Up to 80-90% of people have had at least one headache in their lifetime, most often, a tension-type headache. A study done in 2012 at the Brigham and Women’s Hospital analyzing government records found that 14% of people suffered a severe headache over the 3-month period. Severe headaches are often categorized as migraine headaches and about 1 in every 7 Americans suffer from Migraines each year.

The top symptoms associated with severe headaches include throbbing or sharp pains in the head or behind the neck, nausea and vomiting, sudden onset, photophobia or light sensitivity, weakness or difficulty speaking. For someone with a history of headaches in the past, noticing a change in the pattern and location of the headache as well as the lack of response to headache treatment that worked previously is a good way of understanding that the headache is severe and needs prompt attention. Headaches that are associated with neurological symptoms like visual changes, changes in behavior or personality, weakness or numbness of the arms or legs, particularly when it involves one side of the body, are all signs that the headache needs to be evaluated in the ER.



There are many triggers for migraines. The ones that are best studied include stress, food, the environment (like weather, allergens, lights, smells, noise, etc.), hormones, and infections. Identifying the triggers for each person is essential because some of these can be controlled.


Migraines have been associated with high levels of histamine.

Histamine is a compound that can come from food but can also be manufactured in the body in various ways. Histamine is best known as the cause of allergy symptoms, like runny nose, cough, and itchy eyes. Histamine is released from certain cells in the body called Mast cells. These cells are the line of defense to protect the body from foreign things like pollen but also help the immune system fight off viruses, bacteria, parasites and fungus. They can react to toxins and even stress. Mast cells release histamine during their fight against those things. If the histamine is released in the brain, then a migraine is one of the symptoms. Histamine is also found in foods and if not digested properly can trigger a migraine. Foods that should be avoided in migraine sufferers due to their high histamine levels include alcohol, vinegar, aged cheeses, fermented foods like yogurt and sauerkraut, cured meats, chocolate and nuts. There are others as well, including some healthy foods like avocado, tomato, eggplant and spinach. A low histamine migraine diet can include organic, pasture raised meat and poultry, organic vegetables such as broccoli, asparagus, zucchini, lettuce, etc. and some fruit such as apples, pears, and melons. There are certain foods that can actually help decrease histamine and its effects, so these should be eaten freely: onions, garlic, thyme, tarragon, nettle, ginger and turmeric.


Stress plays an important role in our health.

Stress has been shown to cause the adrenal glands to produce high levels of cortisol, which has far reaching effects on other organs in the body. Cortisol can interfere with learning and memory, lower immune function, lead to weight gain, high blood pressure and even heart disease. But once the stress calms down, cortisol levels start to plummet. Studies show that migraines are more likely to occur as the cortisol level falls. That is because cortisol is an anti-inflammatory hormone that helps with pain relief, so the lower the level of cortisol the more inflammation and pain there is. It is the aftermath of the stress that is truly the problem so avoiding the stress in the first place is paramount. Stress management is critical and techniques used can vary from one person to the next. The key is finding the modality that works for each person. Going for a walk outside, getting fresh air and bonding with nature can decrease stress. For some, reading a book or spending time with family will relieve stress. Others benefit from meditation. Meditation is easy with all the apps that are available to be downloaded on to cell phones. There are a variety of different apps geared to different groups of people, like beginners, children and teens, or even those that have experience already. These apps can be used any time of the day and the time allotted for meditation can vary from a few minutes, which makes this option very accessible, to 20 minutes or more. In addition, there are lifestyle changes that can greatly reduce stress, which in turn will reduce an important trigger for migraines. Getting adequate sleep, which studies show is somewhere between 7 to 9 hours a night, can be difficult in the busy world we live in, but should be a goal to strive for.



If you experience a headache that starts after a head injury- this could mean swelling or bleeding around the brain. If you have a sudden change in vision- blurred or double vision- this could signal something more serious. Weakness or numbness in arms or legs with the headache could mean a ruptured aneurysm. If you have a stiff neck especially when accompanied by a fever, this could be meningitis. Bacterial meningitis can be fatal. If you experience severe sensitivity to light, it could be associated with a severe migraine.



In some cases, the headache might start out milder and build slowly as opposed to starting acutely, and this could make it confusing. Some of the symptoms that are associated with severe headaches are associated with migraine headaches that many people get. Distinguishing a migraine from something more serious can be difficult unless you go to the ER and get evaluated but most people do not want to run to the ER every time they have a headache.