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What Can A Doctor Do For Migraines

How To Reduce The Effects And Treat A Migraine Attack

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Identifying your individual symptoms of a migraine attack can help you treat them early and more effectively. As a headache progresses, treatment is often much less likely to be effective and may have more side effects.

Start by maintaining a headache diary that notes what happens before, during and after the headache part of an attack. Symptoms during the prodromal stage can be non-specific, such as fatigue, irritability, anxiety, yawning, frequent urination, difficulty concentrating and food cravings. So they may be hard to recognize as part of an attack at first.

By noticing these early symptoms, you can quickly treat your migraine to reduce the effects and possibly stop the attack. Acute treatments include over-the-counter or prescription medications, devices or other therapies.

Dont Try Neck Exercises Without An Experts Help

If you strained your neck, its tempting to try and do some stretching or exercises yourself. But DIY treatment may not be helpful and could make it worse.

The neck is very complex, Dr. Estemalik says. Thats why physical therapy is key to treating this type of headache. Your physical therapist can identify which muscles are involved. They can guide you through exercises to strengthen the core muscles that need it. They also help you avoid overusing certain muscles that could cause more pain.

Without expert guidance, you could further strain your neck or work on the wrong areas.

What Else Can I Do To Prevent Migraines

While there are no sure ways to keep from having migraine headaches, here are some things that may help:

Eat regularly and do not skip meals.

  • Keep a regular sleep schedule.
  • Exercise regularly. Aerobic exercise can help reduce tension as well as keep your weight in check. Obesity can contribute to migraines.
  • Keep a migraine journal to help you learn what triggers your migraines and what treatments are most helpful.

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What Do You Think Is Causing My Migraine Attacks

While migraine is still a largely unstudied chronic illness, doctors have identified some possible causes of migraine, such as changes in the brainstem and trigeminal nerve, or imbalances in brain chemicals. Based on the details about your migraine, your doctor may be able to pinpoint some potential causes.

Symptoms Of Ocular Migraines

Functional Medicine Approach To Chronic Migraine ...

Q: I have had ocular migraines for many years. I have the classic jagged strobe effect. No big deal usually.

But last year I had a weird and different thing happen that still worries me. All of a sudden my eyes crossed and stuck that way. My fingertips went sort of numb, and the side of my tongue and bottom lip went numb. When I tried to explain this to the nurse, I sounded like a stroke victim.

I saw a neurologist, and he felt it was just a more intense type of ocular migraine. Have you ever heard of this? The MRI showed nothing significant. S.

A: By definition, this would not be a classic ophthalmic migraine, because the symptoms are outside of what is seen. Therefore, I personally would not classify it as a “more intense type of ophthalmic migraine.” These symptoms could be associated with some of the more common non-ophthalmic migraine phenomena. Dr. Slonim

Q: My husband began having symptoms of something very strange. We looked online and found your site. It turns out he was having an ocular migraine.

Your explanation and even better the visual little flash movie explained exactly what he was having and put our minds at ease. We were both thinking brain tumor or aneurysm . So thank you for putting together such an amazingly informative website.

In reviewing your log, you or your doctor may find a consistent pattern of triggers related to your episodes. Avoiding these triggers might help reduce the frequency of your episodes. Dr. Slonim

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What Are Some Tips For Living With Menstrual Migraine

It is also important to understand that a person with menstrual migraine who is using just acute treatment, and not preventive treatment, is at particular risk of attacks during their menstrual period. It is important to be attuned to the fact that a person with menstrual migraine needs to treat early and aggressively. That requires being aware of their cycles in a way that can enable them to treat earlier during that time period based on the likelihood that a migraine attack will occur.

This article was edited by Angie Glaser and Elizabeth DeStefano, based on an interview with Rebecca Brook NP. Paula K. Dumas also contributed to the content, reviewed by Drs. Starling and Charles.

Psychological Evaluation For Diagnosing Headaches

An interview with a psychologist is not a routine part of a headache evaluation, but it may be done to identify stress factors triggering your headaches. You may be asked to complete a computerized questionnaire to provide in-depth information to the doctor.

After evaluating the results of the headache history and physical, neurological, and psychological exams, your doctor should be able to tell the type of headache you have, whether it’s serious, and whether more tests are needed.

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Medicines For Migraine When Pregnant Or Breastfeeding

Many of the medicines used to treat migraine should not be taken by pregnant or breastfeeding women.

  • For relief of a migraine headache:
  • Paracetamol is the medicine most commonly used, as it is known to be safe during pregnancy.
  • Ibuprofen is sometimes used but do not take it in the last third of the pregnancy .
  • Aspirin – avoid if you are trying to conceive, early in pregnancy, in the third trimester and whilst breastfeeding.
  • Triptans – should not be taken by pregnant women at all. Triptans can be used during breastfeeding, but milk should be expressed and discarded for 12-24 hours after the dose .
  • For feeling sick and being sick – no medicines are licensed in pregnancy. However, occasionally a doctor will prescribe one ‘off licence’.
  • Medicines used for the prevention of migraine are not recommended for pregnant or breastfeeding women.
  • Check with your pharmacist or doctor if you are not sure.

    Your Office Setup May Be To Blame

    What are migraines and how can they be managed?

    A major injury like a fall or accident isnt the only trigger for these headaches. If your desk or office chair causes you to slouch or strain, you could get a cervicogenic headache.

    When you sit at a desk too long, you may have your neck flexed down, Dr. Estemalik says. You might arch your back while youre sitting. This can bring on a cervicogenic headache.

    Look into proper ergonomics for your office if you sit at a desk. Focus on keeping your back and neck straight while you sit, says Dr. Estemalik. Make sure youre not bending forward.

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    How Can I Pinpoint Migraine Triggers

    If you live with migraine, then pinpointing your triggers is the best preventative measure you can take. However, there are at least a dozen common migraine triggers, and not everyone with migraine is impacted by every single trigger. Your doctor may have suggestions on how you can pinpoint these triggers, which may ultimately help you decrease the frequency of your migraine attacks.

    Do You Have Any Recommendations For Other Migraine Symptoms I Experience Such As Nausea Or Vomiting

    While most doctors prescribe medications to help with pain management, you may also need something to help with other symptoms you experience as well, especially if these symptoms impact your ability to function on a daily basis. Its OK to ask your doctor about things you can do or medications you can take to help with these symptoms as well.

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    Throbbing Pain On One Or Both Sides Of The Head

    Pulsating pain is a classic sign of migraines. The throbbing is often felt on one side of the head.

    In an online survey of patients with migraines, the National Headache Foundation found that 50% “always” have throbbing on one side, while 34% say they “frequently” have this symptom.

    Migraine pain often burrows behind the eye.

    People will blame it on eye strain and many will get their eyes checked, but that won’t make their headaches any better, Dr. Messina says.

    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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    Your Insurance May Or May Not Cover It

    Because it’s an FDA-approved treatment, your health insurance may cover all or most of the cost of Botox, though this depends on your specific plan. The drug manufacturer also offers a savings program that can help offset some of the expense.

    To get approval, your insurance company may want to see that you’ve “failed” on two or three oral preventatives first. You may also need to keep a headache diary that shows you’re having 15 or more headache days per month.

    Once you’ve started the shots, your insurance will probably require documentation of improvement to continue paying for the treatment. Depending on your plan, you may also need to come for a follow-up visit between shots.

    Note, however, that if Botox is used as an off-label treatment , insurance companies may not cover it, per the AMF.

    Who Gets Migraines What Are The Risk Factors

    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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    Can Migraines Be Prevented Or Avoided

    Medicine to prevent migraines may be helpful if your headaches happen more than 2 times a month. You may want to consider this medicine if your headaches make it hard for you to work and function. These medicines are taken every day, whether you have a headache or not.

    Preventive medications for migraines can include prescription drugs often used to treat other ailments. Anti-seizure medicines, antidepressants, medicines to lower blood pressure, and even Botox injections are some of the preventive medications your doctor may prescribe. Calcitonin gene-related peptide inhibitors can also help prevent migraines. They do so by blocking a gene-related peptide in your sensory nerves. This peptide is known to increase during a migraine attack, so blocking it can help prevent migraines.

    There are also a number of non-medical treatments designed to help minimize migraine pain and frequency. One is an electrical stimulation device, which has been approved by the FDA. It is a headband that you wear once a day for 20 minutes to stimulate the nerve linked to migraines. Another non-medical treatment is counseling aimed at helping you feel in more control of your migraines. This counseling works best when paired with medical prevention of migraines, as well.

    If I Notice Changes In My Migraine Symptoms Should I Contact You

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    One of the worst parts about living with migraine is that the frequency and severity of your symptoms can change at any time, sometimes with no obvious cause. Your doctor may need to know about any sudden changes, especially if it seems like your condition is worsening or you are experiencing new symptoms.

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    What Is An Aura

    An aura is a group of sensory, motor and speech symptoms that usually act like warning signals that a migraine headache is about to begin. Commonly misinterpreted as a seizure or stroke, it typically happens before the headache pain, but can sometimes appear during or even after. An aura can last from 10 to 60 minutes. About 15% to 20% of people who experience migraines have auras.

    Aura symptoms are reversible, meaning that they can be stopped/healed. An aura produces symptoms that may include:

    • Seeing bright flashing dots, sparkles, or lights.
    • Blind spots in your vision.
    • Numb or tingling skin.

    Some Drugs Should Rarely Be Used

    Migraine attacks can last for hoursor even days. They can cause intense pain, nausea, and vomiting. They can make you sensitive to light or noise, and they can affect your life and work.

    To treat migraines, you may get a prescription for an opioid or a barbiturate called butalbital. These are pain medicines. But you should think twice about using these drugs. Heres why:

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    What Do I Do If My Migraine Lasts For More Than 72 Hours Or Wont Go Away

    You should talk to your provider about a plan should your migraine extend past the 72-hour mark. You may need treatment for a condition called status migrainosus. We define this as a migraine that lasts more than 72 hours without a pain-free interval. Status migrainosus is often treated differently than shorter migraine attacks and may require you to receive different treatments.

    If your pain is different, much more severe than usual and includes any red flag symptoms, get emergency treatment. If youre unsure, call your doctor or a health information line.

    Medicines Plus Behavioural Therapy

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    An interesting research study published in 2010 compared two groups of people who had frequent migraines. One group took a beta-blocker medicine alone. Another group took a beta-blocker but also had a course of behavioural migraine management . BMM included education about migraine, helping to identify and manage migraine triggers, relaxation techniques and stress management. After a number of months the group of people who took the beta-blocker plus BMM had, on average, significantly fewer migraines compared with the group who took beta-blockers alone. Further research is needed to confirm this and to look at BMM combined with other medicines to prevent migraine.

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    When Should You Go To The Doctor For A Headache

    Susan Baggaley: Well, the simple answer is when things aren’t working at home. So if their over-the-counter medicine seems to be less effective, if they start taking more of it, which can perpetuate a daily headache which we can talk about in a little while, but also when things change about their headache characteristics as well.

    Dr. Miller: Quality of headache?

    Susan Baggaley: Right. Quality and character, so different from what their baseline headache may be every day if they wake up and it’s a little, low ache to wake up in the morning and they’re vomiting with the headache, for instance.

    Dr. Miller: But what about the folks that have what they consider to be mild, daily headaches? Is there such a thing and is that different than a migraine headache?

    Susan Baggaley: Well, it can be. The interesting thing about headache in general, it’s genetically predisposed in the population so not all people actually experience headache. In fact, if you look at the statistics, migraine is about 12% of the American population, which is more than asthma and diabetes combined. So it’s a very…

    Dr. Miller: Huge problem.

    Susan Baggaley: common problem. And in fact it’s a public health disaster right now. Part of that reason being because people treat it as a pain condition, not a neurologic disease and end up maybe getting opioids to treat, or pain pills to treat it as opposed to a specific pain medicine.

    Dr. Miller: So, opioids being narcotics?

    To Determine Whether Head Pain Is A Migraine Physicians Follow These Guidelines And Criteria

    Your head is pounding, your stomach is churning, and every whisper sounds like a shout. You think you might suffer from migraines, but the idea of talking with a doctor somehow feels intimidating. How will your physician be able to determine whether your head pain is migraine-related? Heres a quick overview of what to expect when visiting a primary care doctor or neurologist.

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    What Causes Ocular Migraines

    Q: I’m very concerned. This is my third attack of ocular migraine. The first time it ever happened was when the microwave oven at someone’s home was on with nothing in it for over 20 minutes. Not knowing this, I used the microwave oven and heated some items. Thirty minutes later, I had symptoms.

    I actually thought I got radiation in my eyes. Could that be possible? And can things like this trigger an ocular migraine? M.L.

    A: As long as the door on the microwave was closed during those 20 minutes, the outside environment should have been protected from any microwaves trying to leave the oven. The microwaves do not build up in the oven. So when you opened the oven door, there would be little chance, if any, that you were bombarded by a high dose of microwaves that were stored up before you opened the door.

    Remember that ophthalmic migraines do not originate in the eyes. They originate in the brain, but the symptoms are visual because they affect the visual cortex . Dr. Slonim

    Q: I would like to commend you for the fine article on ocular migraine. Especially helpful were the photos, which I recognized from my own attack. I have been doing some heavy dieting and I think that might have triggered the attack. D.B.


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