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IBX Insights

Understanding and Treating Migraines

By July 1, 2022June 6th, 2024Expert Advice Well-being
A young woman massages her temples in the midst of a migraine

A migraine is a recurring headache that is characterized by a moderate to severe pulsing or throbbing pain in the head. Oftentimes migraines are accompanied by nausea, vomiting, or sensitivity to light, sound, or smells. These accompanying symptoms distinguish it from other types of headaches. Migraines also differ from other headaches because they have an intermittent quality to them. Migraines can last anywhere from a few hours to a few days.

Some people may experience an aura before the onset of (or alongside) a migraine. An aura is a sensory episode that may include visual disturbances such as flashes of light, black dots, or blind spots. It may also impact other senses in the form of ringing in the ears, tingling or numbness, difficulty speaking, or changes in smell, taste, or touch.

Although migraines occur intermittently, they can be quite debilitating. Some people who have frequent, severe migraines have trouble getting out of bed or participating in regular activities.

What Causes a Migraine?

During a migraine headache, the blood vessels in the brain constrict and expand rapidly. This rapid constriction and expansion leads to head pain. Although doctors don’t know the exact cause of migraines, it is believed that genetics, brain changes, and environmental factors play a role.

Although migraines can be quite unpredictable, oftentimes they can be traced to certain triggers. These may include:

  • Fatigue or lack of sleep
  • Seasonal or weather changes
  • Bright or flashing lights
  • Hormonal fluctuations in women, particularly around menstruation or menopause
  • Certain odors such as perfumes
  • Certain foods such as chocolate, aged cheeses, or processed foods
  • Alcohol, especially wine
  • Motion sickness
  • Head trauma
  • Caffeine or caffeine withdrawal
  • Asthma and allergies
  • Uncontrolled blood pressure
  • Stress or anxiety 

Risk Factors

Approximately 39 million Americans suffer from migraines. This includes men, women, children, and teenagers. There are certain risk factors that make you more likely to suffer from migraines.


Migraines can often go undiagnosed or untreated, especially among minorities. Early diagnosis of migraines is important because it can lead to better management of the condition. Migraines are also associated with risk of stroke and heart disease, so it’s important to seek treatment if you are experiencing migraines.

It can be helpful to keep a record or diary of your migraine episodes, including your symptoms and how long they last, how often you have them, your sleep and eating patterns, and your family history of migraines, as well as any medications or supplements you take. And don’t be afraid to advocate for yourself.

Talk to your doctor if you’re experiencing headaches that you think may be migraines. Your doctor will ask about your symptoms and medical history, and do a physical and neurological exam. It’s important to rule out other medical conditions first, so your doctor may order a blood test, MRI, CT scan, or other tests. Some patients may also be referred to a neurologist for further testing.

Treatment Options

Before your doctor can recommend a treatment plan, it’s important to try to identify what triggers the migraine, because that will help determine the best course of treatment.

Each treatment is individualized, and can be a combination of pain-relieving medication that stops migraine symptoms as they are happening, as well as daily preventive medication that can help reduce the frequency or severity of a migraine.

Luckily, there are several different treatment options available:

  • Caffeine: Caffeine can be a powerful tool against migraines. Many migraine sufferers report that caffeine pills or even a strong cup of coffee can provide immediate pain relief during a migraine. Caffeine can be tricky though, since too much of it can also trigger migraines. So, it’s important to talk to your doctor about your health history before increasing your caffeine intake.
  • Anti-nausea medication: If you experience nausea and vomiting with a migraine, anti-nausea medication can provide relief.
  • Over-the-counter medications: Tylenol, Aspirin, and Excedrin Migraine (caffeine, aspirin, and acetaminophen) can be used in combination with other treatment options to combat mild to moderate migraines.
  • Triptans: Triptans are a class of medication that can treat migraine pain after it starts. They help relieve symptoms by shrinking swollen blood vessels in the brain that develop from migraine attacks.

There are also medicines that treat a migraine after it starts and may come in the form of a pill, nasal spray, or injection.

Preventive medications

If your migraines are more frequent or severe, and over-the-counter treatments aren’t effective, doctors can prescribe preventive medicine that may include:

  • Blood pressure medications (like beta blockers)
  • Botox injections
  • Certain anxiety/depression medications
  • Anti-seizure medicine
  •  Acupuncture
  • Injectable medications

In addition, lifestyle factors such as sleep habits, exercise, relaxation techniques, diet, water intake, stress management, and certain triggers can impact migraines. Changing these factors may help reduce the frequency and severity of migraines.

As always, ask your doctor if these treatments are right for you.

Mental impact

Because migraines can be so debilitating and unpredictable, people who suffer from them can experience anxiety or depression. Sometimes, patients are so paralyzed by the fear of having a migraine that they won’t leave the house. Migraines can also be disruptive in a work setting, and interfere with employment. Living with migraines can lead to mental health concerns.

For more information about anxiety and depression, and where to find help, talk to your doctor or visit

Dario V. LaRocca, M.D.

I have been a medical director at Independence Blue Cross for over 15 years and have maintained a private practice in Psychiatry for over 30 years. My interest in mental health and its integration with physical health has been my life’s work. My role at IBX allows me to continue this work and be a psychiatric liaison to health services, providers, and hospital systems, as well as provide clinical guidance to programs at IBX.