February 10, 2021

Migraine care: An expert answers your questions

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If you’ve been dealing with migraines, you might be wondering how to get relief. Read on for expert advice on migraine care and treatment options.

A pounding head, nausea, sensitivity to lights and noises — sound familiar? If so, you may be experiencing migraines, and you may have questions about how to get them to go away — or to never begin in the first place.

To answer those questions, we sought the advice of Tigran Kesayan, M.D., assistant professor of Clinical Neurology and Clinical Anesthesiology (Pain Medicine) at Vanderbilt University Medical Center.

How do you define a migraine?

“Migraine is often described as a moderate to severe head pain that is usually on one side of the head and is associated with nausea and/or a discomfort with bright lights and loud sounds,” said Kesayan. “Migraine pain often worsens with routine physical activity like walking or climbing up stairs. Some people experience an aura, which is a temporary set of visual or sensory symptoms which come on before a migraine, though the majority of migraine sufferers do not experience this.”

At what point should a migraine sufferer seek care from a provider?

“It is best to speak with a provider even if you’re having migraines infrequently to see if any diagnostic tests need to be done and to discuss treatment options.”

“For many, a migraine can be severe and interfere with daily life, causing people to take time off from work or miss important family functions,” said Kesayan. “It is best to speak with a provider even if you’re having migraines infrequently to see if any diagnostic tests need to be done and to discuss treatment options.”

Which is more effective: treating the migraine itself, or preventing a migraine from happening?

“For those who have three or fewer migraines per month, acute treatment at the onset of a migraine is often successful in both reducing the severity and longevity of pain,” said Kesayan. “For those who have migraine attacks more frequently — or when the acute treatments are not sufficient — there are multiple options for preventing the onset of migraine or reducing how often one gets a migraine. The specific treatment approach is often tailored to the individual — it’s based on other medical conditions they may have, the potential side effects of available medications, and the patient’s preference.”

What treatment options exist for migraine pain?

“For some patients, changes in their daily routine such as improved sleep, regular eating, routine exercise such as yoga and mitigating stress are very effective in reducing the frequency and intensity of their headaches,” said Kesayan. “For those that need preventative treatment, options include daily supplements such as riboflavin (Vitamin B2) and magnesium, or one of several prescription medications taken by mouth daily. There are also options for once-monthly injections that are administered by the patients at home, or a set of injections that are done by their provider once every three months in the office. There is also an option for a medication given intravenously in the clinic once every three months which is an option for some patients.”

What if the migraine is caused by nerve pain or injury?

“In some cases patients may have inflamed or irritated nerves around the head that can contribute to their headaches, and a nerve block injection performed in the office can be successful in the treatment approach for their pain,” said Kesayan. “There are also patients who may have had prior neck injuries, or have arthritis type changes of their neck which can be a contributing factor for their head pain. In such cases injections or procedures — often by a pain medicine specialist — can be very helpful.”

What about over-the-counter medications for migraines?

“We often see patients who have been trying to treat their headaches and migraines with over-the-counter pain medications too frequently, and unfortunately this has contributed to making their pain more frequent,” said Kesayan. “In the right situation, these medications can be successful in treating infrequent migraines. However, if taken too frequently— for example, more than 10 times per month — they can lead to headaches themselves.”

The Headache Program at Vanderbilt treats patients who are suffering from chronic headaches, including migraines. If you have headaches that are interfering with your quality of life and that haven’t responded well to other treatments, learn more about the program here.

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