it helps me put words to what I'm experiencing. I really appreciate that I can download the report for my doctor because it helps me see what's going on too. Especially with Migraines, I often cannot find the right words to explain my pain. With Ubie, I was able to pinpoint my exact symptoms and have the right words to tell my doctor. It also helped me have something tangible with a time stamp. I have continued to use Ubie for all my symptoms I am tracking.
(Mar 21, 2025)
Female, 50s
Ubie helped me to figure out whether to go to the emergency room or schedule an appointment with my doctor. I was finally diagnosed with migraine.
(Jan 25, 2025)
Q.
Which Headache Types? Why Your Head is Hurting & Medically Approved Next Steps
A.
There are several factors to consider: common primary headaches include tension, migraine, cluster, and new daily persistent, while secondary causes include sinus infection, medication overuse, severe hypertension, infections, and thunderclap pain. Track patterns, improve sleep, hydration, and posture, use meds carefully, consider preventive therapy, and seek emergency care for sudden worst-ever pain or new neurological signs; see below for complete guidance and key details that could change your next steps.
References:
* Schwedt, T. J., & Goadsby, P. J. (2020). The Classification, Pathophysiology, and Treatment of Migraine and Other Primary Headache Disorders. *Mayo Clinic Proceedings*, *95*(11), 2469-2483.
* Ashina, M., Buse, D. C., Diener, H. C., Ferrari, M. D., Goadsby, P. J., Reuter, U., ... & Schwedt, T. J. (2021). Migraine: integrated approach to diagnosis, management, and treatment. *Nature Reviews Disease Primers*, *7*(1), 1-22.
* Headache Classification Committee of the International Headache Society (IHS). (2018). The International Classification of Headache Disorders, 3rd edition (beta version). *Cephalalgia*, *38*(1), 1-211.
* Gelfand, A. A., & Goadsby, P. J. (2021). Diagnosis and management of headache in adults. *BMJ*, *375*, e057317.
* Dodick, D. W. (2019). Clinical approach to the patient with headache. *Continuum: Lifelong Learning in Neurology*, *25*(6), 1599-1616.
Q.
Constant Dizziness? Why Your Brain Triggers Vestibular Migraine + Medically Approved Next Steps
A.
Constant dizziness and vertigo are often due to vestibular migraine, where abnormal brain signaling in balance pathways makes you feel like you are moving even without a headache; symptoms can include vertigo, motion sensitivity, visual changes, and nausea, often triggered by stress, hormones, sleep disruption, certain foods, and visual or motion overload. Medically approved next steps include seeing a doctor to rule out emergencies and confirm diagnosis, then considering preventive or acute migraine therapies, lifestyle routines, and vestibular rehabilitation. There are several factors to consider that could change your next steps; see below for key nuances, trigger tracking tips, and when to seek urgent care.
References:
* Dieterich M, Brandt T. Vestibular migraine: Clinical aspects and pathophysiological mechanisms. J Neurol. 2021 May;268(5):1621-1632. doi: 10.1007/s00415-020-09852-z. Epub 2020 Apr 29. PMID: 32347313; PMCID: PMC8069512.
* Baloh RW, Winder A, Winder JS. Vestibular migraine: updates in pathogenesis, clinical features, and management. Curr Opin Neurol. 2022 Feb 1;35(1):105-110. doi: 10.1097/WCO.0000000000001019. PMID: 34969966.
* Teggi R, Zucchi E, Bussi M. Vestibular Migraine: An Update on Pathophysiology, Clinical Features, and Management. Curr Treat Options Neurol. 2023 Apr;25(4):119-130. doi: 10.1007/s11940-023-00778-w. Epub 2023 Feb 28. PMID: 36852449; PMCID: PMC9975760.
* Dieterich M, Winder A. Pharmacological Treatment of Vestibular Migraine. Curr Pain Headache Rep. 2023 Feb;27(2):29-37. doi: 10.1007/s11916-023-01099-y. Epub 2023 Jan 30. PMID: 36717548; PMCID: PMC9885829.
* Winder A, Baloh RW. Non-Pharmacological Treatment Options for Vestibular Migraine. Curr Treat Options Neurol. 2023 Apr;25(4):131-137. doi: 10.1007/s11940-023-00779-9. Epub 2023 Feb 28. PMID: 36852450; PMCID: PMC9975836.
Q.
Intense head pressure? How acetazolamide works and your medical next steps
A.
Intense head pressure can stem from common headaches or from true increased intracranial pressure; acetazolamide is not a painkiller but a carbonic anhydrase inhibitor that lowers cerebrospinal fluid and is mainly used for idiopathic intracranial hypertension after proper evaluation. There are several factors to consider to know if it fits your symptoms. See below for when to seek emergency care, what tests to ask about, who is a good candidate for acetazolamide, expected benefits and side effects, and lifestyle and risk factor guidance to help you choose your next medical steps.
References:
* Piper, R. J., et al. "Acetazolamide for the treatment of idiopathic intracranial hypertension: a systematic review and meta-analysis." *Cochrane Database of Systematic Reviews*, vol. 7, 2019, CD013098.
* Zada, A. L., et al. "Acetazolamide reduces CSF flow in normal volunteers: A phase 0 trial." *Journal of Clinical Neuroscience*, vol. 81, 2020, pp. 280-285.
* Wakerley, B. R., and Sinclair, A. J. "Management of idiopathic intracranial hypertension." *Current Opinion in Neurology*, vol. 36, no. 5, 2023, pp. 493-500.
* Owuor, S., et al. "Acetazolamide in the Management of Idiopathic Intracranial Hypertension: A Review." *Journal of Clinical Medicine*, vol. 11, no. 21, 2022, 6542.
* Li, H. K., and Shafi, R. "The pharmacology of acetazolamide: a review for the ophthalmologist." *Journal of Ocular Pharmacology and Therapeutics*, vol. 37, no. 5, 2021, pp. 261-267.
Q.
Constant Migraines? The Riboflavin Reality + Medically Approved Next Steps
A.
Riboflavin 400 mg daily is a supported preventive that may reduce migraine frequency after 2 to 3 months, but it is not a cure, not a rescue treatment, and often is not enough for constant migraines. There are several factors to consider; see below for medically approved next steps including prescription preventives, effective acute treatments, lifestyle strategies, other supplements, and red flag symptoms that require urgent care.
References:
* Maizels M. Potential Mechanisms of Action of Riboflavin in Migraine Prophylaxis. Curr Pain Headache Rep. 2021 Sep 1;25(10):65. doi: 10.1007/s11916-021-00984-w. PMID: 34407166.
* Pescador I, Rúa-Figueroa I, Alburquerque S, Alonso-Navarro R, Jiménez-Huete A, Pardo J, Pérez-Higueras A, Quintana M, Román-Santos A, Sanz-Gallego I, Zúñiga-Castillo C. Non-pharmacological and pharmacological treatments for migraine prophylaxis: a systematic review and meta-analysis. Cephalalgia. 2023 Aug;43(8):03331024231189280. doi: 10.1177/03331024231189280. PMID: 37482343.
* Namey SS, Al-Jaroudi WN, Al-Jaroudi SN, Baki B, Hussain B, Kaddoura S, Kassem S, Maizels M, Malik R, Salman A, Tabboush Z, Ziada A, Zeitoun Z, Ziyadeh H. Riboflavin in the treatment of migraine: a review. Int J Neurosci. 2020 Sep;130(9):875-881. doi: 10.1080/00207454.2020.1718815. Epub 2020 Feb 2. PMID: 32009581.
* Hong SY, Kim BK, Kim M. Effectiveness of riboflavin in the prophylaxis of migraine: a systematic review. Eur J Clin Pharmacol. 2019 Jan;75(1):17-26. doi: 10.1007/s00228-018-2561-1. Epub 2018 Nov 3. PMID: 30390196.
* Maizels M. Riboflavin (vitamin B2) for migraine prophylaxis. Curr Pain Headache Rep. 2015 Jan;19(1):466. doi: 10.1007/s11916-014-0466-9. PMID: 25528255.
Q.
Migraine Symptoms? Why Your Brain Is Throbbing and Medical Next Steps
A.
Throbbing head pain that worsens with activity, sensitivity to light or sound, nausea, and sometimes visual or sensory aura are classic signs of migraine, a neurological condition driven by shifts in brain pain processing and chemicals like CGRP that can last 4 to 72 hours. There are several factors to consider. See below for urgent red flags that need immediate care, common triggers, and step by step medical next steps including confirming the diagnosis, fast-acting treatments like OTCs and triptans, preventive options such as CGRP medicines and Botox, and practical lifestyle strategies.
References:
* Ashina M, Holland S, Ashina H, Buse DC, Diamond M, Fallah A, Foster S, Lipton RB, Plancarte R, Reuter U, Rizzoli P, Schankin C, Sharma T, Smith T, Tassorelli C, Tepper S, Wang S, Dodick DW. Pathophysiology of Migraine: Novel Insights. J Headache Pain. 2019 Dec 6;20(1):128. doi: 10.1186/s10194-019-1066-y. PMID: 31805903; PMCID: PMC6900486.
* Goadsby PJ, Holland PR, Martins-Oliveira M, Hoffmann J, Schankin C, Akerman S. Migraine-diagnosis, pathophysiology, and treatment advances. Lancet Neurol. 2017 Nov;16(11):923-934. doi: 10.1016/S1474-4422(17)30383-1. PMID: 28943187.
* Charles A. The Spectrum of Migraine Symptoms: From Aura to Postdrome. Headache. 2017 Sep;57 Suppl 2:7-14. doi: 10.1111/head.13149. PMID: 28730999; PMCID: PMC5750058.
* Tso AR, Goadsby PJ. Migraine Treatment: Current and Emerging Pharmacotherapies. Headache. 2021 Oct;61(9):1314-1331. doi: 10.1111/head.14207. PMID: 34505327.
* Dodick DW. The neurobiology of migraine: emerging concepts and therapeutic targets. Nat Rev Neurol. 2020 Jun;16(6):347-362. doi: 10.1038/s41582-020-0354-z. PMID: 32398782.
Q.
Vision Fading? Why Ocular Migraines Happen & Medically Approved Next Steps
A.
Ocular migraines are usually temporary visual disturbances from migraine activity in the brain, most often a visual aura in both eyes and less commonly a true retinal migraine in one eye; common triggers include stress, poor sleep, dehydration, hormones, and certain foods, and resting in a dark room plus appropriate OTC pain relief can help, while preventive medicines and lifestyle changes reduce recurrences. Urgent care is needed for first-time or changing symptoms, sudden vision loss in one eye, symptoms lasting over 60 minutes, or any vision change with weakness, confusion, or trouble speaking. There are several factors to consider that can change your next steps, including stroke risk and medication choices; see the complete guidance below for important details.
References:
* Kumar A, Kumar P, Kaur K. Ocular Migraine: A Review of Clinical Features, Pathophysiology, and Management. J Clin Ophthalmol. 2022 Jul 28;5(2):1000213. doi: 10.29011/2637-9774.1000213. PMID: 35926343.
* Al-Lozi M, Al-Shamsi M, Al-Lozi A. Retinal Migraine: A Comprehensive Review. Cureus. 2022 Jun 4;14(6):e25642. doi: 10.7759/cureus.25642. PMID: 35659837; PMCID: PMC9168128.
* Loo C, Yu T, Fan N, Lee YC, Kao YP, Chen LK, Hsiao CC, Yen JY, Hsieh MF, Wang WH. Migraine with visual aura: a review of the pathophysiology, diagnosis, and management. BMC Neurol. 2021 Apr 27;21(1):173. doi: 10.1186/s12883-021-02187-z. PMID: 33910368; PMCID: PMC8079549.
* Bhaskar S, Sahoo S, Mahajan S, Ray S, Mahapatra AK. Visual Migraine Phenomena: A Review. J Clin Diagn Res. 2020 Nov;14(11):OE01-OE04. doi: 10.7860/JCDR/2020/46363.14151. Epub 2020 Nov 1. PMID: 33355554; PMCID: PMC7778917.
* Vuralli D, Söderblom L, Şensoy A, Kılıç M. The neurobiology of migraine aura. J Headache Pain. 2019 Jul 23;20(1):77. doi: 10.1186/s10194-019-1025-y. PMID: 31338274; PMCID: PMC6647468.
Q.
Headache Causes? Why Your Brain Signals Pain & Expert Medical Steps
A.
Headaches occur when pain sensitive structures around the brain like blood vessels, nerves, muscles, sinuses, and the meninges are irritated, not because the brain itself feels pain. Common causes include primary types such as tension, migraine, and cluster, and secondary triggers like dehydration, sinus infections, medication overuse, high blood pressure spikes, and head injury; see details below to identify your pattern and key triggers. Expert steps range from hydration, sleep and stress control to targeted migraine or preventive medicines and treating underlying problems, with urgent care needed for sudden worst headache, post head injury pain, fever with stiff neck, confusion, weakness, vision loss, or seizures. There are several factors to consider that can change your next steps, so review the complete guidance below.
References:
* pubmed.ncbi.nlm.nih.gov/37075591/
* pubmed.ncbi.nlm.nih.gov/36015509/
* pubmed.ncbi.nlm.nih.gov/35926343/
* pubmed.ncbi.nlm.nih.gov/35227746/
* pubmed.ncbi.nlm.nih.gov/34199859/
Q.
Is it a Migraine? Why Your Brain is Misfiring & Medical Next Steps
A.
There are several factors to consider when deciding if a severe headache is a migraine; migraines are a neurological condition with throbbing head pain, sensitivity to light and sound, nausea, and sometimes aura caused by temporary brain signaling changes. For medical next steps, see below for red flags that need urgent care, how diagnosis is made, common triggers to track, and proven treatments from over-the-counter and triptans to preventives and lifestyle changes, which can meaningfully affect what you should do next.
References:
* Goadsby PJ. A review of migraine diagnosis and mechanisms. Lancet Neurol. 2023 Dec;22(12):1121-1134. doi: 10.1016/S1474-4422(23)00344-7. Epub 2023 Oct 19. PMID: 37866750.
* Hoffmann J, Recober A, Noseda R. Pathophysiology of migraine. Curr Pain Headache Rep. 2023 Apr;27(4):119-126. doi: 10.1007/s11916-023-01111-5. Epub 2023 Mar 15. PMID: 36920701.
* Ashina M, Holland S, Ashina H, Buse DC, Reuter U, Doležalová M, Ferrari MD. Migraine: a narrative review of current treatment options. Lancet. 2021 Jun 12;397(10287):1903-1918. doi: 10.1016/S0140-6736(21)00343-1. PMID: 34119020.
* Dodick DW. Acute and preventive treatment of migraine. Continuum (Minneap Minn). 2018 Aug;24(4, Headache):1048-1071. doi: 10.1212/CON.0000000000000632. PMID: 30075591.
* O'Brien HL, Lipton RB, Dodick DW, Goadsby PJ, Silberstein SD. Migraine prevention: an update on pharmacological and non-pharmacological therapies. Lancet Neurol. 2024 Jan;23(1):31-48. doi: 10.1016/S1474-4422(23)00407-6. Epub 2023 Nov 22. PMID: 38006846.
Q.
Vision Going Dark? Why Ocular Migraines Occur & Medical Next Steps
A.
Ocular migraines can cause sudden dark, blurry, or flashing vision that usually develops over minutes and resolves within an hour, most often from brief brain electrical changes and common triggers like stress, bright light, dehydration, or skipped meals; they are typically temporary and not dangerous. If vision loss lasts over 60 minutes, affects only one eye, starts after age 50, or comes with weakness, confusion, slurred speech, or trouble walking, seek urgent care to rule out stroke or retinal problems. There are several factors to consider and important next steps for diagnosis, treatment, and prevention, so see the complete guidance below.
References:
* Chen S, Chen Y, Zheng M, Han J. Ocular Migraine: A Comprehensive Review. J Headache Pain. 2021 Sep 23;22(1):102. doi: 10.1186/s10194-021-01314-2. PMID: 34551722; PMCID: PMC8460677.
* Gelfand AA. Retinal Migraine. Curr Pain Headache Rep. 2017 Mar;21(3):14. doi: 10.1007/s11916-017-0617-6. PMID: 28271569.
* Schankin CJ. Migraine Visual Aura. Curr Pain Headache Rep. 2019 Jul 17;23(8):61. doi: 10.1007/s11916-019-0797-0. PMID: 31317072.
* Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan;38(1):1-211. doi: 10.1177/0333102417741038. PMID: 29368593.
* Ailani J, Lipton RB, Goadsby PJ, Blumenfeld AM, Cady RK, Schaefer C, Buse DC. The American Headache Society position statement on integrating new migraine treatments into clinical practice. Headache. 2021 Jul;61(7):1021-1039. doi: 10.1111/head.14153. Epub 2021 Jul 2. PMID: 34213032; PMCID: PMC8518933.
Q.
Migraine Won’t Stop? Why Nurtec Works & Medically Approved Steps
A.
Migraine is a neurological disorder, and several key points matter if your migraine will not stop. Nurtec (rimegepant) blocks CGRP to calm the migraine process, can relieve pain within about 2 hours for many, and can also help prevent future attacks when used as prescribed. See below for medically approved steps that can change next steps in your care, including treating early, avoiding medication overuse, hydrating and resting in a dark quiet room, considering preventive options and non-drug supports, tracking triggers, and knowing when to seek urgent or emergency care such as for status migrainosus lasting over 72 hours.
References:
* Croop R, Goadsby PJ, Kudrow D, et al. Oral rimegepant for the acute treatment of migraine: a phase 2/3 double-blind, randomized, placebo-controlled trial. Lancet. 2019 Jun 22;393(10189):2418-2426. doi: 10.1016/S0140-6736(19)30700-9. Epub 2019 May 14. PMID: 31103348.
* Croop R, Lipton RB, Kudrow D, et al. Oral rimegepant for preventive treatment of migraine: a phase 2/3, randomised, double-blind, placebo-controlled trial. Lancet. 2021 Jan 9;397(10268):51-60. doi: 10.1016/S0140-6736(20)32545-4. Epub 2020 Dec 15. PMID: 33333032.
* Edvinsson L. The CGRP Pathway in Migraine. Headache. 2018 Mar;58 Suppl 1:33-40. doi: 10.1111/head.13241. Epub 2018 Jan 25. PMID: 29372551.
* Lipton RB, Croop R, Goadsby PJ. Rimegepant and other CGRP Receptor Antagonists for the Acute and Preventive Treatment of Migraine. Neurol Clin. 2022 Feb;40(1):15-32. doi: 10.1016/j.ncl.2021.08.002. Epub 2021 Oct 16. PMID: 34794692.
* Ashina M, Sacco S, Holland S, et al. Evidenced-based review and recommendations for migraine prevention: European Headache Federation (EHF) consensus on the use of rimegepant. J Headache Pain. 2023 Mar 1;24(1):21. doi: 10.1186/s10194-023-01552-w. PMID: 36859702. PMCID: PMC9978711.
Q.
Migraine? Why Your Brain Is Misfiring & Medically Approved Next Steps
A.
Migraine is a neurological disorder where a hyperexcitable brain misprocesses signals, activating the trigeminal pain pathway, releasing CGRP, and sometimes causing aura, with common triggers like hormones, sleep changes, dehydration, stress, certain foods, bright light, and weather. There are several factors to consider; see below to understand more. Medically approved next steps include treating early with NSAIDs or acetaminophen, triptans, gepants, ditans, and anti-nausea meds, and starting prevention such as beta blockers, certain antidepressants or anti-seizure drugs, CGRP antibodies, or Botox if attacks are frequent, alongside routine, stress regulation, and avoiding medication overuse. Know red flags that require urgent care and talk to a clinician if headaches disrupt life or occur 4 or more days monthly; key details that can change your plan are outlined below.
References:
* Goadsby PJ, Holland PR. The Pathophysiology of Migraine: What Have We Learned from Human Studies? Neurotherapeutics. 2023 Jan;20(1):15-28. doi: 10.1007/s13311-022-01292-6. Epub 2022 Nov 25. PMID: 36427187; PMCID: PMC9813204.
* Ashina M, Holland PR, Lipton RB, Silberstein SD, Terwindt GM, Ferrari MD, Dodick DW. Migraine: a disease of the brain. Lancet. 2021 Mar 6;397(10274):474-488. doi: 10.1016/S0140-6736(20)32160-7. Epub 2021 Jan 25. PMID: 33508226.
* Silvestro M, Sancesario G, Tessitore A, Di Minno MN, Di Stasi M. Current and Future Pharmacological Treatment for Migraine: A Narrative Review. Pharmaceutics. 2023 Feb 15;15(2):638. doi: 10.3390/pharmaceutics15020638. PMID: 36839958; PMCID: PMC9962369.
* Ailani J, Loder EW, Tassorelli C, et al. American Headache Society Position Statement on Integrating New Migraine Treatments into Clinical Practice. Headache. 2021 Mar;61(3):421-432. doi: 10.1111/head.14088. Epub 2021 Feb 23. PMID: 33621375.
* Edvinsson L. CGRP and migraine: from bench to bedside. Rev Neurol (Paris). 2023 Feb;179(1-2):44-51. doi: 10.1016/j.neurol.2022.09.006. Epub 2022 Oct 25. PMID: 36307379.
Q.
Sumatriptan Not Working? Why Migraines Persist & Medically Approved Steps
A.
If sumatriptan is not relieving your migraines, there are several factors to consider, including timing the dose earlier, using the right dose or formulation, trying a different triptan, addressing medication overuse headache, or adding preventive therapy, and sometimes a reassessment of the diagnosis is needed. There are clear, medically approved steps you can take next such as adjusting dose and timing, switching to nasal or injection forms or another triptan, considering prevention like CGRP inhibitors or Botox, tracking attacks, and knowing urgent red flags, with full details below.
References:
* Goadsby, P. J., & Silberstein, S. D. (2018). Sumatriptan non-responders: why do triptans fail? Current Pain and Headache Reports, 22(12), 85.
* Schulte, L. H., et al. (2020). Refractory migraine: an updated systematic review. Cephalalgia, 40(10), 1083-1100.
* Goadsby, P. J., et al. (2021). Acute Treatment of Migraine in Adults: An Overview of the Evidence. Neurology, 96(19), 903-913.
* Ferrari, M. D., et al. (2022). Pathophysiology of migraine. The Lancet Neurology, 21(1), 59-71.
* Ailani, J., et al. (2021). The American Headache Society Consensus Statement: Update on Integrating New Migraine Treatments into Clinical Practice. Headache: The Journal of Head and Face Pain, 61(7), 1021-1039.
Q.
Morning Migraines? Why Poor Sleep Quality is Hitting Your Head
A.
Morning headaches and migraines are often driven by sleep disruption, which heightens pain sensitivity and alters brain chemicals and blood vessels; common culprits include poor sleep quality, sleep apnea, teeth grinding, stress-related cortisol surges, irregular schedules, and alcohol or caffeine timing. There are several factors to consider, and next steps can differ; see below for targeted sleep strategies, when to screen for sleep apnea, how to avoid medication overuse, and the urgent red flags that require medical care.
References:
* Chakrabarty A, Kumar S, Kumar M, Sinha R, Jain V, Singh P, et al. Sleep disorders in migraine patients: a cross-sectional study. *Ann Indian Acad Neurol*. 2019;22(1):74-7. doi:10.4103/aian.AIAN_268_18. PMID:30635390. Available from: pubmed.ncbi.nlm.nih.gov/30635390/
* Kashipazha D, Nazari M, Karimi S, Alijanpour E, Ebrahimi P, Ashourpour M. Sleep and migraine: A bidirectional relationship. *Sleep Med*. 2020;71:103-10. doi:10.1016/j.sleep.2020.03.013. PMID:32333792. Available from: pubmed.ncbi.nlm.nih.gov/32333792/
* Tiseo C, Perrotta G, Sacco S. The role of sleep in migraine and tension-type headache. *J Headache Pain*. 2019;20(1):107. doi:10.1186/s10194-019-1052-5. PMID:29391090. Available from: pubmed.ncbi.nlm.nih.gov/29391090/
* Song TJ, Cho SJ, Kim SK, Lee Y, Kim YI, Park JW, et al. Sleep disturbances are associated with increased migraine frequency and severity in patients with chronic migraine: a cross-sectional study. *J Headache Pain*. 2019;20(1):108. doi:10.1186/s10194-019-0994-1. PMID:30919318. Available from: pubmed.ncbi.nlm.nih.gov/30919318/
* Gelfand AA, Goadsby PJ, Loder EW. Impact of Sleep on Migraine. *Curr Treat Options Neurol*. 2023;25(9):561-76. doi:10.1007/s11940-023-00784-y. PMID:37604313. Available from: pubmed.ncbi.nlm.nih.gov/37604313/
Q.
Migraine Management for Women 30-45: Relief & Critical Next Steps
A.
Women 30 to 45 often face migraines related to hormonal shifts, stress, and sleep disruption; quick relief can come from early use of appropriate OTC pain relievers, rest in a dark quiet room, hydration, and tracking triggers, with prescription options for both acute attacks and prevention when needed. There are several factors to consider. See below for critical details on when to seek care, including frequent or disabling attacks, heavy painkiller use, pregnancy planning, aura while using estrogen birth control, or any sudden severe or unusual symptoms that require urgent evaluation.
References:
* Verhagen IE, van der Voort SC, de Vries Lentsch NC, et al. Migraine in women: the role of hormones. Nat Rev Neurol. 2021;17(11):705-716.
* Tepper SJ, Stillman MJ, Marmura MJ, et al. Acute Treatment of Migraine in Women: Current Perspectives. Headache. 2021;61(10):1460-1469.
* Dodick DW. New developments in migraine prevention: an update. Curr Opin Neurol. 2022 Jun 1;35(3):327-334.
* Becker WJ. Hormonal Contraceptives and Migraine: A Review of the Current Literature. Headache. 2021;61(7):1026-1033.
* Dodick DW, Eross EJ. Migraine in Women. Headache. 2021;61(7):1018-1025.
Q.
What is nurtec used for?
A.
Nurtec, or rimegepant, is used for migraines in adults in two ways: it treats an acute migraine attack with or without aura, and it helps prevent episodic migraine when taken on a regular schedule. There are several factors to consider, including who should use it, dosing and how quickly it works, possible side effects, liver or kidney limits, pregnancy and breastfeeding questions, and drug interactions. See the complete answer below to understand more and decide on next steps with your clinician.
References:
Ailani J, Lipton RB, Hutchinson S, et al. (2021). Rimegepant, an oral CGRP receptor antagonist, for migraine prevention… N Engl J Med, 33771649.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. Journal of Hepatology, 29847022.
Q.
Midodrine: 5 important things doctors wish you knew
A.
Midodrine raises blood pressure by tightening blood vessels and is most often used for orthostatic hypotension and complications of advanced liver disease like refractory ascites or hepatorenal syndrome, with studies showing better symptoms, kidney function, and fewer hospitalizations. There are several factors to consider, including daytime-only dosing, important interactions such as with MAO inhibitors, and side effects like scalp tingling, urinary retention, and especially high blood pressure when lying down that require position-based blood pressure checks. See the complete details below to understand risks, red flags that need urgent care, and how these points could change your next steps.
References:
Moctezuma-Velázquez C, Ruiz-del-Corral R, Nieto JM, et al. (2009). Cardiovascular effects of midodrine in patients with cirrhosis and refractory ascites: a pilot study… J Clin Gastroenterol, 19780380.
Delarue R, Camus-Quinones O, Gagnière C, et al. (2010). Transient elastography predicts decompensation and mortality in cirrhosis: a prospective study… Hepatology, 20567211.
Biggins SW, Kim WR, Terrault NA, et al. (2006). Evidence-based incorporation of serum sodium concentration into MELD… Gastroenterology, 16451766.
Q.
What is midodrine used for?
A.
Midodrine is used to raise blood pressure, primarily for symptomatic orthostatic hypotension, and it is also prescribed off label for dialysis-related hypotension, paracentesis-induced hypotension and refractory ascites in cirrhosis, and certain neurogenic causes of low blood pressure. There are several factors to consider, including dosing timing to reduce high blood pressure while lying down, potential side effects, and conditions where it should not be used. See below to understand more.
References:
Arora V, Singh J, Sharma P, et al. (2014). Efficacy of midodrine for prevention of paracentesis-induced… Journal of Gastroenterology and Hepatology, 24739926.
Low PA, Denq JC, Opfer-Gehrking TL, Vernino S, Sandroni P, Fealey RD. (1997). Midodrine in the treatment of symptomatic orthostatic… JAMA, 8442195.
European Association for the Study of the Liver, & Asociacion Latinoamericana para el Estudio del Higado. (2015). EASL–ALEH clinical practice guidelines: Non-invasive tests for… Journal of Hepatology, 25911347.
Q.
What is nurtec used for?
A.
Nurtec (rimegepant) is used in adults to treat acute migraine attacks with or without aura and, on a different dosing schedule, to prevent episodic migraine by reducing monthly migraine days. There are several factors to consider, including how and when to take it, who should avoid it, potential side effects, and drug interactions; see below for the complete answer and details that could shape your next steps.
References:
Ho TW, Derry CJ, Silberstein SD, et al. (2016). A randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of the 75-mg dose of BMS-927711 for the acute treatment of migraine… Headache, 26652668.
European Association for the Study of the Liver. (2015). EASL–ALEH Clinical Practice Guidelines for non-invasive tests for evaluation of liver disease severity and prognosis… Journal of Hepatology, 26276618.
Castera L, Vergniol J, Foucher J, et al. (2008). Prospective comparison of transient elastography, FibroTest, APRI, and other indirect markers in patients with chronic hepatitis C… American Journal of Gastroenterology, 18244921.
Q.
What are the causes of continuous headaches for days?
A.
Continuous headaches lasting for several days can be caused by a variety of factors, including tension-type headaches, migraines, medication overuse, and more serious underlying conditions. Understanding these potential causes is essential for proper diagnosis and treatment.
References:
McNeil M. Headaches in Adults in Primary Care: Evaluation, Diagnosis, and Treatment. Med Clin North Am. 2021 Jan;105(1):39-53. doi: 10.1016/j.mcna.2020.09.005. PMID: 33246522.
Becker WJ, Findlay T, Moga C, Scott NA, Harstall C, Taenzer P. Guideline for primary care management of headache in adults. Can Fam Physician. 2015 Aug;61(8):670-9. PMID: 26273080; PMCID: PMC4541429.
Robbins MS. Diagnosis and Management of Headache: A Review. JAMA. 2021 May 11;325(18):1874-1885. doi: 10.1001/jama.2021.1640. PMID: 33974014.
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Link to full study:
https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1Silberstein SD. Migraine. Lancet. 2004 Jan 31;363(9406):381-91. doi: 10.1016/S0140-6736(04)15440-8. PMID: 15070571.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)15440-8/fulltextShah DR, Dilwali S, Friedman DI. Migraine Aura Without Headache [corrected]. Curr Pain Headache Rep. 2018 Sep 17;22(11):77. doi: 10.1007/s11916-018-0725-1. Erratum in: Curr Pain Headache Rep. 2018 Oct 20;22(12):85. PMID: 30225597.
https://link.springer.com/article/10.1007/s11916-018-0725-1Ha H, Gonzalez A. Migraine Headache Prophylaxis. Am Fam Physician. 2019 Jan 1;99(1):17-24. PMID: 30600979.
https://www.aafp.org/pubs/afp/issues/2019/0101/p17.htmlPeters GL. Migraine overview and summary of current and emerging treatment options. Am J Manag Care. 2019 Jan;25(2 Suppl):S23-S34. PMID: 30681821.
https://www.ajmc.com/view/migraine-overview-and-summary--of-current-and-emerging-treatment-optionsDieterich M, Obermann M, Celebisoy N. Vestibular migraine: the most frequent entity of episodic vertigo. J Neurol. 2016 Apr;263 Suppl 1:S82-9. doi: 10.1007/s00415-015-7905-2. Epub 2016 Apr 15. PMID: 27083888; PMCID: PMC4833782.
https://link.springer.com/article/10.1007/s00415-015-7905-2