Migraine is a headache disorder characterized by recurrent head pain that is moderate to severe. Typically, the headaches affect one half of the head, are pulsating in nature, and last from two to 72 hours. Associated symptoms may include nausea, vomiting, sensitivity to light and sound, numbness, visual changes, and even speech difficulty. The pain is generally made worse by physical activity. Up to one-third of people have an aura, which typically means a short period of visual disturbance before the headache starts. Occasionally, an aura can occur with little or no headache following it.

Migraines are believed to be due to a mixture of environmental and genetic factors. About two-thirds of cases run in families. Changing hormone levels may also play a role, and migraines are two to three times more common in women than men. The risk of migraines usually decreases during pregnancy. It is, however, believed to involve the nerves and blood vessels of the brain.

Initial recommended treatments are over-the-counter Advil, Tylenol, and Excedrin. However, when the pain gets serious, we use triptans, ergotamines, nausea medications, as well as daily preventive medications. The preventive medications include some blood pressure medications, anticonvulsants, antidepressants, and Botox. We first evaluate the pain by doing a brain scan and blood work to rule out other causes. We discuss dietary factors, job, sleep, stress, and other environmental factors. If patients fail many medications, Botox is an insurance-covered, strong alternative which has a success rate of 80%.

Resources:  

• Unraveling the Promise of CGRP Receptor Blockers: A Breakthrough in Migraine Treatment
• NIH: Migraines