What Options Are There for Migraines?

Migraine is one of the most common causes of debility for younger to middle-aged working people.

“It can be quite debilitating,” Dr. Jason Ignatius, neurologist and stroke director at Penn Highlands Healthcare, said. “It is the second leading cause of years lived with disability worldwide.”

Migraine is defined, according to Ignatius and clinical guideline’s, as when a person within his/her lifetime has five or more attacks of unprovoked headaches lasting 4-72 hours - even after treatment. Also, it must be severe enough to markedly restrict or even prohibit routine daily activity and is accompanied by nausea or light/sound sensitivity.

Ignatius noted the clinical definition of migraine requires matching two of four typical characteristics:
• Unilateral location – affecting one side of the head;
• Pulsating;
• Moderate or severe pain;
• Causes aggravation or avoidance of routine physical activity.

Twenty to 25 percent of migraineurs – those who suffer from migraines – also experience auras. Auras are when a person sees a light or shape that isn’t there or has a temporary loss in vision. In the minority who do have auras, there are relatively few who experience auras with each and every attack.

When should a person with migraine seek help and what are the options?

“When you are suffering from headaches, I think if they are severe enough that you are missing work and they are taking time away from your family and your life on a weekly basis, then you need to be on something to help you,” Ignatius said.

Ignatius said a person can try over the counter medicine, “but you need to be careful with these because people begin taking them all the time, like candy,” he cautioned.

Ignatius said this can cause pain-killer, or analgesic, over-use headaches or rebound headaches. “It’s very common with patients who come and see me and have been taking over the counter analgesics on a daily basis for three years, and now, we have to get them off of those pills because they are likely contributing to their daily headache,” he said.

Usually, the starting preventative treatment is a medication that is prescribed on a daily basis to decrease how often the migraines occur.

“The standard goal of treatment is always about 50 percent improvement,” Ignatius said. “One migraine a week is an indication for preventative treatment or a lifestyle change. If after doing lifestyle changes and avoiding triggers, you still have one migraine per week, then you should start a prescription medication. Specific migraine vitamins also help reduce migraine frequency as well.”

Ignatius said migraines have become particularly troublesome with the technology age and bright computer screens and sleep deprivation. He said that is just a few of many migraine triggers. He added weather can also affect migraines.

“That has always been known,” he said. “There are many other triggers and stress is one of the biggest. So are multiple foods: Anything fermented, dried, smoked, pickled; anything that sits around on your shelf for a long time and you eat it. Even peanut butter and nuts may be triggers for some patients. ”

Ignatius explained how to treat a migraine when it hits.

“An abortive medication is what you should take when you get a migraine. A migraine is a snowball going down a hill; the longer you wait to treat it, the bigger the snowball gets and have to wait it out until it stops,” he said. “The sooner you treat it, the better off you are.”

Ignatius said you should always carry your rescue medication on you and use it when you feel that bad one coming because “if you know it’s coming, you can prevent/abort it from happening and reduce debility.”

Ignatius said there are other treatments available. “We do use botulinum toxin, a treatment for chronic migraine, which is more than 15 headache days a month,” he said. “It is very helpful for reduction of those with chronic migraine.”

He said they also use nerve blocks around the head to see if it helps reduce headache acutely for some patients.

Ignatius said it is a very good time to be a migraine patient because of new medications that recently became available and are very specific and targeted for migraine. He said the new medications, so far, have relatively no major side effects due to their delivery on a monoclonal antibody.

“Generally, there are really no major side effects with these medications,” he said, adding long term data is not available, yet. “It’s nice to have a prevention medication targeted for migraines. The last time a med was developed for migraine was the triptan class in the ’90s for rescue treatment. There has never been a prevention medication in the history of man until now.”

Ignatius said the picture is still new regarding the medications, but doctors will eventually see which ones work better for certain patients. It is nice to have specific migraine targeted prevention medications available now.”

For more information about neurology at Penn Highlands Healthcare or to find a doctor to get you started on the road to feeling better, go to /service/neurology.