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WHAT IS IT?
For most of us, headaches are a minor nuisance. But people who get the headaches known as migraines must cope with sharp, throbbing pain that disrupts their sleep, work, and play.
Many people describe migraine pain as feeling like the jabs of an ice pick. Beyond that, the pains can vary widely: They often start on one side of the head and may then spread to the other side. Migraines can be mild but are more often severe. They last from a few hours to three days. People may get migraines many times a week or as seldom as once every few years.
About 15 percent of people who have migraines get the type called migraine with aura (or classic migraine): They feel warning signs called an aura shortly before pain strikes. An aura can include nausea, weakness, and visual problems such as seeing light flashes. Most migraines, though, are the type called common migraine, with no aura.
More than 26 million Americans, mostly young women, have migraines. These headaches seem to run in families. Often, people begin to get them during their teens or twenties, then get fewer as they reach middle age.
You can do a lot to prevent migraines by changing your diet, easing stress, and using home remedies. Your doctor can also help you take steps to ease the pain and keep your migraines from coming back.
WHAT IS HAPPENING?
Medical experts remain puzzled about the exact cause of migraines.

One theory is that people who get migraines react to triggers such as stress or certain foods with a spasm of the arteries in the bottom of the brain. The spasm narrows these vessels and reduces the amount of blood and oxygen they supply to the brain.

At the same time, the triggers may also signal the brain to release serotonin, a potent chemical that can narrow the vessels more. As a result, even less blood and oxygen reach the brain. This reduced blood flow may cause the aura that sometimes precedes a migraine, with symptoms of disturbed vision and weakness.

Then, the theory goes, certain blood vessels in the brain respond to the reduced oxygen supply by widening to meet the brain’s energy needs. Arteries in the neck and scalp also widen. This dilation triggers the release of substances that cause pain and inflammation. The widening of blood vessels, along with the release of chemicals, may lead to the throbbing pain of a migraine.
WHAT CAUSES IT?
No one can say exactly why one person gets migraines and another doesn’t, but researchers have found a number of factors that can increase the risk. Some-such as your sex, age, and family history-are beyond your control. But you can do plenty about other risk factors such as diet, alcohol habits, and stress.

THINGS YOU CAN’T CHANGE

Gender
Roughly 70 percent of people who get migraines are women. About 60 percent of these women say they get the headaches more often around their menstrual periods.

Age
Migraine headaches often first appear during the teens and twenties and are most frequent then.

Family history
If a parent, brother or sister, or even a more distant relative such as an aunt or grandparent has migraines, your risk increases. Seventy to 80 percent of people who get migraines have a relative who’s had the illness.

THINGS YOU CAN CHANGE

Diet
Certain foods-most often those with tyramine, a natural chemical-can provoke migraines. These include ripe cheeses such as brie and cheddar, the cheese and yeast in pizza, nuts, peanut butter, chicken livers, smoked meats, and alcohol (especially red wine). Caffeine can also trigger a migraine.

Stress
When your boss dumps a last-minute project on your desk, or when tensions at home build up, your stress level rises. So does the chance of migraine.

Eating and sleeping habits
When you miss meals or sleep too late or too little, your blood sugar may drop and blood vessels may dilate.

Medicines
Some drugs, such as birth control pills and hormone medicines used to ease menopause symptoms, also cause migraines in some women.

Exercise or hard work
Hard exercise or physical work, even sex, can trigger a short-lived migraine (lasting about half an hour) in some people.

Your surroundings
Bright lights or sunlight may bring on an attack, as can smoky, noisy surroundings.

Altitude changes
Many people who get migraines report that abrupt altitude changes, mostly during plane flights, can bring on the pain.
WHAT YOU CAN DO FOR YOURSELF
You can take steps to prevent migraines with smart choices about what you eat, the medicines you take, and the way you react to stress. If you’re in the grip of a migraine, some of these measures can help ease the pain.

Keep a headache diary
Note the time you get each headache and what symptoms you have. Write down what you ate and drank and what you did in the six to eight hours leading up to the headache. After a few weeks, compare your entries and look for any possible triggers. Then try to avoid them.

Stay away from risky foods and alcohol
Shun foods that seem to cause your migraines, but don’t skip meals. If you drink alcohol, be cautious with red wine-many people find that it triggers their migraines.

Relax
Everyone has to deal with stress; the trick is to learn how. Try to take time out every day to relax and have fun.

Meditation may help you relax, and it may thus ease headaches. One three-year study found that meditation helped 72 percent of patients with chronic pain, including headaches, get “moderate to great” relief from pain.

Here is one way to meditate: In a quiet place, sit comfortably in a chair with your feet on the floor. Close your eyes. In your mind, say a simple word or phrase. Researchers often suggest the word one. Focus on the word, but don’t force it or work at it-let it come as if you were hearing it, not thinking it. After 20 minutes (it’s okay to open your eyes and check the time), stop saying the word and sit quietly with your eyes closed for a few minutes.

A number of other exercises can also help you relax. Try this one: Slowly tighten and then relax each part of your body, one part at a time: feet, lower legs, upper legs, abdomen, hands, arms, chest, neck, and face.

Keep steady sleep habits
Get up at pretty much the same time every day, and get the amount of sleep every night that you know you need.

Ask your doctor about medicines
If you think a drug you take is causing your headaches, ask your doctor about switching or using another treatment. For example, if birth control pills bring on migraines, you might explore other ways to prevent pregnancy, such as a diaphragm or condoms.

Ease the pain
If you get a migraine, lie down in a dark, quiet room until the pain goes away. (Don’t do this, though, for cluster headaches.) An ice pack on your forehead may be soothing.

For mild migraines, try over-the-counter pain relievers such as ibuprofen (Advil), naproxen (Aleve), aspirin, or products that combine aspirin, acetaminophen, and caffeine (Excedrin Migraine.) To get the most relief, take these medicines right away at the first sign of a headache.

If your migraines are more severe, however, these common pain relievers may not be strong enough. Talk to your doctor about prescription drugs. If you have more than two headaches each week, though, consider preventive treatment. If medications are taken too often, they can be habit-forming. Then you may get even more headaches.
WHAT YOUR DOCTOR CAN DO FOR YOU
Your doctor may prescribe drugs and treatments such as biofeedback to prevent migraines or ease the pain once a headache begins.