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How Do Neurologists Treat Migraines

When To See A Neurologist For Headaches

How Do You Treat Migraines? – Adel Olshansky, MD – Neurologist

While most headaches are treatable with available painkillers, some persist beyond the treatment. If any of your condition refuses to go away for a considerable period of medication, ask your doctor. It is time to see a neurologist for the headache. Several triggers require a serious check-up by a neurologist. Discuss them with your medical doctor to see the way forward.

Advanced Treatment And Clinical Studies

In rare cases, pediatric-approved medications are not enough to mitigate a child’s migraine. Many treatments shown to be effective in adults are not approved for children by the U.S. Food and Drug Administration . But the 2003 Pediatric Research Equity Act gives the FDA authority to require clinical studies of child-appropriate formulations of new drugs.

Our pediatric headache program is participating in a trial of one such medication called galcanezumab, a calcitonin gene-related peptide that can effectively prevent episodic migraine attacks in children ages six to 17. Eric Remster, M.D., is the principal investigator for UT Southwestern’s site of the REBUILD-1 phase 3 clinical study of galcanezumab.

The drug blocks the CGRP protein and helps regulate vascular dilation, which is part of the migraine process. Galcanezumab binds to molecules that contain the CGRP protein, rendering the protein inactive. This action reduces blood vessel dilation, preventing migraine attacks.

Three other drugs that work similarly are in various stages of clinical trials around the U.S. We expect that CGRP medications, if approved in children, will provide hope and effective relief for children struggling with migraine. Early data appear comparable to adult data, and we plan to begin patient enrollment in late spring or summer 2021.

Confirming The Diagnosis Taking A Careful History And Stopping Medication Overuse Can Enable Effective Pain Relief

Neurology Reviews

RIVIERA BEACH, FLNeurologists sometimes encounter patients with headaches that have not responded to prior treatment. These patients may be demoralized, and neurologists may be at a loss for a way to relieve their pain. Effective treatment is possible for many of these patients, according to Thomas N. Ward, MD, Emeritus Professor of Neurology at Dartmouth College in Hanover, New Hampshire. He described the process of differential diagnosis, as well as outpatient and inpatient therapeutic options for refractory headache, at the 44th Annual Meeting of the Southern Clinical Neurological Society.

Thomas N. Ward, MD

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How To Prevent Migraines Caused By The Weather

While you cant control the weather, you can control other potential triggers, says Dr. Crystal. For some people with migraine, it takes a perfect stormpun intendedto trigger an attack. So, she says, if you know your particular weather trigger, make sure to optimize other conditions. For example, if youre worried about a brewing storm, make sure to avoid your known food triggers, get plenty of rest, and practice stress reduction. And of course, make sure to have your medications on hand.

Moreover, tracking weather can be helpful. I recommend using the WeatherX app, says Dr. Crystal. Once you establish a relationship between weather and your migraines, she says, you can potentially pre-treat with an anti-inflammatory medication.

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Whats A Migraine Journal

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  • Keeping a migraine journal is not only beneficial to you, but it helps your healthcare provider with the diagnosis process. Your journal should be detailed and updated as much as possible before, during and after a migraine attack. Consider keeping track of the following:
  • The date and time of when the migraine began specifically when the prodrome started, if youre able to tell its happening. Track time passing. When did the aura phase begin? The headache? The postdrome? Do your best to tell what stage youre in and how long it lasts. If theres a pattern, that may help you anticipate what will happen in the future.
  • What are your symptoms? Be specific.
  • Note how many hours of sleep you got the night before it happened and your stress level. Whats causing your stress?
  • Note the weather.
  • Log your food and water intake. Did you eat something that triggered the migraine? Did you miss a meal?
  • Describe the type of pain and rate it on a one to 10 scale with 10 being the worst pain youve ever experienced.
  • Where is the pain located? One side of your head? Your jaw? Your eye?
  • List all of the medications you took. This includes any daily prescriptions, any supplements and any pain medication you took.
  • How did you try to treat your migraine, and did it work? What medicine did you take, at what dosage, at what time?
  • Consider other triggers. Maybe you played basketball in the sunlight? Maybe you watched a movie that had flashing lights? If youre a woman, are you on your period?

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Neurology And Women’s Health: Migraines

Migraine headaches, the most common neurological disorder in the United States, are especially devastating for women. Women not only make up three out of every four migraine sufferers, but their migraines last longer, have worse side effects, and are more intense. Fortunately, we know much more how and why migraines occur, and there are a variety of treatments can stop or reduce the effects of this disabling condition. For our next entry in our Neurology and Womens Health series, Hillary Yu, NP-C, MSN, discusses the biological and cultural factors that make migraines so difficult for women. She also talks about the treatment options that are available, lifestyle choices that can make a difference for women, and the research at Duke that is investigating how to better understand and treat migraines.

What are some of the differences in how migraine affects women compared to men?Migraine is the most common neurological disorder and is actually the seventh-leading cause disability worldwide. But its especially common among women–the American Headache Society estimates that women make up about 28 million out of the total of 37 million migraine sufferers in the U.S. In addition, women also have longer migraine attacks, and higher rates of relapse. Finally complications of migraine are worse for women than men–migraine puts women at a greater risk for a heart attack or stroke than it does men.

Top Neurologists In Midtown Miami

Our top Neurologists in Midtown Miami include:

Jeffrey Gelblum, MD has successfully treated thousands of patients over a quarter-century, from South Florida, and around the world. He is considered a global thought leader in the neurologic treatment of dementia, seizure disorders, Parkinsons, Familial Amyloid Polyneuropathy, trauma, and chronic pain, and has hosted educational symposia in the U.S. and overseas.

Raul Grosz, MD is Board Certified in neurology. His specialties include migraine headaches, memory loss, seizure disorders, Parkinsons disease, carpal tunnel syndrome, neuropathy, pinched nerve, sciatica, and radiculopathy and treats all conditions of the nervous system.

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Is It Migraine Or Something Else

It can be difficult for parents to know when theyre child is experiencing a migraine. Generally, a child may be diagnosed with migraines after they’ve had five severe headaches that fit migraine criteria: causing light or noise sensitivity, nausea, vomiting, and/or aura sensory disturbances such as seeing sparks or zig-zag patterns in their peripheral vision right before an attack.

Your child’s first visit will involve a deep discussion about their daily routine. We’ll talk about their current medications and lifestyle routines that might trigger migraines, including:

  • Diet and hydration
  • Medication what has and hasn’t worked
  • School and work schedules
  • Sleeping and waking

We’ll also discuss the type and frequency of their headaches. Definitions matter to get the most effective, least invasive treatment, we must first exhaust all noninvasive options. In general, we follow these criteria:

  • Probable migraine: Infrequent but severe headaches without identifiable triggers or full sensory symptoms .
  • Episodic migraine: Children have up to 14 headache days a month, some with aura.
  • Chronic migraine: Having 15 or more headache days a month, for at least three months, with four to five of the headaches meeting migraine criteria.

The next step is conducting a physical and neurological exam to see if your child is having problems with coordination, movement, or sensation. Some patients may need advanced imaging, such as CT, MRI, or spinal tap to rule out other conditions.

Can Migraines Be Prevented

When to see a neurologist for headaches or migraines | Ohio State Medical Center

Preventive migraine treatments can be helpful for patients with frequent, severe headaches. The main goal for preventive strategies is to reduce the overall frequency and severity of the headaches. Avoiding known triggers may be helpful. Many people find that regular exercise makes them feel better, although strong evidence is lacking to recommend this as a highly effective migraine treatment. Other strategies may include improving sleep habits or learning to cope more effectively with stress, for example by learning relaxation techniques such as biofeedback or meditation.

Numerous medications also can be used as a preventive treatment for migraine. It is often helpful to start with a low dose of medication and increase it slowly in order to find the best balance between benefits and side effects. Some commonly used medications include amitriptyline, propranolol, and topiramate. Valproic acid and lisinopril are less commonly used. For some patients with chronic migraine, botulinum injections can help reduce headaches. Some vitamins, minerals and herbal preparations are also used to help prevent migraines.

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What Are The Symptoms Of A Migraine

Individual migraines are moderate to severe in intensity, often characterized by a throbbing or pounding feeling. Although they are frequently one-sided, they may occur anywhere on the head, neck and face or all over. At their worst, they are typically associated with sensitivity to light, noise and/or smells. Nausea is one of the most common symptoms and it worsens with activity, which often results in patient disability. In many respects, migraines are much like alcohol-related hangovers.

Migraine pain can be felt in the face, where it may be mistaken for sinus headache or in the neck, where it may be mistaken for arthritis or muscle spasm. Complicating the diagnosis of migraine is that the headaches may be accompanied by other “sinus like” symptoms, including watering eyes, nasal congestion and a sense of facial pressure. Most patients who think they have sinus headache in fact have migraines.

In up to 25 percent of patients, the migraine headache pain may be preceded by an aura, a temporary neurological syndrome that slowly progresses and then typically resolves just as the pain begins. While the most common type of migraine aura involves visual disturbances , many people experience numbness, confusion, trouble speaking, vertigo and other strokelike neurological symptoms. Some patients may experience auras without headaches.

Why Are Neurologists Against Migraine Surgery

Many neurologists who specialize in treating headache disorders are of the opinion that there is minimal evidence to support the success of surgical intervention for migraine. These surgical treatments are not extensively studied. While there are some studies that suggest that there might be certain types of people who may benefit from migraine surgery, but since it is difficult to have a thorough trial design in such types of surgical studies, the results are not as reliable as surgeons and doctors would prefer them to be.

Keeping this in mind, the American Headache Society urges patients and doctors not to go ahead with the surgical deactivation of migraine trigger points in the brain outside of clinical trials. The organization firmly declares that there is a lack of reliable research and information about the possible side effects of such a surgery, and there are almost no studies that show the long-term impact of migraine surgeries.

The American Headache Society has also shared that studies that have shown some benefit from migraine surgery have been observational, or they only involved a small number of participants within a controlled trial. And in order to accurately assess the potential effectiveness and side effects of migraine surgery, there have to be large randomized controlled trials that include long-term follow-ups. The major concern with migraine surgeries at this point is the absolute lack of research on the long-term side effects of such a surgery.

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If You Have Additional Illness Conditions See A Neurologist Today

Headaches that manifest with ailments like nausea, vomiting, and diarrhea, call for neurological attention. The pain could be a manifestation of a greater illness. When you see a neurologist for headaches, take the liberty to divulge all the information. If you have diabetes, asthma, or other lifestyle conditions, tell your neurologist. Also, describe the pattern of your headache if it occurs on only one side of the head.

Some additional information crucial for the neurologist includes your personal diagnosis of the headache. Tell the specialist if light, noise, or certain smell affect or trigger your headaches. Also, discuss your sleeping patterns and some biological and sexual inhibitions that you experience. In short, divulge all the information that the neurologist will require. Sometimes, your headaches may be a result of your lifestyle routine.

Headaches are, in most cases, a manifestation of another ailment. Most medications seek to calm down the nerve receptors that trigger pain. In the final analysis, the things to expect at a neurologist appointment for headaches are basic. Remember to tell your neurologist of your medical history and any family connections. As you seek precise medical attention, avoid some unnecessary self-medication.

Who Gets Migraines What Are The Risk Factors

How does a neurologist prepare the treatment plan for ...

Its difficult to predict who may get a migraine and who may not, but there are risk factors that may make you more vulnerable. These risk factors include:

  • Genetics: Up to 80% of people who get migraine headaches have a first-degree relative with the disease.
  • Gender. Migraine headaches happen to women more than men, especially women between the ages of 15 and 55. Its likely more common in women because of the influence of hormones.
  • Stress level. You may get migraines more often if youre high-stress. Stress can trigger a migraine.
  • Smoking.

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What Is A Neurologist

To receive the best care, you should always first consult your primary care doctor. He or she might recommend you see a neurologist, if they are unable to treat your symptoms properly. It is good to be aware then of what a neurologist does and the symptoms they treat.

A neurologist is a specialist who treats diseases in the brain and spinal cord , peripheral nerves , and muscles. Neurological diseases can include headaches epilepsy stroke movement disorders, such as tremor or Parkinsons disease and many others. Read more below about the most common symptoms of neurological disease.

Complementary And Alternative Treatments

Interest in the use of complementary and alternative medicine by headache patients is widespread. A 2002 survey showed that more than 85% of headache patients use CAM therapies and 60% felt they provided some relief. Overall, more than 70% of patients who use CAM do not tell their doctors about it.

Some CAM techniques have good scientific evidence of benefit and have been proven by studies to be effective in preventing migraine. Biofeedback and behavioral therapy should be part of the standard of care for a difficult migraine patient.

Good studies have demonstrated the effectiveness of the herb butterbur in preventing migraines. A guideline from the American Academy of Neurology and the American Headache Society recommends offering butterbur to patients with migraine to reduce the frequency and severity of migraine attacks . Patients on butterbur require monitoring of liver enzymes.

The AAN/AHS found moderate evidence of effectiveness for riboflavin , magnesium, and feverfew. A 3-month, randomized, controlled trial of high-dose riboflavin found that riboflavin was superior to placebo in reducing attack frequency and headache days.

A variety of other CAM techniques are not bolstered by solid scientific data, but they may be perceived to be of benefit to patients. Techniques that some patients use for headache relief include the following:

  • Body work – Eg, chiropractic, massage, and craniosacral therapy )

  • Nutritional/herbal supplements – Eg, vitamins and herbs

  • Biofeedback

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How Are Migraines Treated

Migraine headaches are chronic. They cant be cured, but they can be managed and possibly improved. There are two main treatment approaches that use medications: abortive and preventive.

  • Abortive medications are most effective when you use them at the first sign of a migraine. Take them while the pain is mild. By possibly stopping the headache process, abortive medications help stop or decrease your migraine symptoms, including pain, nausea, light sensitivity, etc. Some abortive medications work by constricting your blood vessels, bringing them back to normal and relieving the throbbing pain.
  • Preventive medications may be prescribed when your headaches are severe, occur more than four times a month and are significantly interfering with your normal activities. Preventive medications reduce the frequency and severity of the headaches. Medications are generally taken on a regular, daily basis to help prevent migraines.

Current Standard Of Care

Step 3: Treatment of Headaches | Clinical Neurology

As for acute medications, preventive treatments can be classified as first-line, second-line and third-line options . However, choice of medication and the order of use depend on local practice guidelines and local availability, costs and reimbursement policies.

First-line medications are beta blockers without intrinsic sympathomimetic activity , topiramate and candesartan,. If these fail, second-line medications include flunarizine, amitriptyline and sodium valproate, although valproate is strictly contraindicated in women of childbearing potential, which greatly limits its utility in migraine,,. Third-line medications are the four CGRP monoclonal antibodies erenumab, fremanezumab, galcanezumab and eptinezumab. These antibodies have been approved for the preventive treatment of migraine in the past few years. In Europe, regulatory restrictions limit their use to patients in whom other preventive drugs have failed or are contraindicated.

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