doctor’s orders
/ by Amaal Starling, MD
Managing a Migraine
Amaal Starling is a Mayo Clinic Neurologist.
Effective treatment options for the debilitating condition
Is it migraine, or just a bad headache that keeps coming back? Patients may be referred to a neurologist when they need specialized medical expertise to diagnose and treat head pain and related symptoms. In the case of migraine, those symptoms can be severe, including sensitivity to light, sounds and smells, vision disturbances, nausea and dizziness. In fact, most significant headaches are actually migraine attacks. People with chronic migraines experience 15 or more headache days per month. Fortunately, new and effective treatments are available. The most common migraine symptom – moderate to severe throbbing, or pressure-like recurring head pain – can occur on one or both sides of the head, and usually worsens with activity. Migraine itself is very common, affecting up to 44 million people in the U.S. This is more than a bad headache. Migraine is the most disabling neurological disease for people under 50. In fact, most people can’t work or function normally during a migraine attack.
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An Invisible Condition Since migraine is such a common, debilitating condition, it’s surprising that so few people with migraine ever consult a doctor about their symptoms. A recent study put the number at less than 50 percent, and even fewer get the right diagnosis and treatment (5-25 percent). That speaks to the stigma around migraine: A selfreported illness with invisible symptoms. As a result, too many people with migraine think they must “power through” an attack. Others avoid medical care because they think there’s nothing to be done.
Treatment Options Here’s the good news: Medicine is entering a new era of effective and targeted treatment options for migraine. Patients’ initial treatment is often a prescription for supplements, such as magnesium and riboflavin. Other options may include oral medications, injections and devices. For migraine attacks, doctors prescribe a “rescue medication,” usually a form of triptan, such as Imitrex or Maxalt. Remarkable new treatment devices are also proving effective at reducing migraine attacks. A noninvasive nerve stimulation device called Cefaly uses electrodes to stimulate the nerve above the eyebrows. Another device, the sTMS mini, transmits a painless magnetic pulse that changes the electrical environment of brain cells. It can be used as both a rescue and for preventive treatment. Patients respond well to both devices. And because they have few or no side effects, devices are often better tolerated than medications.
Start at Home Lifestyle changes can also be helpful, and they’re easy to remember with the SEEDS acronym. To help prevent or minimize migraine attacks, focus on: 1. Sleep: Aim for 7 to 9 hours each night and consistent bedtimes 2. Eat: Regularly timed, healthful meals are best 3. Exercise: Try for 20 minutes per day, 3 times per week 4. Drink: Hydrate with water to prevent dehydration and keep a migraine diary 5. Stress: Try to relax using stress management techniques With today’s effective new treatments, there’s no need to let migraine attacks diminish your quality of life. If you have headaches that affect your ability to function, talk to your doctor, and don’t be afraid to request a referral to a headache specialist or neurologist.