If you’ve ever suffered from an attack of migraine, you’re aware how painful and debilitating they can be.
“One of five Americans suffers from migraine headaches and it’s among the leading factors that cause disability throughout the United States,” says Dr. Nauman Tariq, a neurologist and head of the Headache and Facial Pain Clinic at Atrium Health Neurosciences Institute. “Approximately 40 % of Americans suffer from migraines.”
As we celebrate National Migraine and Headache Awareness Month It is important to be aware of the symptoms and signs of migraine and what to do in the event that you are experiencing headaches regularly.
What exactly is a migraine?
Tariq claims that migraines can be classified into chronic and episodic migraines.
- episodic migraines: Less than 15 migraine days per month
- chronic migraines: At least 15 days of migraines for a period of three months
He estimates that about two percent of Americans suffer from chronic migraines. It is more frequent in women, and it is more prevalent at around the age of 30.
“Chronic migraines can be associated with greater disability because of frequent attacks as well as the inability to recover between migraine attacks” claims Heather Nelson, NP, an adult-gerontology nurse practitioner at Atrium Health Neurology. “Chronic migraines can often be more resistant to lifestyle changes and medications.”
Understanding Migraine Symptoms
“A migraine is fundamentally an unrelieved headache that is caused by vomiting, sensitization lights and sounds, as well as an intense, throbbing pain.” claims Tariq.
The four phases are distinct of the migraine attack. The headache pain is only one of the four phases.
The phases of migraine comprise:
-
Prodrome phase:
A lot of patients notice warning signs prior to the attack of migraine. The symptoms may be present over a period of 24 to 48 hours prior to the beginning of headache. The most common symptoms are:- Neck neck pain
- Irritability
- Fatigue
- Then you’ll be yawning.
- Urinary frequency increases
- Food cravings
- Gastrointestinal upset (diarrhea, bloating, constipation)
- Sensitivity to sound, light or odors
- Problems with concentration and focus
- Anxiety
- Sleep disturbances that disrupt sleep patterns
-
Aura phase
The presence of migraine aura is seen at least 30% of migraine sufferers who have attacks. Migraine auras can be a sensory or visual incident that lasts for up to five minutes prior to the onset of a migraine. The symptoms are:- Tingling in your hands or on the face
- Blind spots
- Light flashes
- Other vision alters
-
Headache Phase:
Some of the symptoms are:- Extreme to moderate pain
- Unilateral pain location
- Pulsating/throbbing pain sensation
- The pain in the head is worsened by routine physical exercise
- Nausea (with or without vomiting)
- Sensitivity to sound and light
-
Postdrome phase
In this phase, headache pain will have gone away but the uncomfortable symptoms of migraine can persist for a while, including:- Fatigue
- Neck discomfort
- Irritability
- The difficulty of concentration
Migraine headaches are typically linked to “sinus symptoms” like nasal congestion, facial pain or clear sinus drainage.
Don’t ignore symptoms of migraine that are painful.
“Migraine attacks can cause lower productivity at work, less time with loved ones and relatives as well as a reduction in activities and a huge emotional cost on those suffering from these attacks,” says Nelson.
She claims that as high as 50% of those suffering from migraine headaches don’t seek medical treatment.
“I have many patients at my clinic who are suffering with a daily, chronic headache for years , which they thought was just an ordinary headache,” says Nelson. “It’s not common to have daily headaches. I strongly suggest that those who experience regular headaches to get an assessment through neurology because there are numerous treatments that can ease headache-free days back to your daily routine.”
The treatment for chronic migraines
Treating chronic migraines is a mix of medication and lifestyle alternatives.
The treatment of migraine is divided into two major categories:
- Acute/abortive treatment to prevent migraine attacks whenever they occur.
- Preventive treatment to decrease the number of migraine attacks
“There is no cure currently available to cure migraine headaches” states Nelson. “However there are many solutions available to reduce the frequency of attacks, duration of migraine pain, and lessen the symptoms that cause migraine. They can provide patients with relief.”
Lifestyle Modifications to Migraine Management
Tariq says that the primary option for migraine management is to implement certain lifestyle changes. Certain changes in behavior can assist in managing migraines including:
- Drinking plenty of water
- Sleeping in a sufficient amount
- Consuming regular meals
- Beware of fasting during periods when you are not eating.
- Consistently taking in large amounts of caffeine
- Exercising regularly
- Avoiding the over-use of prescription drugs to treat migraines
- Integrating relaxation techniques Biofeedback, massage therapy, and Acupuncture
“These modifications help a lot of patients who don’t have the need to take any medication,” says Tariq. “If these lifestyle changes don’t help the patient, then prescription medications are the best option. If migraines are becoming more frequent, it is recommended to see a physician to seek treatment.”
Nelson often suggests over-the-counter magnesium oxide (400 mg) supplements to patients. She claims that this supplement is particularly beneficial to those who suffer from migraines that cause auras.
Abortive (as-needed) Medicines for Migraine Management
In the last few years, numerous innovative, targeted migraine treatments were approved by the United States Food and Drug Administration (FDA) to treat prevention and abortive migraine treatment.
“Many of these medications have had a profound impact on patients suffering with migraines,” says Nelson.
The majority of abortive (as-needed) medication is made as tablets intended for oral use, however, there are also injectables sprays, and tablets that dissolve.
“The most important thing is to take medication right away upon the first sign of headache,” Tariq says. Tariq. “The longer you put off longer, the more difficult it will be for the medications to stop your migraine.”
There are also medicines to alleviate vomiting and nausea that are associated with migraine attacks.
“Treatment for nausea vital in managing migraines since those who suffer from severe nausea and vomiting are more susceptible to dehydration, which could exacerbate the migraine pattern,” says Nelson.
Preventive Treatment for Migraine Attacks
“Until 2018 we didn’t have any medication specifically designed to prevent migraine headaches,” says Nelson.
There are many classes of medication which have been shown to reduce migraine frequency which include:
- Calcitonin gene-related protein (CGRP) inhibitors
- Beta-blockers
- Calcium channel blockers
- Antidepressants
- Anti-seizure medications
- Botox
Although these treatments have many advantages, they also come with a number of negative side adverse effects. Furthermore, preventive treatments usually require between 2 and 3 months of regular usage to show outcomes.
Alternatives to treatment for migraine that are drug-free
Neuromodulation therapies, also known as devices that utilize electricity to change nerve activity within the human body. These are drug-free alternatives that have become more popular in recent years.
“Although these devices aren’t considered to be a first-line treatment for migraine issues at present but they’re an appealing option for patients who are not tolerant the effects of or do not want to use the use of prescription medications,” says Nelson. “Many options aren’t insured by insurance and their costs can be prohibitive to patients who would like to explore these alternatives.”
In-Nation First-in-Nation Migraine Clinical Trials
Another alternative to migraine treatment without drugs is the Atrium Health CALM (cooling to relieve migraine) clinical trial, conducted by Tariq. Atrium Health is the first in the United States to provide this study.
“During the procedure each patient is fitted with a machine that delivers dehumidified air to their nasal cavity for 15 to 20 minutes” Dr. A.S. says. “The air melts the mucus in inside the nose cavity resulting in cooling of the nerves that cause migraines. The purpose of this treatment is to eliminate migraine headaches within two hours after using this device.”
Tariq claims that the results of earlier studies are promising.
“We were looking to create an alternative treatment that doesn’t have the usual side effects associated with oral medicines,” he says. “We conducted a study pilot of 50 patients. The study has been published 2021. The results were very impressive in general. We also have safety information from a different study that has been published. All patients who participated in the study had adverse reactions. Overall, it was an extremely safe procedure that was conducted in a secure setting by researchers.”
It is available to those who
- Have periodic migraines (fewer then 15 migraines per month) lasting for at least one year
- Are between 18 to 80
- Living within 50 miles of the Atrium Health Headache and Facial Pain Clinic in downtown Charlotte
At present, the treatment is only available in clinics however Tariq claims a handheld at-home device is in process. The device is expected to be available to patients by close in the calendar year.
“We improve science through trying out new therapies,” says Tariq. “We are extremely grateful to the patients who participate in these studies.”
Find out more details about the CALM Clinical trial.
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