Michael Nelson
Migraines are a seriously painful and debilitating condition that can cause people to call in sick and skip events with family and friends. They’re also treatable. As a neurologist at Vancouver Clinic, I often see patients who have been bravely dealing with head pain on their own, either because they haven’t been properly diagnosed or because they aren’t aware of the many options available. With the FDA’s recent approval of several new migraine medications, now is a good time for patients to talk with their doctor and develop or revisit their care plan.
Is it or isn’t it?
The first step in managing migraines is diagnosing them. Migraines are not just severe headaches. In fact, headaches and migraines have different symptoms. With a headache, a person’s entire head, and possibly neck, hurts. A migraine usually occurs on one side of the head and often includes nausea, sensitivity to light, an aura, or shimmering lights. A doctor can determine which problem a patient is dealing with. It’s not uncommon for patients to believe they’re suffering from sinus or tension headaches when they actually meet the criteria for a migraine diagnosis.
A common myth is that migraines are the result of something wrong with the brain. In fact, an MRI can’t pick up any abnormalities in the brains of migraine patients. Instead, migraines run in families. Individuals who have one first-degree relative with migraines have a 40 percent chance of suffering from them as well. Gender is also a risk factor — some 18 percent of women get migraines, and attacks often occur with monthly hormone changes.
Ways to stop the pain
Patients who get migraines infrequently often just need a way to stop them from getting worse. Triptans are a fast-acting group of drugs that can help reduce head pain in just two hours. Over-the-counter medications are also an option, but they are generally less effective. They can also cause rebound headaches if used too often. Options that contain caffeine can be problematic as caffeine is a common migraine trigger.
Patients who get eight or more migraines a month will likely want to work with a neurologist on a prevention plan. Several drugs originally designed to treat other conditions are FDA approved for migraine prevention. These include specific antidepressants, seizure medications, blood pressure pills, and even Botox. It’s a motley, but often effective crew. For patients dealing with multiple health concerns, one pill can sometimes manage two conditions.
Finally, there are calcitonin gene-related peptide inhibitors—the newest class of drugs and the only ones specifically made to prevent migraines. Because they just entered the market, insurance coverage varies. They’re mainly reserved for patients who have 15-plus migraines a month and who don’t respond to other medications.
Natural solutions
Of course, not all migraine solutions come in a bottle. Lifestyle changes can make a big difference for some patients. Physical therapy and massage can be valuable for individuals whose migraines are triggered by neck tension. Caffeine, wine, chocolate, cured meats, and cheese are associated with migraines, and avoiding them can be an effective strategy. Magnesium and riboflavin (vitamin B2) supplements help some people, as does acupuncture.
It’s also important for patients to pay attention to environmental conditions. Blue light from computer monitors, changes in weather, fluorescent lights, glare from sunlight, and perfumes can be triggering. When the problems are a result of indoor office conditions, patients can speak to their managers about accommodations.
Talk to a doctor
If you need help managing migraine or headache symptoms, talk to your doctor. Your provider will want to know what your symptoms are, if you have noticed any triggers, how often your pain occurs, and what you’ve used to manage the issue before. Be prepared to also talk about your family history. By partnering closely with your doctor, you can get the help you need to better control this common condition.
About the writer
Dr. Michael Nelson is a neurologist at Vancouver Clinic. He cares for patients with a broad range of neurologic conditions, but has a special interest in helping individuals dealing with migraines and headaches.
