If you’ve ever experienced a migraine, you know how debilitating it can be.
“One in five Americans has migraine headaches and it’s one of the top five causes of disability in the United States,” says Dr. Nauman Tariq, a neurologist and the director of the Headache and Facial Pain Clinic at Atrium Health Neurosciences Institute. “Approximately 40 million Americans experience migraines.”
As we recognize National Migraine and Headache Awareness Month, it’s important to know the signs and symptoms of a migraine and what to do if you experience them on a regular basis.
What is a migraine?
Tariq says migraines are categorized into episodic and chronic migraine patterns.
- Episodic migraines: Less than 15 migraine days per month
- Chronic migraines: At least 15 days of migraines for three months
He says approximately 2% of Americans experience chronic migraines. It tends to be more common in women and peaks in their mid-30s.
“Chronic migraines can be associated with higher disability due to the frequency of attacks and lack of recovery time in between attacks,” says Heather Nelson, NP, an adult-gerontology nurse practitioner at Atrium Health Neurology. “Chronic migraines can often be more resistant to lifestyle and medication interventions.”
Understanding Migraine Symptoms
“A migraine is essentially a headache that is accompanied by nausea, sensitivity to light and sounds, and throbbing, pounding pain,” says Tariq.
There are four distinct phases to a migraine attack. The headache pain is just one of the four stages.
Migraine phases include:
- Prodrome phase: Many patients experience warning signs before their migraine attack. These symptoms can occur for 24 to 48 hours prior to the onset of the headache pain. Common symptoms include:
- Neck pain
- Irritability
- Fatigue
- Yawning
- Increased urination
- Food cravings
- Gastrointestinal upset (diarrhea, bloating, constipation)
- Sensitivity to light, sound or smells
- Trouble with focus and concentration
- Anxiety
- Disrupted sleep patterns
- Aura phase: Migraine aura occurs in 30% or less of patients who experience migraine attacks. A migraine aura can be a visual or sensory event that lasts five minutes to an hour before the onset of a migraine. Symptoms include:
- Tingling in the hands or face
- Blind spots
- Flashes of light
- Other vision changes
- Headache phase: Symptoms include:
- Moderate to severe pain
- Unilateral pain location
- Pulsating/throbbing pain sensation
- Headache pain worsened with routine physical activity
- Nausea (with or without vomiting)
- Sensitivity to light and sound
- Postdrome phase: During this phase, the headache pain has resolved, but the bothersome symptoms of migraine can linger, such as:
- Fatigue
- Neck pain
- Irritability
- Difficulty concentration
Migraine headaches are often associated with “sinus symptoms," such as facial pain, nasal congestion and clear nasal drainage.
Don’t Ignore Painful Migraine Symptoms
“Migraine attacks can lead to reduced work productivity, lost time with family and friends, reduction in activities, and a significant emotional toll for those who suffer from them,” says Nelson.
She says up to 50% of people who experience migraine headaches don’t seek medical care.
“I meet many patients in my clinic who have been dealing with a chronic, daily headache for years that they considered to be just a regular headache,” says Nelson. “It’s not normal to experience a headache every day. I strongly encourage those experiencing daily headache symptoms to seek an evaluation with neurology as there are many interventions that can help add headache-free days back into your life.”
Treatment for Chronic Migraines
Treatment for chronic migraines includes a balance of lifestyle interventions and medication options.
Migraine treatment is divided into two main categories:
- Acute/abortive therapy to stop migraine attacks when they occur
- Preventive therapy to reduce the frequency of migraine attacks
“There is no treatment at this time that cures migraine attacks,” says Nelson. “However, there are numerous options available to help decrease attack frequency, duration of migraine pain, and reduce the bothersome symptoms of migraine, offering patients some relief.”
Lifestyle Modifications for Migraine Management
Tariq says the first line of defense for migraine management is to make some lifestyle changes. Certain behavioral modifications can help with migraine management, such as:
- Staying well-hydrated
- Getting adequate sleep
- Eating regular meals
- Avoiding periods of fasting
- Consuming consistent amounts of caffeine
- Exercising regularly
- Avoiding overuse of over-the-counter medications for migraine management
- Incorporating relaxation techniques, biofeedback, massage therapy and acupuncture
“These changes help a lot of patients without the need for any medicine,” says Tariq. “If these lifestyle changes aren’t helping, then over-the-counter medicines are the way to go. And if migraines become more frequent, then we recommend seeing a doctor for treatment.”
Nelson sometimes recommends over-the-counter magnesium oxide (400 mg) supplements to her patients. She says this supplement is particularly helpful for people who experience migraines with auras.
Abortive (as-needed) Medications for Migraine Management
In the past several years, several new, targeted migraine therapies have been approved by the United States Food and Drug Administration (FDA) for preventive and abortive migraine therapy.
“Many of these new medications have been life-changing for patients who suffer from migraines,” says Nelson.
Most abortive (as-needed) medications are designed as tablets for oral use, but there are also injectables, sprays and dissolvable tablets.
“The key is to take medicine right away at the onset of the migraine,” says Tariq. “The longer you wait, the harder it is for the drugs to knock out the migraine.”
There are also medications to treat nausea and vomiting associated with migraine attacks.
“Treatment of nausea is crucial in migraine management as patients who experience significant nausea and vomiting may be more prone to dehydration, which can exacerbate the headache cycle,” says Nelson.
Preventive Therapy for Migraine Attacks
“Until 2018, we did not have any medications specifically developed for preventive treatment of migraine headache,” says Nelson.
There are numerous classes of medications that have been shown to decrease migraine frequency, including:
- Calcitonin gene-related peptide (CGRP) inhibitors
- Beta-blockers
- Calcium channel blockers
- Antidepressants
- Anti-seizure medications
- Botox
While these options offer many benefits, they also come with side effects. Additionally, preventive treatments often require two to three months of daily use to see results.
Drug-free Migraine Treatment Options
Neuromodulation therapies, or devices that use electrical stimulation to alter nerve activity in the body, are medication-free options that have become increasingly popular in recent years.
“Although these devices are not considered first-line therapy for headache disorders at this time, these are appealing options for patients who do not tolerate, have not responded to or prefer to avoid prescription medication therapy,” says Nelson. “Many of these devices are not covered by insurance and the cost can be prohibitive for some who want to try these options.”
First-in-nation Migraine Clinical Trials
Another drug-free migraine treatment option is Atrium Health’s CALM (cooling to alleviate migraine) clinical trial, led by Tariq. Atrium Health is the first in the nation to offer this trial.
“During the treatment, the patient wears a device that sends dehumidified air into their nose for 15 minutes,” he says. “The air evaporates the mucus around the nasal cavity, which results in the cooling of the nerves that are responsible for migraines. The goal of this treatment is to abort migraine headaches within two hours of using this device.”
Tariq says the results from previous studies have been promising.
“We wanted to develop a treatment that didn’t give the conventional side effects of oral drugs,” he says. “We did a pilot study of 50 patients, which was published in 2021. The results were impressive overall. We also have safety data from another published study. None of the patients in that study experienced adverse side effects. Overall, this is a very safe treatment conducted in a safe environment by research nurses.”
The trial is open to people who:
- Experience episodic migraines (fewer than 15 attacks per month) occurring for at least one year
- Are between the ages of 18 and 80
- Live within 50 miles of Atrium Health Headache and Facial Pain Clinic in uptown Charlotte
Currently, the treatment is only available in-clinic, though Tariq says a handheld, at-home device is in the works. He says the device will likely be available to patients by the end of the year.
“We advance science by testing new treatments,” says Tariq. “We really appreciate patients who volunteer for this study.”
Learn more about the CALM clinical trial.
