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What To Do For Chronic Migraines

Treatment Of Chronic Migraine

What to do if you have chronic migraines

There are three broad approaches to treating chronic migraine: lifestyle and trigger management, acute treatments , and preventive treatments . While many patients find that lifestyle adjustments such as regularizing meals and sleep can reduce the frequency of their attacks, some form of medication or other treatment is almost invariably necessary in patients with chronic migraine. The National Institute for Health and Care Excellence have recently published guidance on the diagnosis and treatment of migraine, and further consensus guidelines have been published by the British Association for the Study of Headache, the American Headache Society and American Academy of Neurology, and the European Headache Federation .

How Are They Treated

Both migraine and chronic migraine can be treated with the same drugs. These include medications that treat the pain and symptoms as well as drugs that treat the underlying cause of migraine. In some cases, there are medical devices you can use to interrupt the headache. Still, no treatment is perfect.

Because of that, chronic migraines can take a toll on your personal life. If you get painful headaches for half of each month, you lose days of work or school and precious time with friends and family. Itâs common for people with chronic migraines to also have depression.

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.

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Do You Have The Legal Right To Work Accommodations

An anti-discrimination law called the Americans With Disabilities Act requires employers with 15 or more employees to provide âreasonableâ accommodations for qualified workers with disabilities, unless those accommodations would create âundue hardshipâ for the company.

The law doesnât list the medical disorders it covers. That means it doesnât specify that it protects people with chronic migraine. Instead, it says that youâre eligible for its protection if you meet its definition of having a disability. According to the ADA, thatâs someone who:

  • Has a physical or mental challenge that greatly limits them from doing one or more âmajor life activities,â like working, hearing, seeing, speaking, and walking
  • Has a history or record of such an impairment
  • Is perceived by other people as having the impairment

You could ask your doctor or headache specialist to write you a letter that explains to your employer how chronic migraine impacts your ability to function day to day.

To be covered under the ADA, you also have to be a âqualifiedâ employee, meaning you meet your employerâs requirements for the job and youâve shown that you could perform your key duties with or without accommodations.

Diagnosis And Patient Assessment

Chronic Daily Headache

Migraine has well-established diagnostic criteria4 . Good evidence supports the use of the POUND mnemonic for migraine diagnosis6 . Assessment aims to confirm diagnostic criteria, evaluate for alternative explanations, identify comorbidities that could complicate management ,8 and document the baseline pattern and severity of episodes. A variety of conditions can present as headache, most of which can be identified by the history and physical examination .6 The only indications for ancillary testing are to identify causes of secondary headaches or comorbid conditions.9,10 Table 4 lists red flag symptoms that indicate the need for neuroimaging and/or urgent referral.9,10

International Headache Society Diagnostic Criteria for Migraine Headache With and Without Aura

Migraine without aura

*Recurrent disorder manifesting in headaches with reversible focal neurologic symptoms that usually develop gradually over 5 to 20 minutes before onset of the headache and last for less than 60 minutes. Headache with the features of migraine without aura usually follows the aura symptoms. Less commonly, headache lacks migrainous features or is completely absent .

Adapted with permission from Gilmore B, Michael M. Treatment of acute migraine headache . Am Fam Physician. 2011 83:272.

International Headache Society Diagnostic Criteria for Migraine Headache With and Without Aura

Migraine without aura

POUND Mnemonic for Diagnosis of Migraine

Clinical features:

Clinical features:

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Implement Good Sleep Hygiene

Interestingly, the vast majority of people with migraines also deal with insomnia, a risk factor associated with the likelihood of progressing from episodic migraines to chronic. Because of this close connection between sleep and migraines, research is continuously being done on the relationship between the two.

Our Experts Use Multiple Approaches

Our headache clinic team is led by neurologists. They are specialists in treating conditions of the nerves and nervous system. Our doctors are trained to diagnose and treat all types of headaches.

Our doctors work with other providers to provide complete care for your whole self. Integrative health providers combine Western medicine with natural medicine therapies such as acupuncture and yoga. Interventional pain specialists use injections and nerve blocks to stop and reduce pain. Pain psychologists treat the emotional aspects of chronic pain with strategies like behavioral therapy and guided imagery. Physical therapists use exercises to reduce muscle tension and build strength.

Our providers

Patient and support services

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Stress Anxiety And Depression

The most common trigger of chronic headaches is stress, and stress can come from just about anything including:

  • Major life changes such as a move, new job, marriage, or death in the family
  • Deadlines at work, problems with the boss or a coworker, or loss of a promotion
  • Unexpected car repair
  • Driving to and from work
  • Arguing with a spouse or significant other
  • Difficulty with children

Chronic stress can lead to other chronic conditions such as anxiety or depression, both of which can cause chronic daily headaches. Chronic stress can also cause tension in the muscles of the neck which can cause tension-type headaches.

Can Migraines Be Prevented

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You can’t prevent every migraine. But learning your triggers and trying to avoid them can help. Take a break from activities that might start a migraine, such as using the computer for a long time. If you know that some foods are triggers, skip them. Some people find that cutting back on caffeine or drinking a lot of water can help prevent migraines.

Make a plan for all the things you have to do especially during stressful times like exams so you don’t feel overwhelmed when things pile up. Regular exercise also can reduce stress and make you feel better.

The more you understand about your headaches, the better prepared you can be to fight them.

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Drink Caffeinated Tea Or Coffee

Sipping on beverages that contain caffeine, such as tea or coffee, may provide relief when you are experiencing a headache.

Caffeine improves mood, increases alertness and constricts blood vessels, all of which can have a positive effect on headache symptoms .

It also helps increase the effectiveness of common medications used to treat headaches, such as ibuprofen and acetaminophen .

However, caffeine withdrawal has also been shown to cause headaches if a person regularly consumes large amounts of caffeine and suddenly stops.

Therefore, people who get frequent headaches should be mindful of their caffeine intake .

Certain herbs including feverfew and butterbur may reduce headache symptoms.

Feverfew is a flowering plant that has anti-inflammatory properties.

Some studies suggest that taking feverfew supplements in doses of 50150 mg per day may reduce headache frequency. However, other studies have failed to find a benefit .

Butterbur root comes from a perennial shrub native to Germany and, like feverfew, has anti-inflammatory effects.

Several studies have shown that taking butterbur extract in doses of 50150 mg reduces headache symptoms in both adults and children .

Feverfew is generally considered safe if taken in recommended amounts. However, butterbur should be treated with caution, as unpurified forms can cause liver damage, and the effects of its long-term use are unknown (

Foods containing them have been shown to trigger headaches in some people.

What Triggers A Chronic Migraine

While the cause of migraines isn’t totally clear, doctors have gained a better understanding of what’s happening when migraines start to become chronic. A migraine “is a problem with how you interpret sensory stimuli from your body and from the environment,” explains Dr. Cowan. “Your brain starts to adapt. It lowers its pain threshold. It’s almost like when you hear a sound in the night, suddenly your senses seem to be heightened.”

A variety of lifestyle and environmental factors, known as “triggers,” can set off a migraine episode.

“Triggers are very real for some people,” says Mason Dyess, DO, a general neurology and headache medicine physician at Ochsner Medical Center in New Orleans. But Dr. Dyess emphasizes that the better you’re managing your migrainesby working with a doctor on preventive strategies and pain management when a migraine strikesthe less you have to worry about triggers.

“Traditionally, the better controlled your headaches are, the fewer you have per month, and the faster you can stop them, the less sensitive you are to triggers,” he says.

Until your migraines are under control, “if you know something’s going to give you a migraine, avoid it, especially until we get a strong preventive and acute regimen in place for you,” he says.

Some of the most common triggers include:

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What Are The Symptoms Of Migraine

The main symptoms of migraine are an intense, throbbing or pounding headache often affecting the front or one side of the head, nausea and sometimes vomiting , and an increased sensitivity to light smells and sound. The throbbing headache is often made worse by the person moving.

Other symptoms of migraine might include poor concentration, feeling hot or cold, perspiration , and an increased need to pass urine. This can occur before, during or after the migraine attack.

People might also experience stomach aches and diarrhoea.

It is common for people to feel tired for up to two or three days after a migraine.

Migraine Treatment And Home Remedies

Infographics for Patients

There’s no cure for migraine headaches. But many drugs can treat or even prevent them. Common migraine treatments include:

Home remedies

You may ease migraine symptoms by:

  • Resting with your eyes closed in a dark, quiet room
  • Putting a cool compress or ice pack on your forehead
  • Drinking plenty of liquids

Complementary and alternative treatments

Some people get relief with therapies they use in addition to or instead of traditional medical treatment. These are called complementary or alternative treatments. For migraine, they include:

  • Biofeedback. This helps you take note of stressful situations that could trigger symptoms. If the headache begins slowly, biofeedback can stop the attack before it becomes full-blown.
  • Cognitive behavioral therapy . A specialist can teach you how actions and thoughts affect how you sense pain.
  • Supplements. Research has found that some vitamins, minerals, and herbs can prevent or treat migraines. These include riboflavin, coenzyme Q10, and melatonin. Butterbur may head off migraines, but it can also affect your liver enzymes.
  • Body work. Physical treatments like chiropractic, massage, acupressure, acupuncture, and craniosacral therapy might ease headache symptoms.

Talk to your doctor before trying any complementary or alternative treatments.

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The Challenge Of Taking Acute Medication Early Enough But Not Too Often

Many people with migraine are prescribed triptans to stop a migraine attack in its early stages. But if you have chronic migraine, it can be difficult to know when to take them, says Dougherty.

People are told, Dont treat too often, but in order for the triptan to be effective, you need to treat really early, Dougherty says. If youre a rule follower trying to heed both of those things, that can be a real challenge, she adds.

Dougherty tells her patients that triptans can be a double-edged sword, in the sense that they can effectively relieve a migraine attack, but if taken more frequently than recommended, their use can lead to medication-overuse headache and raise the risk for chronic migraine.

Medication-overuse headache, also called rebound headache, is a chronic daily headache that happens when acute medications for headache or migraine are used more than two or three days per week, according to the American Migraine Foundation.

In addition to triptans, these headaches are linked with ergotamines, opioids, and over-the-counter pain relievers such as Tylenol , nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen, and combination pain relievers that contain aspirin and caffeine, according to the American Migraine Foundation.

Because of these concerns, there are people who have angst every time they take a triptan, says Dougherty, adding that they may feel guilty and think they are contributing to their disease process.

Utilize Nonmedication Therapies Whenever Possible

Dougherty likes to give patients a big toolbox in how they can address their migraine, and medications are just one part of that.

Nonmedication interventions are often underutilized because they arent covered by insurance, she adds.

A few of the therapies and practices that can have a positive impact on migraine include the following:

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Who’s At Risk For Chronic Migraine

Some people are more likely than others to develop chronic migraines. You cannot change certain risk factors, while others may be modifiable. They include:

Family history. If one or both of your parents has migraines, you have a 50-75% chance of developing them, according to the American Migraine Foundation.

Age. Migraines can start at any ageas young as adolescencebut they’re often worst in your 30s before becoming less frequent and severe, says the Mayo Clinic.

Sex. Women get the short end of the stick herethey’re three times more likely than men to get migraines, the Mayo Clinic points out.

Certain medical conditions. The American Migraine Foundation lists depression, anxiety, obesity, and snoring among a number of conditions associated a greater likelihood of having migraine episodes that can lead to chronic migraines.

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Soothe Pain With A Cold Compress

Treating Chronic Migraine: Remember the Fundamentals

Using a cold compress may help reduce your headache symptoms.

Applying cold or frozen compresses to the neck or head area decreases inflammation, slows nerve conduction and constricts blood vessels, all of which help reduce headache pain .

In one study in 28 women, applying a cold gel pack to the head significantly reduced migraine pain .

To make a cold compress, fill a waterproof bag with ice and wrap it in a soft towel. Apply the compress to the back of the neck, head or temples for headache relief.

Coenzyme Q10 is a substance produced naturally by the body that helps turn food into energy and functions as a powerful antioxidant .

Studies have shown that taking CoQ10 supplements may be an effective and natural way to treat headaches.

For example, one study in 80 people demonstrated that taking 100 mg of CoQ10 supplements per day reduced migraine frequency, severity and length .

Another study including 42 people who experienced frequent migraines found that three 100-mg doses of CoQ10 throughout the day helped decrease migraine frequency and migraine-related symptoms like nausea (

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What Are The Symptoms Of Migraines

There are four different phases of migraines. You may not always go through every phase each time you have a migraine.:

  • Prodome. This phase starts up to 24 hours before you get the migraine. You have early signs and symptoms, such as food cravings, unexplained mood changes, uncontrollable yawning, fluid retention, and increased urination.
  • Aura. If you have this phase, you might see flashing or bright lights or zig-zag lines. You may have muscle weakness or feel like you are being touched or grabbed. An aura can happen just before or during a migraine.
  • Headache. A migraine usually starts gradually and then becomes more severe. It typically causes throbbing or pulsing pain, which is often on one side of your head. But sometimes you can have a migraine without a headache. Other migraine symptoms may include
    • Increased sensitivity to light, noise, and odors
    • Nausea and vomiting
    • Worsened pain when you move, cough, or sneeze
  • Postdrome . You may feel exhausted, weak, and confused after a migraine. This can last up to a day.

Migraines are more common in the morning people often wake up with them. Some people have migraines at predictable times, such as before menstruation or on weekends following a stressful week of work.

How Are Migraines Diagnosed

To make a diagnosis, your health care provider will:

  • Take your medical history
  • Ask about your symptoms
  • Do a physical and neurological exam

An important part of diagnosing migraines is to rule out other medical conditions which could be causing the symptoms. So you may also have blood tests, an MRI or CT scan, or other tests.

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Remedies To Get Rid Of Headaches Naturally

Headaches are a common condition that many people deal with on a daily basis.

Ranging from uncomfortable to downright unbearable, they can disrupt your day-to-day life.

Several types of headaches exist, with tension headaches being the most common. Cluster headaches are painful and happen in groups or clusters, while migraines are a moderate-to-severe type of headache.

Although many medications are targeted at relieving headache symptoms, a number of effective, natural treatments also exist.

Here are 18 effective home remedies to naturally get rid of headaches.

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