Migraines can be brutal. For severe sufferers, a migraine attack means nausea, vomiting and extreme head pain, often for days at a time. But there are many variations: Pain can be on one side of the head or on both, it can be intensified by anything from odors to noise to light, and it can be triggered by any one of those things, along with certain foods or drinks (particularly alcoholic ones).

“This is an under-researched area of medicine, and it’s amazing how many people have them,” says Dr. Elizabeth Loder, who heads Brigham and Women’s/Faulkner Hospitals’ Division of Headache and Pain in the Department of Neurology. “It’s hard to distinguish underlying causes because there are so many. It is so individual. But there is a genetic tendency. Some people have brain tissue that’s more susceptible to sensitivity. Migraines really do run in families.”

Treatment varies from alleviating the symptoms via pain medications to altering brain chemistry to change the genetic sensitivity. “There are medications that make the brain less susceptible to the triggers. These are taken every day by people who have extreme migraines,” says Dr. Loder.

Migraine patients can also learn about their triggers. Common ones include red wine, chocolate, cheese, light, noise, odors and even emotional stress. Not getting enough sleep and skipping meals can lead to migraines too.

“You really need to find out what’s useful for you,” says Dr. Loder. “Find out what triggers the sensitivity in you, and then avoid them.”


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Dr. Loder advises migraine sufferers to keep a diary, noting when a migraine occurs, its severity and what you had been doing or what was happening around that time. “This can be very helpful,” she says. “You don’t have to write every hour — just make notes every day or so. Diagnosis is done by listening to the patient. There’s no EEG [electroencephalography, a measure of brain movement] to detect it. So the more you tell your doctor, then the more effective the treatment.”

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