What is a migraine?
Migraine headaches affects one in five women and one in 16 men. You are far more likely to develop migraines, if one or both parents have this condition.
Most often, a migraine headache is described as a pounding or throbbing headache which if untreated, typically lasts from 4-72 hours. It can involve one or both sides, can occur anywhere on the head, neck or face and can switch sides (most commonly eye, frontal, occipital). Migraines are usually accompanied by nausea and sensitivity to light and noise and are worsened with activity. During the course of their headache. most will seek a dark and quiet room in which to rest.
While symptoms vary from one person to the next, migraine headaches often have distinct phases.
- Premonition – A change in mood or behavior hours or days before the headache
- Aura– Seen in 20 percent of patients and often involves visual, sensory or motor symptoms that can precede the headache. Examples include flashing lights and blind spots, as well as confusion, speech difficulties and other neurologic symptoms.
- Headache– Phase of the actual headache with throbbing pain on one or both sides of the head, nausea, light sensitivity and fatigue.
- Resolution– Lessening of pain after the headache phase. Pain can be replaced by fatigue, irritability and trouble concentrating.
What triggers a migraine?
While the cause of migraines is unknown, they can and do run in families. Overall, it is not clear why some people get migraines and others don’t. There are common “triggers” for migraines include:
- Certain foods (chocolate, red wine, MSG)
- Strong smells
- Teeth grinding at night
- Weather Changes
- Lack of sleep
- Schedule/ routine changes
How are migraines diagnosed?
Despite their dramatic symptoms, migraines are rarely due to an underlying problem that can be diagnosed with testing or brain imaging studies such MRI. The diagnosis is made through a detailed neurological examination and obtaining a careful medical, family and headache history. However, your physician may order tests or imaging studies to exclude an underlying condition which could mimic the symptoms of migraine.
How are migraines treated?
Migraine prevention may include dietary modifications, lifestyle changes, and the use of certain vitamins and minerals, such as B2, Coenzyme Q10 and magnesium. Prescription medications used to abort (interrupt) the headache include the Triptans (such as Imitrex), nonsteroidal anti-inflammatory drugs such as Toradol, anti-nausea agents such as Reglan or Compazine, ergot compounds such as Migranal and sometimes steroids. If migraines are frequent, preventative agents are used and may include certain blood pressure (Lisinopril), anti-epilepsy (Topamax, Lyrica, Neurontin, Depakote) and anti-depressant medications (Elavil), to name only a few. Botox has also been shown to be effective and is usually administered every three months.
Recently, there has been a major breakthrough in preventative medications for migraine. These are “custom made” monoclonal antibodies which block the effects of CGRP. CGRP is a small protein and when released into the blood stream, is a major initiator of the headache. Approximately 40% of patients who have failed to respond to other migraine medications, have had a favorable response to the injectable monoclonal antibodies. These medications are administered either once per month or every other month and thus far, the side effect profile has been encouraging. Currently there are three such medications, which go by the tradenames of Aimovig, Ajovy and Emgality.
How can Interventional Headache Management help with migraines?
If you continue to have migraines which disrupt your regular activities in spite of prior medical care (including relevant testing), Interventional Headache Treatment may be an effective way to treat your migraines. Through injection procedures, Interventional Headache Treatment can be used to identify the structures or nerve pathways which are causing or contributing to your headache. Once identified, some patients have a favorable response to a series of local anesthetic blocks and others may require radiofrequency procedures to achieve longer term relief. This and other treatment options will be discussed as part of your initial consultation.