Fred Cohen, MD, assistant professor of medicine and neurology at Mount Sinai, with board certification in headache medicine, says that sleep serves many functions, one of which correlates with headaches. “Throughout the day, the brain engages in feeling, acting, and thinking through the use of neurotransmitters and neuropeptides,” Dr. Cohen explains. “These substances, which are similar to any fuel source, generate waste products that are pro-inflammatory.” These waste products may contribute to headaches if they are not cleared from the brain. The clearance process happens via a network of channels known as the glymphatic system. Dr. Cohen says that the latter is akin to the lymphatic system, a body-wide network of vessels, tissues, and organs that manages fluid levels in the body. “The glymphatic system also is instrumental in circulating nutrients throughout the brain,” Dr. Cohen adds. “It performs its functions when we are in deep sleep— therefore, maintaining both high-quality and sufficient sleep enables the glymphatic system to effectively cleanse the brain, reducing inflammation and, consequently, the likelihood of headaches.”

Migraine Symptoms May Differ in Older Adults

Subtle signs may herald the onset of a migraine attack. These signs may include food cravings, constipation, increased urination, and frequent yawning for one or two days before a migraine hits. Odd sensations—known as an “aura”— also may occur, manifesting visually (flashing lights, temporary loss of sight) and as tinging and numbness in parts of the body. “These are known as premonitory symptoms, and are quite common in migraine,” says Dr. Cohen.

In younger people, migraines usually are one-sided, but in older adults, pain is more likely to affect both sides of the head. People have reported the pain as hammering, throbbing, or drilling, and it may be accompanied by nausea and vomiting, nasal congestion, and watery eyes. While most people have an increased sensitivity to light and noise during a migraine, this is less likely in older adults—they also are less likely to experience nasal congestion and watery eyes.

Migraine Medications

Some drugs may reduce the frequency and duration of migraine attacks. Referred to as rescue or abortive medications, they include beta-blockers like metoprolol (Lopressor®) and propranolol (Inderal®), both of which are used to treat high blood pressure. Other options include the seizure drugs divalproex sodium (Depakote®), and topiramate (Eprontia®, Topamax®). “The overall consensus by the academic community is to administer a rescue or abortive medication at the onset of migraine pain rather than during the premonitory phase or at the start of an aura,” Dr. Cohen notes. “Despite this, I have had patients who experienced effective prevention of their migraine attacks by taking their rescue medication during the premonitory phase. With that said, if you are experiencing five or more migraine attacks a month, you should ask your provider whether a migraine preventive treatment might be advisable.” No matter what is prescribed, it is vital to “start low and go slow”—that is, begin taking the drug at a low dose and increase slowly as needed while monitoring for side effects.

If you don’t manage to cut a migraine off at the pass, over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil®, Motrin®) and naproxen (Aleve®) may be sufficient to ease

your headache. However, NSAIDs must be used with caution, since they are associated with potentially severe side effects in older adults, including a raised risk of gastrointestinal issues like ulcers and bleeding. Analgesic painkillers like acetaminophen (Tylenol®) are considered safer for older adults, but limit yourself to 3,000 mg (mg) milligrams per day (a maximum of six 500 mg tablets). Don’t forget to factor in other medications that contain acetaminophen, such as over-the-counter cold and flu remedies. Dr. Cohen adds that combination medications, such as aspirin-acetaminophen-caffeine (Excedrin®) also can be effective, as can prescription drugs, such as triptans. These include sumatriptan (Imitrex®), frovatriptan (Frova®), and naratriptan (Amerge®), but because these drugs narrow the arteries they may not be suitable if you have cardiovascular issues. Medications from another drug class—gepants—may be used instead and include rimegepant (Nurtec®), ubrogepant (Ubrelvy®), and zavegepant (Zavspret®).

Self-Help Strategies

The study we reference highlights the importance of sleep as a migraine mediator, so take sleep-hygiene precautions to help you slumber better. Ensure that your bedroom is dark enough—install blackout blinds if necessary to prevent streetlights from disturbing you. If your neighborhood is noisy at night, consider using ear plugs or try tuning a radio to static, since this type of “white noise” can help mitigate other sounds. Avoid eating or drinking too close to bedtime, and maintain a consistent bedtime and wake time. If you’ve tried these approaches but still feel you don’t sleep as well as you would like, it’s possible you may have a sleep disorder, especially if you snore and awaken with a sore throat every morning. Discuss these symptoms with your doctor—it is possible he or she may refer you to a sleep specialist.

The following approaches also may provide some relief from migraines and other types of headaches, although you may still need to take medications.

• Apply an ice pack If you don’t have a proper ice pack, you can use a bag of frozen corn or peas, wrapped in a towel. Lie down with it placed on your forehead or allow it to rest on the back of your neck and your shoulders.

• Try massage Tension headaches especially are associated with muscle tension in the neck and shoulders, and massage can help ease this. Massage also may help reduce migraines—in one study, people who suffered from regular migraines reported fewer headaches when they had a 45-minute massage each week.

• Meditate to focus your attention away from stress and pain. Sit in a quiet room with your eyes closed, regulating your breathing, and being conscious of the sound of your breath as you inhale and exhale. There are many guided meditations available online—you also might want to download a smartphone meditation app, like Headspace or Calm.

• Avoid food and drink triggers Migraines especially may be influenced by food—culprits include chocolate, aged cheese, processed meats, or foods containing monosodium glutamate (used in Chinese food and many condiments). Alcohol (particularly red wine) also can trigger migraine symptoms. Avoiding these triggers may help reduce the frequency of migraine attacks. Too much caffeine can cause or worsen migraines and other headaches, but if you’re a regular coffee drinker, stopping cold turkey also can cause a headache. Try to keep your coffee intake to one or two cups a day, and if you currently have more than this, cut back gradually. Many soft drinks also contain caffeine, so watch your intake of these.

• Get enough fluids Dehydration can contribute to migraines and tension headaches. In older age your thirst sensation wanes, so don’t rely on feeling thirsty to signal that you need to rehydrate. Eight glasses of water a day is a good general target for fluid intake but remember that your fluid consumption total can include other fluids. You also can factor in fluids contained in foods— for example, soup and fruits and vegetables that contain high levels of water (examples include watermelon, apples, grapefruits, lettuce, and broccoli).

• Don’t slump Poor posture can contribute to cervicogenic headaches, according to Dr. Cohen. “These are headaches that start in the cervical, or neck, area of the spine,” he explains. “They typically are related to musculoskeletal pain, and present with neck tension and/or tenderness.” Better posture may help prevent these headaches, so try to keep your head lined up between your shoulders and your shoulders lined up with your hips whether you are sitting or mobile. The best way to do this is to imagine an invisible string is attached to the top of your head, pulling it slightly backward and up.

Seek Medical Advice

If you suffer new-onset headaches or regular headaches that are becoming burdensome, Dr. Cohen urges you to discuss the problem with your primary care provider. He or she may refer you for tests to rule out possible underlying causes. “Many treatments exist for various headache disorders,” Dr. Cohen adds. “There’s no reason to live in discomfort and pain.” You can find more information on different types of headaches and how to ease them at Dr. Cohen’s website (www.headache123.com).

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A:  A migraine headache is a neurological condition (i.e., it’s a disease of the nervous system) and unlike other kinds of headaches, a migraine has other symptoms, such as nausea, vomiting, and dizziness. The pain is intense and can last four to 72 hours, it can affect one or both sides of your head, and the pain usually gets worse with activity. Other symptoms include being sensitive to light, sounds, and smells, and feeling weak. Some people with migraines have different triggers, such as stress and anxiety, certain foods/beverages, changes in hormone levels, inadequate sleep, sudden weather changes, and medication overuse, which can happen from long-term use of some prescription and over-the-counter medications. To help your physician diagnose yoru headache, keep track of what might be triggering your symptoms, when they started, what the pain feels like, how long it lasted and anything that might have helped relieve it. Try to recall any subtle changes prior to the commencement of the pain (e.g., mood changes, food cravings, frequent yawning, increased urination, or fluid retention). After the pain passes, some people feel drained, while others might feel elated. There are some prescription medications that can help prevent migraine symptoms as well as nonpharmaceutical remedies that may be helpful. Digestive conditions such as irritable bowel syndrome and celiac disease might be linked to migraines. Treating these conditions may help reduce or eliminate migraine occurrence.

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“If you have not seen a neurologist or headache specialist for some time, I recommend checking back in,” says Joshua Kamins, assistant clinical professor of neurology, UCLA David Geffen School of Medicine. “You might be surprised how many treatment choices are now available.”

Any new-onset headache, unusually excruciating headache, or extremely worsening headache requires emergency care, as these symptoms signal a possible stroke or intercranial bleeding.

Any new-onset headache, unusually excruciating headache, or extremely worsening headache requires emergency care, as these symptoms signal a possible stroke or intercranial bleeding.
© PeopleImages | Getty Images

Classifying Headaches

Most headaches are classified as tension type headaches (TTH) or migraines. “Migraines are significantly incapacitating and are the second leading cause of disability in the world,” says Dr. Kamins. “Untreated migraines can have both professional and personal ramifications, as the physical and emotional suffering experienced during migraine can result in missed days at work and missed opportunities with loved ones.”

Because older adults are more prone to have “secondary” headaches, physicians may want to rule those out first.

Secondary Headaches

A secondary headache is one that occurs because of some other condition, such as inflammation, brain damage, a structural problem with the spine, or from medications or other underlying conditions. Understanding your headache history will help physicians make a diagnosis and treatment recommendations. Take note of when the headaches strike as well as the circumstances that occurred beforehand.

• Morning headaches. Headaches that occur in the morning point to the possibility of sleep apnea. Given that incidences of sleep apnea increase with age, especially in postmenopausal women, it’s valuable to be screened for this sleep disorder. Morning headaches accompanied by extreme thirst, and/or the tongue feeling thick and sticking to the roof of the mouth suggests dehydration. Treating sleep apnea and making sure hydration is adequate throughout the day may alleviate morning headaches.
• Headache with vision problems. People who experience headaches with blurry vision triggered by low-light conditions may need to be screened for subacute glaucoma. This condition increases pressure in the eye. Treatments that lower eye pressure include prescription eyedrops, oral medications, and/or laser surgery.
• Headaches with neck pain. A disorder or trauma involving the cervical spine can cause headaches. Older adults also are more prone to degenerative cervical disk disease that can lead to head pain. Treatment may involve nonsteroidal anti-inflammatory drugs, nerve blocks, and/or physical therapy.
• Headache due to medications. Taking multiple medications and experiencing headaches for 15 or more days per month is classified as a medication overuse headache. This may also be true if you receive a new medication and then experience a headache. Treatment involves reviewing medications and deprescribing.

Primary Headaches

As in secondary headaches, there is a list of reasons why a primary headache occurs. We focus here on the two most common types of primary headaches.

• Tension-type headaches. Dull throbbing pain, feeling like a clamp is squeezing your skull, tight neck, shoulders and jaw muscles, and pressure in the forehead, top or sides of the head are all signs of a TTH. These headaches can last anywhere from an hour to few days. Episodic tension headaches are those that occur occasionally, whereas chronic tension headaches occur more than 15 days a month. TTHs can make it difficult to sleep and concentrate. Fatigue, irritability and sensitivity to light or noise are also possible. There are many reasons why a TTH may occur, and treatment includes accounting for these conditions, which is why your recent history is important to know. TTHs can be caused by poor posture, anxiety, fatigue, emotional stress, depression, hunger, low iron levels, alcohol, caffeine, jaw problems, hunger, eye strain, and smoking. Over-the-counter treatments such as acetaminophen (Tylenol), naproxen (Aleve) or ibuprofen (Motrin) can help relieve TTHs.
• Migraine. Intense pain, usually on one side of the head and generally associated with sensitivity to light and sound and accompanied by nausea, are classic migraine symptoms. Attacks can last four to 72 hours, if untreated. Migraine is three times more common in women versus men. Triggers include stress, anxiety, hormonal changes, certain odors (e.g., perfumes), bright lights, alcohol, lack of sleep, and certain foods. Migraines have a genetic component and can run in families. Prevention and treatment includes the use of medications and other therapies.

“When a nonpharmacological treatment is an option, it should always be considered,” advises Dr. Kamins. “There are a handful of what we have termed ‘nutraceuticals,’ or vitamins and supplements, that can reduce migraine sensitivity. Additionally, there are electronic devices with good evidence for the acute and preventive treatment of migraine, also known as neuromodulation devices. For certain patients, we also offer specific procedures or injections that can reduce headache burden. Lastly, for some people, mind-body therapies such as meditation or cognitive behavioral therapy can be very effective at reducing pain.”

Some people find relief from headaches and migraines by applying a cold compress or ice pack to the head or neck. The cold helps numb the pain and constricts blood vessels. Try this method for about 20 minutes. Dr. Kamins also recommends several lifestyle options that can reduce migraine and headache episodes, including frequent exercise, consistent sleep schedules, good nutrition, and stress management.

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The most common over-the-counter (OTC) pain relievers are nonsteroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen (Advil, Motrin), naproxen (Aleve), and salicylic acid (aspirin), and acetaminophen (Tylenol).

Taking NSAIDs is associated with an increased risk of cardiovascular disease (CVD) and events, including heart attack, stroke, and heart failure, especially in people who already have heart disease or are at high risk of heart disease. Taking higher doses of NSAIDs and/ or taking them for longer periods of time further increase the risks.

NSAIDs may also cause bleeding in the gastrointestinal (GI) tract. This risk is higher for patients who take blood thinners (warfarin or any of the newer anticoagulants, including Eliquis, Pradaxa, Xarelto, Plavix, and Brilinta) or who are at increased risk of GI bleeding for other reasons, such as having a peptic ulcer, an inflamed esophagus, or intestinal disease.

Possible consequences of GI bleeding include significant blood loss, which can lead to anemia. If GI bleeding is sudden and severe, it can cause shock, unconsciousness, and even death.

Aspirin is also an NSAID. It carries a similar risk of GI bleeding as the other NSAIDs, but it does not carry the same risks of CVD.

A low-dose daily aspirin is recommended for people with CVD who have had a heart attack or stroke, bypass surgery, or a procedure to open narrowed or blocked arteries. And millions of people who don’t have CVD take aspirin in hopes of preventing a cardiovascular event. But we now know that the benefit of a daily aspirin is offset by the risk of internal bleeding, especially for people age 70 and older, and the American Heart Association advises against this practice.

Acetaminophen relieves pain by a different mechanism than NSAIDs. It is usually recommended as the first choice for people with cardiovascular disease who take blood thinners and daily aspirin.

Your body clears safe doses of acetaminophen without a problem, but high doses can cause liver damage. You’re also at higher risk of liver toxicity if you take acetaminophen and you have more than three alcoholic drinks every day.

And you may be taking more acetaminophen than you realize: Hundreds of combination medications contain acetaminophen. Be sure to check the labels of all OTC products, especially cough, cold, and flu medicines, for acetaminophen. If you take any prescription medications, ask your pharmacist if any of them contain acetaminophen.

Bottom line: Choose your OTC pain reliever carefully depending on your doctor’s recommendations, and always use the smallest amount for the shortest period of time possible. If you have chronic pain, talk with your doctor about the many other strategies and treatments that may reduce your pain.

What new medications are available for migraines?

Several new drug options for migraine have been approved by the U.S. Food and Drug Administration in the past few years. New medications for preventing migraine include erenumab (Aimovig), galcanezumab (Emgality), fremanezumab (Ajovy), and epitenezumab (Vyepti). These medications are delivered by injection every one to three months.

New oral medications include ubrogepant (Ubrelvy) and rimegepant (Nurtec). These medications are taken when migraine symptoms begin; for many patients, they decrease or eliminate symptoms within one to two hours. These drugs were initially approved for treating migraine symptoms, but recent clinical trials have shown that they may also be used for migraine prevention.

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Migraines

Migraines produce throbbing pain that tends to occur in the front or one side of the head and is worsened by movement. About 25 to 30 percent of migraine patients experience an “aura”—a visual disturbance such as flashing lights, spots, or zigzag lines across your field of vision—before the headache starts. Migraine causes sensitivity to light and noise and may cause nausea and vomiting. Migraines are more common in women than in men.

Factors linked with a higher likelihood of having migraines include a genetic predisposition (the majority of migraine patients have a family history of migraines), hormonal changes, epilepsy, asthma, and bipolar disorder.

Common triggers for migraines include bright or flashing lights, strong odors, and certain foods, including chocolate, aged cheese, processed meats, red wine, and caffeine. Some evidence suggests that fatigue, hunger, dehydration, and overexertion also may play a role in migraines.

Several new treatment options for migraine have been approved by the U.S. Food and Drug Administration recently. New medications for preventing migraine include erenumab (Aimovig), galcanezumab (Emgality), fremanezumab (Ajovy), and epitenezumab (Vyepti). These medications are delivered by injection every one to three months. New oral medications include ubrogepant (Ubrelvy) and rimegepant (Nurtec). These medications are taken when migraine symptoms begin; for many patients, they decrease or eliminate symptoms within one to two hours. These medications can be expensive, but costs will vary depending on insurance status, and the cost may be as little as $5 per month for patients who are eligible for assistance.

Tension Headaches

Tension headaches, also referred to as “stress headaches,” are the most common type of headaches, characterized by a feeling of constant pressure on both sides of your head. Tension headaches are often related to high stress levels; when you are stressed, if the muscles in your neck, upper back, and shoulders tense up, a headache can result. Other possible causes of tension headaches include:

• Arthritis in the vertebrae of the neck
• Poor posture
• Anxiety or depression
• Hunger or dehydration
• Fatigue
• Temporomandibular joint disorder (TMJD), a condition that affects the jaw joints

“Tension headaches can sometimes be prevented with lifestyle changes, and/or with physical therapy or meditation,” says Louise Klebanoff, MD, a neurologist at Weill Cornell Medicine.

For some people, tension headaches can be alleviated by therapies that help reduce stress, such as mindfulnessbased stress reduction, biofeedback, and cognitive-behavioral therapy. Massage and neck and shoulder stretches also may help prevent or ease a tension headache. If your headaches are caused by TMJD, your dentist may provide an oral appliance that may help.

Cluster Headaches

Cluster headaches occur on a daily basis at the same time each day, typically for about six to 12 weeks, followed by a period of remission. A cluster headache may be preceded by an aura and tends to occur on one side of the head.

Factors that contribute to a higher risk of cluster headaches include genetics (about 20 percent of cluster headache sufferers have a family history of the condition), current or previous tobacco use, and taking nitroglycerin, a medication used to treat heart disease. Cluster headaches may be treated with a variety of medications; some are taken when a cluster episode begins, in an effort to prevent future headaches. Some patients get pain relief by inhaling oxygen.

Rebound Headaches

“If you take over-the-counter medications for headaches three times a week or more, you can get a ‘rebound’ headache,” explains Dr. Klebanoff.

Analgesic medications—acetaminophen (Tylenol) and medications that combine acetaminophen, aspirin, and caffeine (for example, Excedrin)—put you at greater risk for rebound headaches than NSAIDs such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn). Rebound headaches often occur first thing in the morning, since painkillers taken the night before will have worn off overnight.

Help for Headaches

“If your headaches are frequent, bothersome, and your current treatment regimen is not giving you relief, consult a neurologist,” says Dr. Klebanoff. A neurologist has expertise in diagnosing and treating headaches.

Dr. Klebanoff says that most headaches are not caused by another medical condition. However, on rare occasions, headaches may be due to an underlying condition, such as a brain tumor or aneurysm. If you have any of these symptoms, report them to your doctor immediately:

• New onset of headaches if you’re over age 50
• Sudden, severe headache
• Headache that wakes you up
• A change in your headache pattern
• Pain that occurs on only one side of your head.

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For many people, occasional use of over-the-counter (OTC) sleep aids will cause no harm, but for others with certain medical conditions, it’s best to avoid these drugs. Anyone with glaucoma, breathing problems, or chronic bronchitis, and men who have difficulty urinating due to an enlarged prostate gland, should not take OTC sleep medications. Additionally, these medications may exacerbate restless legs syndrome.

It’s important to keep in mind that, although these medications are available without a prescription, they are still drugs, and they should be taken with caution. They are not meant for regular or long-term use.

OTC sleep aids include Unisom, Nytol, Compoz, Sleep-eze, and Sominex. They all contain the same 50-milligram dose of diphenhydramine (Benadryl), which produces drowsiness.

Some people have reported that OTC sleep aids have a lasting effect the next day; they may cause a morning “hangover,” diminished cognitive function, and even delirium, particularly in the elderly.

There are many non-drug strategies that may help you fall asleep faster and sleep better. For example, go to bed and get up at the same time every day, keep your bedroom quiet and cool, and don’t use electronic devices, such as a tablet or smartphone, for at least an hour before bedtime. Also, avoid alcohol before bedtime: It may help you fall asleep, but it can also disrupt your sleep later in the night.

If you continue to have problems sleeping, report it to your primary care physician; he or she may be able to help you identify the cause. Medications, increased stress and anxiety levels, and the drop in certain hormone levels during and after menopause are some possible underlying causes.

What differentiates a migraine headache from other types of headaches? Can any medications prevent migraines or stop them once they’ve started?

Migraines produce throbbing pain that tends to occur in the front of or one side of the head and is worsened by movement. About 25 percent of migraine patients experience an “aura”—a visual disturbance such as flashing lights, spots, or zigzag lines across your field of vision—before the headache starts. Migraine causes sensitivity to light and noise and may cause nausea and vomiting. Migraines can last for up to 72 hours.

In comparison, tension headaches—the most common type of headache—tend to be less severe, shorter in duration, and don’t cause an aura or sensitivity to light and sound.

Several medications have been approved by the U.S. Food and Drug Administration (FDA) in the past few years to prevent migraines. These drugs, which include erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality), are once-monthly self-injectable medications.

Another strategy that may prevent migraines is identifying what brings on or “triggers” a migraine and avoiding those triggers whenever possible. Common triggers include bright or flashing lights, strong odors, and certain foods, including chocolate, aged cheese, processed meats like bacon and sausage, monosodium glutamate (usually associated with Chinese food but also found in many processed foods made in the U.S.), red wine, and caffeine.

Within the past year, three oral medications—lasmiditan (Reyvow), ubrogepant (Ubrelvy), and rimegepant (Nurtec)—have been approved by the FDA for short-term treatment of migraine with or without aura. These medications were specifically designed to relieve migraine symptoms, and studies have shown that they lessen or relieve migraine pain for some patients within two hours.

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Melatonin, most commonly known as the sleep hormone, helps to control our circadian rhythm, the 24-hour cycle that tells our bodies when it is time to sleep._[1] Although it’s primary function is biological timekeeping, researchers have found that it can also modulate and decrease pain, possibly playing an important a role in migraine prevention. 

Melatonin Benefits for Pain

Produced by the pineal gland, melatonin is at its lowest level during the light of day and steadily increases to a maximum level late at night._[1] Researchers noted that many people have less pain at night—just when melatonin is peaking. They looked deeper and learned that melatonin acts on the receptors for many pain-relieving molecules in the brain (eg, opioid receptors), leading to a decrease in pain sensations when melatonin levels are high. Melatonin supplements have been shown to lower pain intensity in conditions such as fibromyalgia, irritable bowel syndrome, and migraine headaches._[2]

Decreased Melatonin Levels in Migraine Patients

Strengthening the link between melatonin and migraine, multiple studies have found that patients with migraine have significantly lower melatonin levels at night than healthy controls._[3,4] Perhaps even more interesting is that melatonin levels in migraine patients do not increase during the menstrual cycle the way that they normally do, implicating melatonin as a factor in menstrual migraine, a very common occurrence for women._[3,5]

Melatonin May Prevent and Treat Migraines

Based on these findings, melatonin is being pursued as a possible therapeutic tool to prevent migraines. A clinical trial found that 3 mg of melatonin 30 minutes before bedtime helped to reduce the overall frequency, intensity, and duration of headaches for the subjects in the study. 25 out of the 32 participants saw a decrease in headache frequency of 50 percent, and eight participants saw a complete remission of headaches. This study also found menstrual migraines to be improved as well for the female subjects._[6]

Researchers also looked at the use of agomelatin, a melatonin receptor agonist (something that acts like melatonin in the brain), to treat migraines. They found that the intensity and duration of migraine attacks decreased with use of agomelatin, and overall depression and sleep disruptions improved as well._[7] Although agomelatonin itself is not naturally occurring, these results add to the growing body of evidence of the promising melatonin benefits for migraine sufferers.

Try Melatonin for Yourself

To try using melatonin as a preventative migraine treatment at home, take it 30 to 60 minutes before sleep on a daily basis. The most promising studies show a dosage of 3 mg to be effective in reduce migraine symptoms._[6] Along with helping you to fall and stay asleep, a melatonin supplement might just help relieve some of your pain and let you live more migraine-free days. Give it a try and tell us what you think.

Share Your Experience With Melatonin and Migraines

Do you suffer from migraine headaches or other painful conditions? Have you tried melatonin or other natural remedies? Have you experienced other melatonin benefits? What migraine remedies have you found to be the most effective?

Please help our community by sharing your thoughts, questions, and experiences. You can comment below, visit us on Facebook or follow us on Twitter.

SEE ALSO:

What You Should Know About Using Melatonin for Sleep
Melatonin Benefits for IBS Sufferers

[1] CNS Drugs. 2006;20(5):343-50.

[2] Curr Neuropharmacol. 2012 Jun;10(2):167-78.

[3] Cephalalgia. 1995 Apr;15(2):136-9; discussion 79.

[4] Cephalalgia. 1994 Jun;14(3):205-9.

[5] Cephalalgia. 2005 Jun;25(6):403-11.

[6] Neurology. 2004 Aug 24;63(4):757.

[7] Zh Nevrol Psikhiatr Im S S Korsakova. 2011;111(9):32-6.

Originally published in 2014, this blog has been updated.

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A: Migraines produce throbbing pain that may occur on one or both sides of the head. About 30 percent of migraine patients experience an “aura”—a visual disturbance such as flashing lights, spots, or zigzag lines across the field of vision—before the pain begins. Migraine causes sensitivity to light and sound and may cause nausea and vomiting, and they can last for up to 72 hours if they are not treated. Migraines are three times more common in women than in men.

Common triggers for migraines include bright or flashing lights, strong odors, and certain foods, including chocolate, aged cheese, processed meats, monosodium glutamate, red wine, and caffeine. Some evidence suggests that fatigue, hunger, stress, anxiety, dehydration, and overexertion also may play a role in migraines.

Factors linked with a higher likelihood of having migraines include a genetic predisposition (the majority of migraine patients have a family history of migraines), hormonal changes (especially in women), epilepsy, asthma, and bipolar disorder.

If you have migraines (or any other type of headaches) that interfere with your ability to work or take care of your daily responsibilities, consult a neurologist, a specialist who has expertise in diagnosing and treating headaches.

For people who have migraines 15 or more days a month, the preventive medications erenumab (Aimovig), galcanezumab-gnlm (Emgality), or fremanezumab (Ajovy) may be prescribed. These medications reduce the frequency of migraines.

Medications used for treating migraines once they’ve started include ubrogepant (Ubrelvy), lasmiditan (Reyvow), zolmitriptan (Zomig), and sumatriptan (Imitrex). Several of these drugs have been approved by the U.S. Food and Drug Administration in just the past two years. For some people, over-the-counter pain relievers such as ibuprofen, naproxen, and acetaminophen help ease migraine symptoms.

Q: Are skin tags precancerous or cancerous, and should they be removed?

A: A skin tag is a small, elongated, skin-colored growth made up of a core of fibers and ducts, nerve cells, fat cells, and a covering. Skin tags are not a form of skin cancer and they do not develop into skin cancer.

Skin tags usually form near the neck, armpits, trunk, breasts, or other areas of the body where the skin folds. Skin tags do not grow (they are usually just a fraction of an inch in diameter) and they do not cause pain, but they can become irritated if clothes or jewelry rub against them.

Skin tags are more common in older adults, patients with type 2 diabetes, and people who are obese. They appear to be linked with metabolic syndrome (a group of risk factors that include a large waistline, high triglycerides, low HDL cholesterol, high blood pressure, and high fasting blood sugar).

A skin tag can be removed during an office visit with your dermatologist. Removal methods include excision (cutting it out), cryotherapy (freezing it), cauterization (burning it off with an electrical current), or ligation (interrupting the blood supply). Removing larger tags may require a local anesthetic. It is ill-advised to try to remove a skin tag without medical assistance because of the risk of bleeding and infection.

You cannot prevent skin tags—they just happen. But unless they regularly become irritated or unsightly, or they change in color, size, composition, or sensitivity, there is no reason to seek treatment for them or report them to your doctor.

-Orli R. Etingin, M.D.

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Sleep Phase Problems

When you have a sleep phase problem, you may prefer to stay up late and have difficulty waking up early in the morning, or you may fall asleep early and wake up earlier than average. In some cases, lifestyle or a professional activity (such as staying up late to finish work) may be to blame. Distractions, including the use of electronics and gaming at night, also may delay sleep onset if the stimulation and bright light exposure occur too close to the sleep period. An inactive retirement with too much time spent indoors also may cause disruption in sleep phases.

People who suffer from advanced sleep phase syndrome (ASPS) fall asleep far too early and awaken far too soon. The root of this problem is unknown, but some scientists speculate it may be due to genetic factors or even the degeneration of nerve cells that help set the circadian pacemaker, as if part of the mechanism of the biological clock has broken down.

Those with delayed sleep phase syndrome (DSPS) have the opposite problem—they can’t get to sleep when they need to and are unable to get out of bed at a normal waking time. They may lie awake for hours, feeling completely alert, but once they get to sleep, they sleep well. A person with DSPS who tries to force a normal bedtime will appear to have insomnia. The difference is that an individual with insomnia may have trouble falling asleep each time he or she tries to go to sleep, while a person with DSPS can fall asleep late at night (or in the “wee hours of the morning”) with ease, but is likely to have trouble getting up on time. On the weekends, people with DSPS may sleep late, often in an attempt to make up for chronic sleep deprivation during the week. Young adults are more likely to have DSPS than older adults.

How Sleep Phase Problems Are Treated

Bright light therapy is used to reset the biological clock in both sleep phase problems. People with ASPS are exposed to bright light in the late afternoon or evening and are encouraged to increase outdoor activities. Pushing back the bedtime of people with ASPS by 15 to 30 minutes each day also can help.

Treatment for DSPS also employs bright light, but in the early morning hours soon after waking (7 a.m. to 9 a.m.) to help obtain an earlier sleep onset. People with DSPS should avoid bright light in the evening, since it may promote wakefulness. The use of low-dose melatonin supplements taken at specific times to advance the sleep cycle can have a favorable effect on adjusting the sleep phase. Hypnotic sleep medications may help people with this disorder get to sleep earlier, but it’s not an ideal solution for long-term management. Chronotherapy, a practice that either advances or delays a person’s bedtime by a certain amount of time every day until his or her schedule reaches more normal hours, also may work for people with sleep phase problems.

Jet Lag

Jet lag is a sleep phase disorder that occurs when traveling across time zones. In the days of leisurely ocean liner crossings and cross-country rail travel, the body had time to adjust to different time zones. The advent of air travel changed that.

When you cross into a different time zone, your body stays on its original biological schedule for several days, so you feel sleepy during the daytime and wide awake at night. How badly you suffer from jet lag depends on the number of time zones you crossed and the direction in which you flew. When your sleep and wake patterns remain set to your home time zone, you may have trouble getting to sleep or awaken too early, your sleep may become fragmented, and you may awaken frequently during the night.

Jet lag symptoms usually last longer after an eastbound flight, which can shorten your day by several hours. When you fly from Los Angeles to New York City, for example, you may have trouble getting to sleep at your regular bedtime. By contrast, westbound flights lengthen your day, making it easier to adjust. When you head to L.A. from New York, you’re more likely to awaken too early.

People over age 50 are more prone to developing jet lag—and if you’re sleep deprived to begin with, your jet lag may be worse. In addition to altered sleep/wake patterns, other jet lag symptoms may include gastrointestinal upsets, headaches, mood disturbances, and muscle aches.

Treating Jet Lag

The best advice for minimizing jet lag is to follow the sun. Take a night or overnight flight eastbound so that you can sleep on the plane. If you arrive in the morning, get out in the sun as soon as possible, so your body gets the proper light-dark cues for sleep in that time zone. If you take a morning flight westbound, hit the sack at your usual time (even if being in the new time zone puts bedtime a couple of hours later), so that your body stays more in sync with your normal sleep-wake patterns.

Avoid alcohol and eat meals at the appropriate times in your new location once you reach your destination. Napping can have mixed results: It may limit your sleep deprivation, which is a jet lag symptom, but it also may interfere with your ability to sleep through the night.

Melatonin may help some people adjust more quickly to the new time zones, but there is little evidence that it can prevent jet lag. However, newer strategies for combining melatonin with light exposure days before you take your flight may help minimize jet lag. Research findings also suggest that fasting before a long flight may help ease jet lag.

Environmental Sleep Disorder

Nighttime noise from road traffic, planes, and passing trains can disturb sleep and impair your performance in the morning. In one study, a significant slowing of reaction times was seen the morning following exposure to traffic noise. Performance on a test of reaction time was just as bad following exposure to just one type of noise as it was after exposure to several sources of nighttime noise. The sound of passing trains caused the highest waking and arousal probabilities, followed by automobile traffic and airplane noise. However, each mode of noise caused a similar level of impairment. This study reinforces the importance of a quiet environment for healthy, undisturbed sleep.

Exposure to room light between dusk and bedtime may affect sleep quality. Research suggests it also may influence blood pressure and diabetes risk. In one study, exposure to room light before bedtime shortened melatonin duration by about 90 minutes, compared with dim light exposure. Furthermore, exposure to room light during the usual hours of sleep suppressed melatonin by more than 50 percent.

Electronic glow is no exception. Light from electronic devices with backlit displays suppresses melatonin production and can affect the ability to go to sleep. As little as two hours of exposure to the light can make a difference in sleep. Backlit devices should be dimmed as much as possible at night to minimize melatonin suppression, and the amount of time spent using such devices before bedtime should be limited.

The American Medical Association (AMA) reinforced the recommendation to limit exposure to excessive light at night, including extended use of electronic devices. In an official policy statement, “Light Pollution: Adverse Health Effects of Nighttime Lighting,” the AMA stated that using dim red lighting in the bedroom at night can minimize the effects of exposure to excessive light that otherwise may disrupt sleep or exacerbate sleep disorders.

Medication Side Effects

Many older people with chronic health problems take multiple medications, one or more of which can affect sleep. Drugs that have stimulating side effects include certain antidepressants, decongestants, bronchodilators, corticosteroids, and blood pressure medications. Some drugs, such as the respiratory stimulants that are used to treat chronic obstructive pulmonary disease (COPD), may cause insomnia, and, when taken at night, can hamper the ability to fall asleep.

Cardiac drugs such as beta-blockers, which are used to treat high blood pressure or irregular heartbeat, can increase the number of arousals from sleep and may even cause you to awaken during the night. However, because beta-blockers slow your heart rate, they can make you feel tired, so many people find these drugs are best taken an hour before bedtime.

Some medications, including benzodiazepines, are especially sedating and can contribute to a “hangover” effect in the morning. Benzodiazepines and other drugs—including antihistamines, anti-anxiety drugs, and anticonvulsants—can cause daytime drowsiness or impair alertness. Sedating antidepressants are frequently used to improve sleep in people with depression, but they can cause daytime sleepiness.

Important Precautions

Older people taking OTC or prescription sleep aids or antidepressants should avoid allergy remedies such as diphenhydramine (Benadryl) and other similar compounds, which can intensify the effects of these drugs. Look for non-drowsy allergy formulas.

Many prescription and OTC drugs also contain stimulants such as caffeine or ephedrine. Some people reach for an OTC remedy without considering whether it could be responsible for disrupting their nighttime sleep. For example, allergy or cold remedies may include small amounts of ephedrine to counteract the effects of antihistamines that can cause drowsiness. If you take such OTC remedies, check the list of active ingredients, or ask your doctor or pharmacist if the products you take may be disrupting your sleep.

Chronic Pain

Chronic pain from arthritis, headaches, back problems, and other medical disorders can keep you tossing and turning at night. A study found that among patients with rheumatoid arthritis, poor sleep quality correlated with higher levels of depressive symptoms, greater pain severity, increased fatigue, and greater functional disability. According to test results, 61 percent of patients were poor sleepers, and 33 percent reported having pain that disturbed their sleep three or more times per week.

Another study showed that cognitive behavioral therapy (CBT) for insomnia is an effective treatment for older adults with osteoarthritis and insomnia. CBT enabled participants to increase their sleep efficiency by as much as 13 percent and decrease their pain levels by as much as 9.7 points.

Another study compared the sleep quality of 70 chronic back pain patients with that of 70 pain-free controls. More than half of the chronic-pain patients displayed signs of clinical insomnia, while only 3 percent of the pain-free controls displayed such signs.

Finding a comfortable sleep position when you have back pain can seem impossible. Chronic back pain due to degenerative disk disease, spinal stenosis, or other conditions not only makes it harder to fall asleep, but it also may cause sleep disturbances during the night. Sleep studies reveal that people who have experienced a back strain display a disturbance in brain waves during slow-wave sleep, which is usually a restorative state.

Fatigue is a common complaint among people with arthritis and other rheumatic diseases. While some fatigue may be due to their disease, up to 75 percent of people with arthritic diseases report sleep problems. At the same time, the symptoms caused by restless legs syndrome and periodic limb movement disorder may mimic osteoarthritis by producing morning stiffness and pain. The generalized aches and pains of fibromyalgia also contribute to sleep problems.

People who suffer from migraines may be awakened by their headaches during sleep. Sleep deprivation also can trigger a migraine. Studies show that migraine sufferers who improve their sleep habits often have fewer and shorter headaches and a reduction in other migraine symptoms, such as nausea and light sensitivity. Also, morning headaches are three times more common among people with apnea and heavy snorers. Treating obstructive sleep apnea often can help.

Changing sleep positions and making other lifestyle changes can help relieve nighttime pain for people with back and neck problems. Treating these and other pain disorders with appropriate therapies and medications—and timing those drugs so that they relieve nighttime and morning pain—also can aid sleep considerably.

That being said, a study showed that individuals with chronic pain who take opioid-based pain medications develop sleep apnea at a much higher rate than people in the general population.

Leg Cramps

Some people find their sleep interrupted by painful muscle spasms in the leg or foot that can last for a few seconds or for as long as 30 minutes. Many factors—from tight muscles to medication side effects—can cause these muscles to contract. However, nocturnal leg cramps do not appear to be caused by strenuous daytime activity or exercise, nor are they related to restless legs.

Muscle cramps often are caused by diuretic medications prescribed for edema (fluid retention and swelling) or high blood pressure. If you’re taking such a medication, have your sodium and potassium levels checked. Taking supplemental forms of certain vitamins and minerals also may help reduce cramps. One study found that taking a vitamin B-complex tablet daily for three months reduced nocturnal leg cramps in elderly patients with hypertension.

Doing evening exercises that gently stretch leg muscles, such as calf stretches, also may help.

Depression

Insomnia is a classic symptom of major depression and persistent depressive disorder (dysthymic disorder).

In the late fall and winter, when there are fewer hours of daylight and the nights are longer, some people may experience a form of depression called seasonal affective disorder (SAD), which also causes them to sleep longer at night and feel sleepy during the day. Depression is a risk factor for having difficulty sleeping, and poor sleep also contributes to depression. This is especially true for people with chronic insomnia.

Other symptoms of depression include losing interest in normally pleasurable activities and feeling sad, hopeless, or worthless (see “Symptoms of Depression” for a more comprehensive list). Late-life depression also can produce physical symptoms, such as headaches, stomachaches, and joint or back pain. Thoughts of death or suicide are a red flag. Remember that depression is treatable at any age.

Stress and Anxiety

Some stress in life is normal, but excessive stress can take a physical and mental toll and cause sleepless nights. The body perceives stress as a threat or danger. Being under stress sends a signal to the brain that activates the sympathetic nervous system to produce stress hormones such as epinephrine (also known as adrenaline), norepinephrine (noradrenaline), and cortisol.

Epinephrine increases the heart rate, blood pressure, and breathing to send more blood and oxygen to the parts of the body that need it (such as the muscles in your legs), so that—at least theoretically—you can flee the danger. Stress hormones make you more alert and prompt the release of sugar and fats into the bloodstream to provide quick energy. Once the danger passes, the body secretes hormones such as acetylcholine to counteract the effects of stress hormones, so you then calm down and your heart rate and breathing return to normal.

In prehistoric times, the fight-or-flight response helped humans get away from predatory animals. In today’s world, a traffic jam or an auto accident is likely to trigger the same type of response in the sympathetic nervous system. When you get angry or frightened, your body experiences the same physiologic response. Transient stress may raise blood pressure temporarily, but it’s not a health threat. However, chronic stress can keep stress hormones elevated for longer periods, and this can lead to high blood pressure and interfere with sleep. Prolonged stress also may lead to chronic anxiety, which can keep you awake at night.

When you’re under stress, you may eat or drink compulsively, bite your nails,  or binge-watch TV. You may feel on edge and nervous, fatigued and drained, or sad and lonely. Some research suggests that older adults who sleep poorly have an altered immune system response to stress that might increase their risk for both mental and physical health problems. One study found a heightened inflammatory response to acute stress among poor sleepers that put them at greater risk for illness and death. After taking stressful tests, poor sleepers had a significantly larger increase in interleukin-6, a biomarker of inflammation, than good sleepers.

Like stress, anxiety can contribute to sleepless nights. One study showed that people who suffer from anxiety due to stressful life situations may be more likely to experience sleep disturbances for at least six months after the event. Other research demonstrated that even unfounded anxiety can take a toll on sleep. In one instance, researchers found that a significant number of women ages 50 to 70 worried about cancer (even though they had not been diagnosed with cancer) and may have experienced sleep disturbances as a result. The odds of women who worried about cancer reporting sleep complaints were nearly 50 percent greater than the odds for women who reported no cancer concerns.

Chronic Worry

Some people are chronic worriers, no matter their age. Later in life, they tend to focus excessively on getting older, life changes, or medical problems. Excessive worry that keeps you awake at night, makes you fatigued and restless, and interferes with concentration may be a symptom of generalized anxiety disorder (GAD). Chronic anxiety and GAD are underdiagnosed and undertreated in older people. Anxiety often goes hand in hand with late-life depression.

How Stress and Anxiety Are Treated

Psychotherapy, medication, or a combination of both can help relieve GAD. The type of psychotherapy often used to treat GAD is short-term cognitive behavioral therapy (CBT). CBT usually involves eight to 12 weeks of therapy to get at the roots of anxiety and change negative thoughts and behavior patterns. Medications also may be prescribed by a mental health professional on a longer-term basis. However, recent concerns about increased suicidal behavior among younger people taking SSRI antidepressants prompted the FDA to put a black-box warning on these medications. A black box means the drug carries a significant risk for serious or even life-threatening adverse effects. Anti-anxiety drugs such as benzodiazepines work quickly, but they may affect cognitive functioning and be habit-forming.

Dementia

Sleep disturbances are common in people with Alzheimer’s disease (AD) and other forms of dementia. Sleep-disordered breathing problems also occur more frequently in people with AD, and research suggests that orexin, a protein that helps regulate the sleep cycle, appears to be directly involved in the buildup of abnormal protein plaques that are a hallmark of AD. Caregivers for AD patients often report sleep disruptions, including frequent waking and night wandering.

Researchers recently found that a comprehensive sleep education program helped improve sleep in people with AD being cared for at home. Patients in this study were instructed to walk daily for 30 minutes outdoors, usually accompanied by a caregiver, and to increase their daily light exposure by one hour using a light box. People who walked and used the light box daily reduced their awake time at night by 30 minutes and had about five fewer nighttime awakenings, compared with what they were experiencing at the start of the study. Depression and daytime sleepiness also decreased. The patients maintained these benefits even after six months. If you’re caring for a family member with AD, you may want to discuss the use of a light box and other behavioral therapies with your physician.

It is important to note, however, that many treatable conditions can mimic dementia, including depression. Medication side effects, medication misuse or overuse, poor diet, alcohol abuse, and conditions such as anemia also can be mistaken for dementia. It is vital to have the appropriate diagnosis so that sleep problems can be properly evaluated and appropriate treatment can be provided.

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Exertion headache symptoms can be similar to migraine symptoms. For example, you may experience throbbing pain in your head, increased sensitivity to light, nausea, and vomiting. An exertion headache can last from as little as five minutes to as long as one or two days.

Exertion Headache Causes

An exertion headache after running is common; other sports that particularly increase your exertion headache risk include weightlifting and tennis. It may be that the excessive perspiration that goes with these and other strenuous sports—and the potential for dehydration—can come into play; a dehydration headache, after all, can feel similar to an exertion headache.

Other factors that make an exertion headache more likely include a poor diet, hunger and the low blood sugar that can result from it, heat and humidity, and exercising at high altitudes where there is less oxygen in the air you breathe.

As to what’s going on inside your brain during an exertion headache, the precise mechanisms that underlie headaches aren’t fully understood. However, it is thought that vigorous physical activity may dilate blood vessels to the extent they pull on the nerve fibers that surround them, resulting in the transmission of pain messages to the brain.

Exertion Headache Treatment

An exertion headache is usually harmless, but in rare cases it can red-flag brain aneurysm symptoms or a brain tumor.

If you experience your first exertion headache very abruptly, contact your doctor for advice. If you have other brain aneurysm symptoms or a family history of brain aneurysms, your doctor may order imaging tests such as a CT scan or magnetic resonance imaging to check that all is well.

If there is no underlying reason for your exertion headaches, try taking a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) 30 minutes before exercise sessions. Your doctor also may prescribe another NSAID called indomethacin (Indocin), which also is used for ice pick headache treatment.

Indomethacin must be taken sparingly, particularly if you have heart disease, since long-term use is associated with a greater risk for heart attack and stroke. It also has been linked to eye problems, so if you take it, you should have regular eye exams. Furthermore, your gastrointestinal health may be affected by taking indomethacin, so if your doctor prescribes it, he or she may recommend that you also take an antacid such as omeprazole (Prilosec).

Preventing Exertion Headaches

There are no hard-and-fast rules for preventing exertion headaches, but there are some tips you can follow alongside the practice of taking a painkilling drug before you exercise.

First, you definitely should not stop working out just because of your tendency to develop exertion headaches, since physical activity is important for helping to preserve your cardiovascular health and bone density, and also may help protect you against depression. But do take the time to warm up slowly before you exercise, as opposed to launching straight into vigorous activity. You can warm up by taking a few minutes to do some stretches, and by marching or jogging on the spot while circling your arms at the shoulders. It is also important to cool down after exercising—you can do this with stretches, and with step-touching from side-to-side as your heart rate begins to slacken.

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