904.202.4002
At Baptist Neurology Group, we treat patients for migraine and other forms of severe headache using a combination of medications, lifestyle changes and other remedies.
Migraine is a kind of chronic vascular headache syndrome that usually starts early in life—in adolescence or young adulthood. The headaches are caused when blood vessels in the brain become dilated (wider). When this happens, the nerves surrounding the blood vessels release chemicals that cause pain, swelling and more dilation. The process can lead to a spiral of pain that spreads throughout the body and can last hours or even days.
The enlarged blood vessels in the head can also trigger a response in the stomach, which slows down absorption of pain medications in pill form. The same response mechanism reduces blood flow through other parts of the body, which can lead to pale skin, coldness in the extremities and sensitivity to sounds and light.
Although an estimated 28 million Americans experience migraines, it is often undiagnosed, misdiagnosed and inadequately treated. Fortunately, a number of treatment options are available to control this condition.
Migraine symptoms differ from one patient to another. Some have them once or twice a year, while others may have several episodes a month. Most patients experience a throbbing, pulsating or pounding headache on one or both sides of the head. It may also be located behind the eyes or in the back of the head. If the pain from one attack is located on one side, it may migrate to the other side next time. The pain gets worse with physical activity and may be accompanied by nausea, vomiting, diarrhea and sensitivity to sound and light.
Aura: Some migraine patients experience a warning sign, known as an aura, before an actual migraine starts. For those patients who experience them, an aura is a signal to take medications to reduce migraine symptoms and to get to a quiet, dark room. The aura might be experienced as flashes of light or a tingly feeling in the arms or legs. Other aura symptoms include:
The underlying cause of migraine has not been conclusively determined, but much is known about the factors that can trigger an episode. Like specific symptoms, the specific triggers will vary from one person to another. Each person's list is different.
It can take hours or days between exposure to a known trigger and the onset of a migraine headache. Exposure to a patient's known triggers doesn't always produce a migraine. And while avoiding known triggers can reduce the frequency and severity of a patient's migraines, they can still occur.
Foods that can trigger a migraine include alcoholic beverages, especially beer and red wine, and chocolate. Food additives and chemicals include:
Stimuli found in a person's immediate environment can trigger a migraine. These include bright or flashing light, sun glare, television, loud noises, unusual odors (including nail polish, perfumes, paint thinner, secondhand smoke) and changes in barometric pressure.
Migraines can be triggered by a variety of lifestyle factors. Some can be controlled while others cannot. Among the most common triggers: stress, sleep disturbances, fasting and physical exertion such as exercise or sexual activity. In addition, changes in women's estrogen levels can act as a trigger. This is important for women who are menstruating and those who take birth control pills.
Treating migraines generally includes two different kinds of medications: Rescue medications reduce the severity or duration of a migraine after it has started. Preventive medications are taken on a regular basis by patients who have migraines often. These medications can reduce the duration, frequency and severity of symptoms in many cases.
Anti-nausea medications: These relieve the nausea and vomiting associated with migraine but do not treat the headache itself. Examples include prochlorperazine and metoclopramide.
Ergot: Ergotamine (Migergot, Cafergot) and dihydroergotamine (Migranal, an ergot derivative) can help reduce migraine symptoms. They tend to be both less costly and less effective than other rescue drugs.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These medications are sold over-the-counter in non-prescription strength. Some patients are allergic to NSAIDs, and others have experienced stomach problems such as bleeding and ulcers and even rebound headaches after taking the drugs for prolonged periods. NSAIDs include ibuprofen (Advil® or its equivalent) and aspirin.
Opiates: These medications, most notably codeine, contain narcotics and are used as a last resort when the patient cannot take other rescue medications.
Triptans: These can be quite effective at relieving migraine symptoms, including head pain, nausea and sensitivity to sound and light. Triptans have side effects of their own, including muscle weakness and nausea. Examples include:
Medications in this category are taken regularly—in some cases on a daily basis—to reduce the frequency and duration of migraines as well as the severity of symptoms. However, side effects are common. For many patients, however, a preventive strategy can improve daily life significantly.
Cardiovascular drugs: Three kinds of heart-related medicines can also help with migraines. Beta blockers such as atenolol (Tenormin) and many others can help make migraine symptoms less severe. Calcium channel blockers like verapamil (Calan or Isoptin) can help prevent migraines and symptoms of the aura that often precedes an episode. Antihypertensives such as lisinopril (Prinivil or Zestril) and candesartan (Atacand) can reduce the duration and severity of migraines.
Antidepressants. Certain antidepressants can help prevent migraines. These include tricyclic antidepressants like amitriptyline, nortriptyline (Pamelor) and protriptyline (Vivactil).
Anti-seizure drugs. Some drugs normally used to prevent seizure can also help reduce the frequency of migraines. However, high doses of these drugs can have serious side effects. Drugs in this category include divalproex (Depakote), topiramate (Topamax) and gabapentin (Neurontin).
Botulinum toxin type A (Botox). This drug, normally used to immobilize muscles in patients with some kinds of seizures, can be helpful in some migraine patients.