When Diana Daniele had her first migraine headache she had no idea what was happening. It was 2009, and she was at a large charity event at LA's Dodger Stadium when she began to experience an "aura" and passed out (aura is the name for the visual disturbances—like blurry vision and flashing lights—that can be part of a migraine).
After waking up surrounded by EMTs and being evaluated by doctors she was told that she probably had either an inner ear infection or a migraine headache.
"I rejected the headache diagnosis, because I didn't feel any pain," says Diana. Plus, she had no family history of migraines (there's often a hereditary component) and no personal experience with them in her 40+ years of life. But over weeks and months that followed she experienced nausea and vertigo, and would pass out. After three months of this she got a bad headache, and a neurologist diagnosed her with migraine.
Until then Diana was a high-functioning working mom of two kids, with a great marriage and lots of friends. But after she was diagnosed with migraines she spent much of that first year lying down in a dark room. There are different types of migraines and Diana suffers from "chronic migraine," meaning that she has a headache (or the accompanying symptoms like aura and nausea) at least 15 days per month for four or more hours per day. Women are three times more likely than men to experience migraines.
Three years have passed since then, and Daniele has figured out a migraine prevention program—a combination of medications and lifestyle changes—that has allowed her to get her life back. She's learned to avoid and manage stress, and abstains from food and drink (including aged cheese and alcohol) which she knows to be triggers. She takes a prescription anti-seizure medication daily (anti-seizure meds help prevent migraines in some people) and every three months she gets Botox injections into specific points in her face and back.
Botox, more widely known for its wrinkle-busting benefits, was approved by the FDA for prevention of chronic migraine in 2010. It works by blocking sensory nerves in the head, neck and back that connect to the brain and are involved in migraine. I learned about Diana because she was one of the winners of a contest called Rewrite Your Day, sponsored by Allergan, the company that makes Botox. As a winner of the contest she was given the chance to re-do an important event in her life that her chronic migraines had stolen from her. Because her headaches had prevented her from celebrating her wedding anniversaries over the past few years, she decided to do a vow renewal ceremony with her husband Drew this past spring, on their 15th wedding anniversary, with their twelve-year-old son and five-year-old daughter as attendants. She didn't have a migraine that day and it was, in her words, "wonderful, one of the top ten days of my life."
Although she still experiences migraines, "with the Botox I don't have them as often and I don't get nauseated when I do," says Diana. "They're less frequent and less severe. When I haven't had it for a while I can feel it wearing off and the pain starting to come back." Botox is administered every three months for chronic migraines.
If you have migraines and haven't found relief with your current migraine prevention strategy, and or if you have severe headaches but aren't sure if they're migraines, it's imperative that you get checked out by a headache specialist and get help. Aside from the immediate suffering they cause, "there's evidence that migraine isn't good for you," says Dr. Mark Green, Professor of Neurology, Anesthesiology and Rehabilitation Medicine and the Director of Headache and Pain Medicine at the Mount Sinai School of Medicine. "If they're not treated well early on they are more likely to progress."
He also suggests that you keep a detailed diary of your symptoms and when your headaches occur. "Keeping a diary is very important," he says. "You wouldn't try to manage diabetes without keeping track of blood sugar." By keeping a diary you'll hopefully be able to understand what triggers your migraines. "Triggers are very individual," says Dr. Green. "A common one is stress, but also the relaxation following stress. Others are undersleeping, oversleeping , missing a meal, changes in hormones, changes in time zone, weather changes—people with migraines have brains that don't respond well to change. Although you can't control the weather, it helps to understand your triggers."
Diana has made it her mission to get the word out about migraine prevention: "Find a specialist who can help you, keep a diary so you can understand your triggers and change your diet if necessary, and don't go overboard on over-the-counter painkillers," she says. "Take care of yourself."
More about migraines: