The pain, light sensitivity, nausea and fatigue you feel with a migraine might feel like it strikes out of the blue. But sometimes, there’s a health condition that’s triggering your migraines. And that means treating those other health problems could help keep your migraines at bay.
“When you have a choice between treating a symptom, like migraines and fixing the underlying cause, it’s generally better to address the underlying cause,” said Joshua Tobin, MD, a neurologist with Banner Brain & Spine.
He explained more about medical conditions that can cause migraines. These conditions are often called migraine triggers or migraine comorbidities and they can either cause migraines or make migraines worse.
1. Sleep disorders
Insomnia, sleep apnea, poor sleep hygiene, leg cramps or restless leg syndrome (RLS) can contribute to migraines. “Some people are flabbergasted that their headaches could be related to their poor sleep,” Dr. Tobin said.
During deep sleep, your brain cells shrink away from each other, and fluid passes between them. “This probably has the effect of clearing toxins out of the brain,” Dr. Tobin said. When you don’t get enough restorative sleep, these toxins can cause headaches and the “brain fog” common in people with sleep problems.
To improve your sleep, you need to address the underlying problem. That could mean making lifestyle changes, improving your sleep hygiene or trying medical interventions. “For example, if you snore loudly, have a small airway and are older or overweight, there’s a good chance you have sleep apnea, which is very treatable,” Dr. Tobin said.
2. Hormonal changes
You can treat menstrual migraine with hormonal birth control, which keeps estrogen levels relatively constant throughout the month. “Since the estrogen level never drops, the migraine isn’t triggered,” Dr. Tobin said.
You can also take pain medications continuously during the time of the month you normally get headaches. But Dr. Tobin usually treats menstrual migraines like other migraines. You can use medications to make them less frequent and to cut their duration. You can also identify and treat any other causes, such as poor sleep.
Women who have hormonal migraines in menopause may want to consider hormone replacement therapy (HRT). If you get migraines while pregnant, you should talk to your doctor about the safest treatment options.
3. Tension headaches
Many people have both tension headaches and migraines. With tension headaches, you’ll feel constant, mild to moderate pain around your head. “Tension headaches are separate from migraines, but they share triggers, especially poor sleep,” Dr. Tobin said.
You can treat tension headaches with over-the-counter (OTC) pain relievers such as ibuprofen (Advil, Motrin) or naproxen sodium (Aleve). Learning effective stress management techniques and relaxation exercises may help make tension headaches less frequent.
4. Anxiety and depression
“Lots of anxious people just can’t shut their brains off when it’s time to go to bed, so they don’t wake up refreshed and then they have headaches. Their poor sleep and pain become additional stressors. This leads to a vicious cycle of anxiety, poor sleep and pain,” Dr. Tobin said.
To treat anxiety and depression, you’ll probably do best with a combination of therapy, medications, stress management and lifestyle modifications.
5. Chronic pain
The pain of conditions like fibromyalgia, temporomandibular joint disorder (TMJ), and neck or back pain can contribute to migraines. “When pain interferes with sleep, it tends to cause more pain,” Dr. Tobin said. And the sleep struggles you may face with chronic pain can trigger migraines.
You might need a combination of treatments to help with chronic pain. Physical therapy, medications and lifestyle adjustments can all be effective.
6. Neck pain
Neck pain is so well-recognized as a cause of headaches that it has a name: cervicogenic headache. “There’s heavy overlap between migraines and cervicogenic headaches—many people have both,” Dr. Tobin said.
“Physical therapy is usually the best treatment for these headaches—I love physical therapists,” he said. Occipital nerve blocks and Botox might also help.
7. Nutrient levels
Riboflavin and omega-3 fatty acids have links with migraines. Riboflavin helps improve your mitochondrial function. Mitochondria help power your cells and are often less efficient in people who have migraines.
Omega-3 fatty acids are anti-inflammatory. “Migraine involves inflammation of blood vessels inside the skull, so omega-3 fatty acids probably act to blunt this inflammation,” Dr. Tobin said.
Testing can help determine if you have nutritional deficiencies. “I order riboflavin and omega-3 fatty acid level tests in people who have headaches, and I’m surprised at how many people are deficient in them,” Dr. Tobin said. You can treat these deficiencies by eating more foods that contain these nutrients. You may need supplements as well.
8. Too much pain medication
Using too much over-the-counter or prescription pain medications can lead to medication-overuse headaches or rebound headaches. “People take pain medications for the head pain, which improves the pain in the short term but causes more headaches long term,” Dr. Tobin said.
“As a rule of thumb, most over-the-counter and prescription pain medications can cause medication overuse headache if you don’t have at least 21 days per month when you’re not taking anything for pain,” Dr. Tobin said.
For opiates such as hydrocodone (Vicodin), oxycodone (OxyContin, Percocet), oxymorphone (Opana) and morphine (Kadian, Avinza), and medications that contain barbiturates, such as Fioricet and Fiorinal, medication overuse headaches can occur when you’re taking medication even less often.
Your doctor can help you identify medications that might be triggering migraines. “I used to tell people to stop their pain pills, but I’ve learned that the best thing is actually to teach them what is going on. They can decide whether to stop the pain pills and endure more pain now and less later or keep taking them and suffer less now but more later,” Dr. Tobin said.
The bottom line
Lots of health conditions could be causing your migraines, making them worse or making them last longer. “It’s impossible to prove that any of these conditions are the cause of your headaches. The closest you can come is to treat the possible underlying cause and see if the headaches improve,” Dr. Tobin said. “But the most important step is being aware that these disorders are linked—most people are not aware of these connections.”
Everyone’s experience with migraines is different, and personalized treatment plans are vital. Consulting with a neurologist or headache specialist can help diagnose any underlying conditions, so you can develop a treatment strategy to minimize your migraines. If you would like to connect with a headache expert, reach out to Banner Brain & Spine.
Other useful articles
- 5 Treatment Options to Help Relieve Your Excruciating Migraines
- 5 Drug-Free Ways to Combat Migraine Headaches Head-On
- Migraine Pain: When Should You Worry?