Minor issues like headaches can become major problems when they affect the work efficiency of a valued group member. The group medic should know how to identify and treat them; one of the most problematic are called “migraines.”
Migraines are a type of primary headache. Primary headaches are recurrent and not caused by underlying medical diseases; the headache is the problem in itself. Although not considered life-threatening, migraine can cause significant pain and would certainly affect quality of life and work efficiency in survival settings. It’s important to be able to identify them and have a plan of treatment.
Migraine headaches affect 10-15% of the world’s population. They’re much more common in women than men, starting in teenage or young adult years. They usually reach a peak in a person’s late thirties or early forties.
WHAT CAUSES MIGRAINES?
The exact cause of migraines is a matter of some debate. Changes in brain chemicals, known as “neurotransmitters,” are believed to be a factor. They are thought by some to be related to spasms in the brain’s blood vessels. Others believe environmental triggers are to blame, such as:
- Caffeine
- Alcohol
- Food additives like MSG or nitrates
- Emotional stress
- Bright lights, loud noises, and strong smells.
- Sleep Disturbances
- Physical exertion
- Certain drugs
- Changes in the weather or barometric pressure
In women, hormonal changes related to the menstrual cycle, puberty, or menopause may play a role.
MIGRAINE PHASES
There are four phases to a migraine, although not everyone experiences all of them:
1) The “prodrome”, which occurs hours or days before the headache
2) The “aura”, which immediately precedes the headache
3) The “pain phase” (the actual headache)
4) The “postdrome”, the effects experienced following the end of a migraine attack
THE PRODROME
Prodromal symptoms occur in the majority of migraine sufferers. They represent essentially a “premonition” that there’s a migraine in your future. Prodromes can start anywhere from two hours to two days before the actual headache and include all sorts of symptoms, including:
- Mood swings
- Fatigue
- Stiff neck
- GI irregularity
- Increased sensitivity to noise or smells
- Food cravings
AURAS
A prodrome may be followed by an “aura”. An aura is an unusual sensory effect that usually precedes a headache but is not uncommonly part of the headache itself. Symptoms can vary from person to person: They may report strange visual phenomena (the most common), unusual sensations, and other irregularities.
THE ACTUAL HEADACHE
The actual migraine headache (the “pain phase”) can last two to 72 hours and has certain signs and symptoms. Usually, they are:
- One-sided
- Throbbing in nature
- Pain-inducing when looking at light sources
- Causative of visual changes such as blurring, lights, and color phenomena
- Made worse by physical activity
- Nausea inducing, sometimes causing vomiting and other GI symptoms
There are, of course, variations to the above and different persons will experience different symptoms. For example, in a minority of cases, the pain is on both sides of the head or involves the neck. In others, dizziness and confusion are part of the symptom complex.
THE POSTDROME
After the headache has subsided, a lot of people report soreness in the area, a foggy feeling similar to a hangover, weakness, and other symptoms. These resolve over time.
TREATMENT
Initial treatment for a mild migraine simply involves bedrest in a dark, quiet room, a cold pack to the area, and Ibuprofen (Advil) or acetaminophen (Tylenol) for pain. If that fails, a combination of acetaminophen, aspirin, and caffeine, each of which has known beneficial effects, is worth a shot.
Some older medications like ergotamine, sometimes combined with caffeine (Migergot) are still prescribed for migraines orally or in suppository form. Some of these meds can cause spasms of the coronary arteries, so if you have significant heart, liver, or kidney disease, they may not be for you.
Another family of drugs that work to relieve migraines are in the “triptan” family, the most popular being sumatriptan (Imitrex). These are effective against both pain and nausea in the majority of patients and are often given when simpler treatments fail. Taken in combination with Naproxen (Aleve), they are even stronger in their effectiveness.
In 2023, the US Food and Drug Administration approved a new nasal spray as a rapid treatment for migraine pain in adults. The nasal spray zavegepant (sold as Zavzpret), may decrease pain and other migraine symptoms as soon as 15 minutes after one 10mg dose. It has the added advantage of minimal cardiac side-effects.
Other medications thought to have a preventive effect against migraines, including valproate, metoprolol, and topiramate.
Of course, you won’t have access to some of the options above in survival settings. Low-tech strategies for prevention:
- Take a multi-vitamin supplement, such as vitamin B complex
- Take a magnesium supplement of 200-300mg twice a day
- Eat or take fish oil 3-4 grams per day or other Omega-3 rich foods
- Stay well-hydrated
- Don’t skip meals if possible
- Avoid caffeine
- Limit salt intake
- Stay away from alcoholic drinks
- Increase potassium intake
Herbal teas are also thought to be helpful for treatment and prevention. Consider infusions made from ginger, chamomile, lavender, peppermint, or turmeric. Dried feverfew leaves or gingko extract is another way to go. As with any alternative remedy, your experience may vary.
Another strategy involves the use of acupressure. Apply pressure to the opposite hand from where the migraine pain is. For pain on the right side, apply pressure with your right thumb on the fleshy space between the index finger and thumb on top of the left hand. Firmly massage in a clockwise fashion, then reverse, for 2 to 3 minutes.
In future parts of this series, we’ll discuss tension, cluster, and other headaches the medic may see in survival settings.
Joe Alton
Dr. Alton
