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Diagnosis Migraine FAQs

Amaal Starling, M.D., a neurologist at Mayo Clinic, answers the important questions you may have about migraine.

Hi, I'm Dr. Amaal Starling, a neurologist at Mayo Clinic. And I'm here to answer some of the important questions that you might have about migraine.

Migraine is a disease of abnormal function within the setting of normal brain structure. An MRI of the brain solely tells you about the structure of the brain but tells you very little about the function of the brain. And that is why migraine doesn't show up on an MRI. Because it's abnormal function in the setting of normal structure.

Migraine is highly disabling for some individuals. In fact, it is the second leading cause of disability worldwide. Disabling symptoms are not just the pain, but also the sensitivity to light and sound, as well as the nausea and vomiting.

There is a wide range of disease severity in migraine. There are some people who only need a rescue or an acute treatment for migraine because they have infrequent migraine attacks. But there are other people who are having frequent migraine attacks, maybe two or three times a week. If they used rescue treatments for every attack, it could potentially lead to other complications. Those individuals need a preventive treatment regimen to reduce the frequency and severity of attacks. Those preventive treatments might be daily medications. They might be once a month injections or other injectable medications delivered once every three months.

This is why preventive treatment is so crucial. With preventive treatment, we can reduce the frequency as well as the severity of attacks so that you're not having attacks more than two times per week. However, for some individuals, despite preventive treatment, they may still have migraine symptoms more frequently throughout the week. For them, there are non-medication options for treating pain, such as biofeedback, relaxation techniques, cognitive behavioral therapy, as well as a number of devices that are non-medication options for treating migraine pain.

Yes, that is an option for the preventive treatment of chronic migraine. These onabotulinum toxin A injections are administered by your doctor once every 12 weeks to reduce the frequency and severity of migraine attacks. However, there are many different preventive treatment options. And it is important for you to speak with your doctor about which option is best for you.

The best way to partner with your medical team is to, number one, get a medical team. Many people living with migraine have not even talked to a doctor about their symptoms. If you have headaches where you have to rest in a dark room, where you might get sick to your stomach. Please talk to your healthcare professional about your symptoms. You might have migraine and we can treat migraine. Migraine is a chronic disease. And to best manage this disease, patients need to understand the disease. This is why I prescribe advocacy to all of my patients. Learn about migraine, join patient advocacy organizations, share your journey with others, and become empowered through advocacy and efforts to shatter the stigma of migraine. And together, the patient and the medical team can manage the disease of migraine. Never hesitate to ask your medical team any questions or concerns that you have. Being informed makes all the difference. Thanks for your time and we wish you well.

If you have migraines or a family history of migraines, a doctor trained in treating headaches (neurologist) will likely diagnose migraines based on your medical history, symptoms, and a physical and neurological examination.

If your condition is unusual, complex or suddenly becomes severe, tests to rule out other causes for your pain might include:

Migraine treatment is aimed at stopping symptoms and preventing future attacks.

Many medications have been designed to treat migraines. Medications used to combat migraines fall into two broad categories:

Your treatment choices depend on the frequency and severity of your headaches, whether you have nausea and vomiting with your headaches, how disabling your headaches are, and other medical conditions you have.

Medications used to relieve migraine pain work best when taken at the first sign of an oncoming migraine as soon as signs and symptoms of a migraine begin. Medications that can be used to treat it include:

Pain relievers. These over-the-counter or prescription pain relievers include aspirin or ibuprofen (Advil, Motrin IB, others). When taken too long, these might cause medication-overuse headaches, and possibly ulcers and bleeding in the gastrointestinal tract.

Migraine relief medications that combine caffeine, aspirin and acetaminophen (Excedrin Migraine) may be helpful, but usually only against mild migraine pain.

Dihydroergotamine (D.H.E. 45, Migranal). Available as a nasal spray or injection, this drug is most effective when taken shortly after the start of migraine symptoms for migraines that tend to last longer than 24 hours. Side effects can include worsening of migraine-related vomiting and nausea.

People with coronary artery disease, high blood pressure, or kidney or liver disease should avoid dihydroergotamine.

Some of these medications are not safe to take during pregnancy. If you're pregnant or trying to get pregnant, don't use any of these medications without first talking with your doctor.

Medications can help prevent frequent migraines. Your doctor might recommend preventive medications if you have frequent, long-lasting or severe headaches that don't respond well to treatment.

Preventive medication is aimed at reducing how often you get a migraine, how severe the attacks are and how long they last. Options include:

Ask your doctor if these medications are right for you. Some of these medications are not safe to take during pregnancy. If you're pregnant or trying to get pregnant, don't use any of these medications without first talking with your doctor.

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When symptoms of migraine start, try heading to a quiet, darkened room. Close your eyes and rest or take a nap. Place a cool cloth or ice pack wrapped in a towel or cloth on your forehead and drink lots of water.

These practices might also soothe migraine pain:

Exercise regularly. Regular aerobic exercise reduces tension and can help prevent a migraine. If your doctor agrees, choose aerobic activity you enjoy, such as walking, swimming and cycling. Warm up slowly, however, because sudden, intense exercise can cause headaches.

Regular exercise can also help you lose weight or maintain a healthy body weight, and obesity is thought to be a factor in migraines.

Nontraditional therapies might help with chronic migraine pain.

A high dose of riboflavin (vitamin B-2) may reduce the frequency and severity of headaches. Coenzyme Q10 supplements might decrease the frequency of migraines, but larger studies are needed.

Magnesium supplements have been used to treat migraines, but with mixed results.

Ask your doctor if these treatments are right for you. If you're pregnant, don't use any of these treatments without first talking with your doctor.

You'll probably first see a primary care provider, who might then refer you to a doctor trained in evaluating and treating headaches (neurologist).

Here's some information to help you get ready for your appointment.

Take a family member or friend along, if possible, to help you remember the information you receive.

For migraines, questions to ask your doctor include:

Don't hesitate to ask other questions.

Your doctor is likely to ask you a number of questions, including:

Originally posted here:
Migraine - Diagnosis and treatment - Mayo Clinic

This entry was posted on December 3, 2022 at 12:13 am and is filed under Preventative Medicine. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed. |