I am 33. How to manage severe migraines, nausea, and aura?

Question

Hello doctor,

I am a 33-year-old woman experiencing severe, throbbing headaches on one side of my head 12 to 15 days per month, often accompanied by nausea, vomiting, and sensitivity to light and sound. My headaches are preceded by visual aura, with flashing lights and zigzag patterns, and my magnetic resonance imaging (MRI) with contrast was normal. My migraine disability assessment (MIDAS) score is 35, indicating severe disability, and my magnesium level is low at 1.5 mg/dL.

The migraines worsen around my menstrual cycle, and I have noticed they have been becoming more frequent and severe over the past two years. I am missing work regularly, and my relationships are suffering due to canceled plans. Could these frequent migraines lead to medication overuse headaches (MOH) or stroke, and am I at risk of developing chronic daily headaches, depression, or cognitive problems from repeated migraine attacks?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

You have frequent, severe migraines with aura, which worsen around menstruation. Low magnesium levels can also increase the frequency of attacks. Over time, untreated frequent migraines can progress into chronic migraine (more than 15 headache days per month).

If you take painkillers (such as Paracetamol, non-steroidal anti-inflammatory drugs [NSAIDs], or Triptans) on more than 10 to 15 days per month, your brain can become sensitized, leading to medication overuse headaches (MOH). This makes migraines harder to control. Preventive treatment is needed to reduce this risk.

Migraine with aura is linked to a slightly higher risk of ischemic stroke, especially in young women, and even more so if you smoke or use estrogen-containing birth control pills. The absolute risk is still low, but important to recognize.

Frequent migraine attacks can evolve into chronic daily headaches if not controlled. Repeated disabling attacks also increase the risk of depression, anxiety, and cognitive difficulties (such as memory and concentration problems), mostly due to poor sleep, stress, and social or work impact rather than permanent brain damage.

I would suggest the following measures:

Maintain good sleep hygiene, stay well-hydrated, manage stress, and avoid known triggers (such as alcohol, certain foods, and prolonged fasting).
Oral magnesium supplementation often helps reduce migraine attacks.
Medications such as beta-blockers, Topiramate, Valproate, Amitriptyline, or newer options like calcitonin gene-related peptide (CGRP) monoclonal antibodies may be recommended depending on your individual case.
Short-term preventive treatment around the menstrual period can sometimes help reduce attacks.
Limit painkiller use to less than 10 days per month.

With the right preventive strategy, your headache frequency can be reduced dramatically, improving both work performance and social life.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.

I am 33. How to manage severe migraines, nausea, and aura?

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