We all know how awful it is to have a headache, and for the 12% of Americans who chronically get migraine headaches the pain is so severe that it interferes with their daily activities. The medical establishment has not nailed down exactly what causes migraines yet, although signs lead to genetics and environmental factors. Migraines can affect anyone, but certain factors make you more prone to them:
- Migraines are three times more common in women.
- We mentioned genetics as a factor above, and indeed migraines have a family history, so if you have family members who get migraines then you are more prone to them too.
- The first occurrence tends to be during adolescence, with migraine frequency peaking in a person’s early 30s and becoming less frequent and severe for people aged over 40.
- Since we mentioned women get them more frequently and the first occurrence is during adolescence, you may have put it together that hormonal changes may be one of the causes. For many women, migraines tend to appear just before or after menstruation, and they improve after menopause.
- Sufferers of certain medical conditions have a higher incidence of frequent migraines. These include anxiety, sleep disorders, epilepsy, bipolar disorder and depression.
A migraine is a headache that is severely throbbing, often on one side of the head and it usually has nausea, vomiting, as well as, sensitivity to light and sound along with it. An attack can last for hours or days with pain so severe it interrupts your daily life. About one-third of migraine sufferers have an “aura” attack precede the onset of a migraine. An “aura” attack consists of seeing flashing lights, zig-zag lines or dots in your vision or even a temporary loss of vision altogether. In fact, there are four distinct phases of having migraines. These include:
- Prodrome—a phase 24-hours before getting the migraine during which you crave certain foods, have fluid retention or increased urination, mood swings and uncontrollable yawning.
- Aura attack—the visual symptoms described above can happen right before a migraine or last during it as well.
- The migraine headache—It usually starts gradually and gets more severe with throbbing or pulsing pain often on one side of the head, nausea or vomiting, sensitivity to light and sound, worse pain when you move.
- Postdrome—The aftereffects of a migraine can last for up to a day and includes feeling weak, exhausted and possibly confused.
Most people never even seek medical attention for their migraines, they merely live with them and do their best to avoid the environmental factors that can trigger them. These may include stress, strong scents, caffeine, not enough sleep, alcohol, chocolate, MSG, yeast, aged cheeses, processed meats, some fruit and nuts, fermented or pickled foods. Quite often the way people treat a migraine is simply to pop some aspirin or ibuprofen and go lie down in a quiet, darkened room.
However, as concierge doctors, we believe strongly in preventative medicine, to try to keep you from having to go through the pain at all. So we recommend coming in to us, as your primary care doctors, and having us diagnose the issue officially, and go over treatment options with you.
We will look at several things in terms of diagnosing your migraines. As with all new patients, we will take a complete medical history. That’s why it’s important that you keep a log of when your migraines occur, what environmental factors may have triggered them and what you did to treat them. It is also important for you to seek into who in your family suffered from migraines. We will do a thorough exam and may send you for blood tests, an MRI or CT scan or other tests jut to rule out other medical conditions that can cause the same symptoms as a migraine.
There’s no full cure for migraines, however, we can create a treatment plan that focuses on preventing attacks and relieving symptoms when you do get a migraine. There are preventative medications to lessen the number of migraines you get and pain medication that can be taken during an attack. With the right combination of medicines and lifestyle changes, we can help begin to alleviate your migraine issues.
Let’s look at relieving the symptoms. There are three types of drugs that can help relieve your symptoms when you experience an attack. These include:
Pain relievers—These can include your typical over-the-counter drugs such as aspirin or ibuprofen or prescription pain relievers such as triptans or DHEs or opioids like codeine.
Triptans—These are prescription drugs taken as pills, shots or nasal sprays, that block pain pathways in the brain.
DHEs (dihydroergotamines)—Prescription drugs taken as shots or as a nasal spray which are taken shortly after the start of migraine symptoms. These are specifically for people who have migraines that last for more than 24-hours.
- Anti-nausea drugs
There are also preventative medications we can prescribe. They are taken regularly, usually daily, to reduce the frequency and severity of migraines. These are often related directly to what we feel are the causes of your specific type of migraine.
- Beta blocking or calcium blocking blood pressure lowering meds
- Calcitonin gene-related peptide monoclonal antibodies
- Anti-seizure drugs
- Hormone therapy for women whose migraines are linked to their menstruation cycle
- Botox injections
We are excited to be able to offer migraine sufferers the option of getting two of the newest treatments for migraines, hormone therapy and Botox injections. Let’s talk just a little about Botox injections and why they can help migraine sufferers. Botox was FDA approved for migraine treatment in 2010 and since then more than 2 million treatments have been given in the U.S. to treat migraines.
Here’s how it works. . . Botox blocks neurotransmitters that carry pain signals from your brain. It stops the pain signals before they can get to the nerve endings around your neck and head. So the Botox is injected around the specific pain fibers that are involved in your headaches. It enters those nerve endings and then it prevents the activation of the pain networks in the brain by blocking the release of chemicals involved in pain transmission. So it stops migraine headaches before they start, but Botox takes time to work.
Recent studies show that almost half of the people who get chronic migraines (15 days or more of them per month) got pain-free relief and a lot fewer headaches days through the use of Botox injections. And in another study, half the people who had taken two rounds of Botox reported that they cut the number of days they had headaches in half. By five rounds of treatment 70% of people reported cutting their headache days in half.
Because Botox is FDA approved for chronic migraine, it’s covered by most plans, including Medicare and Medicaid. It is approved to treat any form of migraine, as long as it’s a chronic migraine of at least 15 days of 4-hour duration headaches per month. That’s the main eligibility criteria for most insurance reimbursement. Another criteria may be that you tried but failed to respond to at least two other preventative medications first before trying Botox. The treatment lasts for 10-12 weeks.
If you are having chronic headaches, or regular migraines, we urge you to give us a call at PremierMD Care to see if we can help prevent your pain.