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Migraine Headache Treatment Program • Common Migraine • Classical Migraine • Cluster Headache
What Happens In Your Head When A Migraine Strikes • How Migraine Headaches Are Treated • Chronic Daily Headache
Preventative Treatment • Abortive Treatment • Abortive Medication • Final Thoughts About Migraine
For the migraine sufferer there is nothing worse than the pain, disability and suffering that results from the intense throbbing pain of a migraine attack. All people who suffer from severe recurrent headache identify with the isolation that results from the lack of understanding from family and friends who expect you to "take an aspirin and get on with it." This is simply is not effective with migraine patients, as you are well aware.The effective treatment of chronic recurrent headache is complex and requires considerable teamwork with your doctor. Migraine is a chronic disease, like hypertension. Thus, as with hypertension, it cannot be "cured", but it can be controlled. Migraine is an inherited genetic disease. 90% of people with migraine have others in their families who have some kind of headache.
The key to the control of migraine is preventative treatment rather than symptomatic treatment. Prevention consists of several strategies that can take up to three months before they become effective. To achieve this result, cooperation and teamwork between the patient and physician are essential.
Research has shown that here are 28 million people with migraine in the United States, 8 million of which suffer disabling, severe attacks every year. If you include Chronic Daily Headache, the total is 40 million. These individuals collectively lose 60 million work days a year and cost the nation about 17 billion in lost time and medical expenses.
There are two forms of migraine: Classical (with aura) and Common (without aura). Eighty percent of migraine patients do not have aura, the remaining twenty percent have aura. Migraine affects twenty-two percent of the population in the north central United States and women suffer from the disease three times more than men. The attacks are brought on by "triggers". Contrary to popular belief, migraine is infrequently triggered by "nerves".
Cluster headache occurs in one percent of the population and men are afflicted five times more than women. It is said to be the worse pain known to man. The pain is boring, invariably located in the eye on one side. There can be a lid droop and a stuffy nostril on the same side as the head pain, among other symptoms. The attacks occur in "clusters" and then go away for months or years before returning again. They frequently occur at the same time every day, often at night. The attack profile is much different than migraine. Attacks are most likely to occur spring and fall.
A typical patient with migraine is a woman in her thirties and forties, whose headaches are becoming intolerable, and whose headaches started in adolescence. Women are effected three times more than men. The typical headache is one sided, throbbing in nature, and of moderate to marked severity. It can be associated with light and sound sensitivity, nausea and sometimes vomiting. Untreated, it can last from several hours to three days. An attack that lasts longer than three days is termed Status Migrainosus, which can require intravenous medications and hospital treatment. Although an attack may begin at any time a day, if it is present on awakening in the morning it could signify rebound headaches. (This will be covered later). The frequency of the headaches is extremely variable, but on average patients experience one to three attacks a month. Migraine is by definition, an episodic illness. The term common migraine cannot be applied to the first attack because other conditions inside the head can cause a similar headache.Prodromes are early warning signs. They are often ignored because people do not realize the significance of them. They may occur hours or days before an attack. The most common prodromes are: changes in mood (irritability, euphoria, and a desire to withdraw), fatigue, yawning and neck stiffness. Other prodromes may include: craving for certain foods, thirst, weakness, and difficulty concentrating or thinking. It is common for a loved one to know that a migraine is coming on before the migraineur because they recognize the prodromes signs. Tenderness of the blood vessels in the temple and neck, the presence of associated symptoms during a migraine attack is essential for the diagnosis. The most common symptoms are: nausea, sensitivity to bright light, loud noise, and sometimes smells. Other symptoms during a severe migraine attack include: vomiting, abdominal pain, blurred vision and/or tunnel vision, changes in skin color and temperature between sides of the face, and stiffness.
After the headache the patient enters the resolution phase. The migraineur may feel "washed out" or full of energy and euphoric. These symptoms may last a few hours to as long as two days. Still other patients may feel depressed or have symptoms similar to the prodrome. This can lead to the fear that it is starting all over again and the resultant anxiety can indeed trigger another attack.
In Classical Migraine, all of the symptoms of Common Migraine can exist except it differs in that there is a visual aura, which occurs 30 to 60 minutes before the pain begins. Au aura is considered any sign of brain dysfunction. If the aura is the typical stereotype of classical migraine, the diagnosis can be made with the first attack. A typical aura is a C shaped arc of flashing, rotating lights of different colors in which the center part of the C is blind or gray, and the lights are on the outer edge of the C. The Aura begins as a dot and gradually expands until it fills the entire visual field. The expansion of the arc takes about 15 to 20 minutes. The blind area left in the aura’s wake gradually resolves in another 10 to 15 minutes. Other auras that may occur include: loss of part of the visual field (such as not being able to see to the right), numbness or tingling over one side of the face and arm, vertigo, weakness on one side of the body, or trouble speaking if the headache is on the opposite side of the dominant hand. To be diagnosed as an aura, any of the above symptoms must occur before the pain begins.There are subtypes of Classical Migraine which are distinguished by the features of the aura, the neurological symptoms during the pain and the duration of the neurological deficits. In Hemiplegic Migraine there is one sided weakness or paralysis, or there can be one sided numbness. The Triptan drugs should not be used with Hemiplegic Migraine because there is a stroke risk. In Retinal Migraine blurring or blindness occurs in one eye. In Opthalmoplegic Migraine (mostly in children) double vision occurs and can persist long after the pain has stopped. There is a rare type of migraine I call the Alice in Wonderland migraine that occurs in younger people where there is visual distortion such that they cannot recognize their surroundings and can see over the top of their mother and see behind her. As you could imagine this causes tremendous anxiety.
In Basilar Migraine the symptoms indicate that the problem is in the brain stem and cerebellum rather than the cerebral hemispheres. This type of migraine produces a variety of symptoms which include: vertigo or trouble walking, double vision or blindness in both eyes, hearing impairment or ringing, trouble speaking or swallowing, as well a weakness and numbness on both sides or numbness around the mouth. Marked confusion may occur, especially in children.
In Complicated Migraine the focal neurological symptoms persist after the headache phase. Migraine Equivalents are transient cerebral symptoms without the headache.
Cluster Headache is said to be the most severe pain known to man. It is a periodic disease occurring in "clusters" of attacks for a time then going away, sometimes for years. It is common for the attacks to occur in the spring and fall. Men are afflicted with cluster headaches five times more often than women.The attack profile differs considerably from that of migraine. There are no aura or prodrome symptoms. The attack starts rapidly and builds to a peak in 10 or 15 minutes. It is always on one side of the face and remains there for the cluster period. Invariably the site of maximum pain is in or around the eye. The pain is described "as if the eye ball is being pushed out." There can be other pain in the neck or the back of the head.
The pain is excruciating and described as penetrating or stabbing, but rarely throbbing. It usually lasts for forty-five minutes to an hour. The number of attacks per day vary from one to three, but can range from one a week to eight or more per day. In addition, there can be a clock-wise regularity in the attacks, such as at 2:00 AM each day.
Other associated symptoms of cluster include: drooping of the eye lid, tearing of the eye, redness of the eye, and nasal stuffiness on the sane side as the pain. Sometimes there can be weakness on the side of the face. The patients pulse rate can go down as low as forty.
The behavior of the patient is totally different than that in migraine. Instead of wanting to be left alone, these people are restless and cannot lie down. They may pace the floor, moan, scream, pound their head against the wall, or even threaten suicide. After the attack they are exhausted for some period of time.
I decided to include this explanation in order to underscore the importance of early action on your part when you become aware that something is beginning to happen. A migraine attack involves a whole series of events, most of which occurs before the migraineur is aware of what is in store for them. These events can reach an untreatable stage shortly after the first sign of an attack. I hear many patients say that they wait until they are sure that this is a migraine before they treat it. This is a mistake! I tell migraine patients to consider all headaches as migraine, some are severe and some are not.The progress is a cascade. The process begins with a trigger. There are many things that can trigger an attack. A particular patient may trigger from some things and not others. The patients are instructed in how to identify and avoid triggers. Triggers can occur from one hour to three days before the onset of symptoms. The process then begins. It starts with some electrical activity in the brain stem, the primitive part of our brains. (This is probably when prodrome symptoms occur) This spreads to the cerebral hemispheres and spreads from the back to the front. If you get an aura, it will occur at this stage. The activity then goes through the Trigeminal nerve to the blood vessels on the surface of the brain in the covering called the Dura. The blood vessels are stimulated and constrict for a time. After a while they fatigue and dilate to a larger that normal size. This stimulates sensory nerve fibers and we begin to feel pain. With more time the areas where the nerve connects to the blood vessel become inflamed. A little later and the inflammation spreads along the blood vessel. As a result, the blood vessel begins to leak a protein fluid into the surrounding tissues. The result is an increasing area of inflammation, and an untreatable status.
An attack that lasts longer than three days is called Status Migrainosus. This can require treatment with steroids or hospitalization. Each step in the process can be stopped much like you can block a row of falling dominos. Anti-inflammatory medications can sometimes block the headache at the prodrome stage. These would include Advil or Aleve. In order to do this you must be able to recognize you prodrome symptoms. Not everyone gets prodrome symptoms. Prophylactic medications block some of the early steps in the migraine cascade.
In reality the process is complex and controversial. The above model, however, gives the patient enough appreciation about the process so that she/he can know what is coming next and can take action based upon what stage they are in.
In the last several years it has become recognized that a certain group of migraine patients have persistent daily headache of mild to moderate severity which they are unable to break. No matter what the patient tries the headache is with them every day interfering with their daily performance. They have developed rebound headaches from the analgesic medication.If the patient stops taking their daily analgesic medication their headaches go to severe intensity and become disabling. Taking the analgesic medication does not stop the headaches. A unique metabolic phenomena occurring only in migraine patients is responsible for rebound headaches. When a migraine patient takes these analgesics on a regular basis, more often than two days a week, the body changes the way it handles these drugs and Chronic Daily Headache develops. Anti-inflammatory drugs, such as Advil and Nuprin, do not cause this complication. The treatment of Chronic Daily Headache involves withdrawal and detoxification from the analgesic product. Severe rebound headache after withdrawal of analgesics can require hospital treatment. A short course of steroids often prevents the need for hospitalization. The severe rebound period can last as long as six days and it may take several months before a patient will achieve significant headache free days.
We do not simply give you a pill and send you on your way. We document your progress, make adjustments, and continue to monitor you until you are under good control and not missing work or social events.Migraine is best treated by interfering with the series of steps in the migraine cascade that leads to the headache stage. This includes: avoiding triggers, following a Tyramine restricted diet, preventative and symptomatic medications, behavior modification, biofeedback, and relaxation training. Patients have variations in the way migraine affects them. Because of this, it is important that programs are customized to each individual headache pattern in order to achieve optimal results.
There are two basic kinds of treatment, and must be thought of separately by the patient. First, and most important, is preventative treatment. Second, is abortive treatment (what you do when the headache begins). In addition, it is important to discuss a serious complication that often develops in migraine patients, they self medicate with aspirin, caffeine, Tylenol or other drugs that contain these compounds. The condition is Chronic Daily Headache and results from a transformation from migraine caused from the regular usage of combination analgesics.
This form of treatment is the essential element to successful control of migraine. Because there is no cure for migraine, prevention works to reduce attack frequency, severity and duration.Migraine is a progressive disease that increases in severity and frequency, peaks out in the early forties, then declines if analgesic rebound is not present. A small percentage of women will stop having headaches after menopause. Due to the progressive nature of the disease, it is important take preventative measures early and continuously. The longer an individual lives with uncontrolled pain, the more difficult it is to obtain long term control of the pain.
Preventative treatment consists of: medication, dietary restrictions, identification and avoidance of triggers, and behavior modification.
Prophylactic medications are taken on a daily basis, regardless of the existence of a headache. Patients should not become discouraged early on in the use of these medications as they often require three to six weeks before they begin to act, and three months or longer for full effect to develop. When they begin to act, we expect to see a gradual reduction in frequency and severity of the headaches. In the event this does not occur medication dose adjustments are made, and sometimes another drug is added.There are several medications that are used for prevention. These are medications that are generally used to treat other conditions, but also have anti-migraine activity. We call this off-label prescribing. They function by blocking various steps in the migraine cascade before the pain stage.
The four classes of drugs that we use are: Beta Blockers, Calcium Channel Blockers, Anti-Depressants and Anti-Seizure medications.
Beta Blockers include Inderol, and Corgard among other. These cannot be used in people with asthma or diabetes. Athletic people will find it slows them down.
Calcium Channel Blockers include Verelan and Verapamil. These drugs work by blocking a hold through the cell membrane of muscle cells in the blood vessels and the nerves. The action stabilizes these structures, which are over active in migraine patients.
Anti-Depressants include: Effexor and Cymbalta. These drugs work on two brain chemicals, serotonin and norepinephrine, which result in better pain control. Also Paxil, Prozac and Zoloft can be used. They work by raising brain Serotonin levels, which can be lowered in migraine. Anti-Seizure medications include Lyrica, Depakote, Keppra and Zonegran. They work by stabilizing the nervous system. Lyrica, a new drug, works by blocking the transmission of pain signals of neuropathic pain, which includes Chronic Daily Headache. It produces its effect as quickly as a week. Keppra works well in post-traumatic headache. All of these drugs, except Lyrica, can take six to eight weeks before they produce improvement.
Drug selection for new migraine patients is based on Dr. Kirchner’s years of experience in treating thousands of headache patients. Selection is also based on the presence of co-existing conditions. People with Chronic Daily Headache are usually treated with Lyrica. All other factors being equal, Calcium Channel Blockers are usually used first in Classical Migraine, Cluster and people with cold extremities. Slow release forms of the drugs are essential for good effect in migraine. Side effects are mild and usually limited to transient constipation for a couple of weeks. Beta Blockers may be used for people with Common Migraine. Anti-Depressants and Anti-Seizure medications are often used for Chronic Daily Headache and more difficult patients.
Generic prophylactic drugs are often less effective than brand name drugs. This is because the FDA allows generics to have a 25% dose fluctuation from pill to pill. A 100 mg pill could have 75 mg, 125 mg, or 100 mg. The difference between 125 mg. to 75 mg. is 50%. Prophylactic effect develops much better when blood levels are constant.
Vitamin B2 and magnesium can be especially useful in Chronic Daily Headache because frequent headaches result in deficiencies. The recommended dose is B2 400 mg, and Magnesium 500 mg. You will have to ask the pharmacist to order it for you.
It is important to remember that it takes at least three months on these medications for prophylactic effect to develop.
There are many foods that can trigger migraine in about 50% of patients. Most new patients are unaware of any food triggers, but find out as they go through the program that they have several food triggers. The reason is that there can be up to a three day delay after eating the food until the headache occurs. New patients are taken off all diet trigger foods for the first four months. This is done to avoid triggering a headache while we are gaining control with the prevention process.After we have achieved control of the headaches, we have the patient test one food at a time and wait three days. If there is no headache in that time, they may eat that particular food. Food triggers, however, can change over time. If after several months you start having headaches again, go back on the full diet again until the headaches stop then begin the food testing again.
Some people are able to control their migraine without any medication if they are able to identify and avoid all of their triggers. This is not often possible, however, because many triggers, such as weather triggers, cannot be avoided. Abortive drugs taken in anticipation of these triggers can sometimes prevent a headache.In order to help the patient to identify their triggers and to accurately show us what the response is to treatment, we have all new patients keep a headache calendar to document the changes in the headache pattern. We do not have a blood test to tell us if you are improving. We must have an objective tool to document changes so that correct treatment adjustments can be made. This calendar must be presented at each office visit in order for us to make the appropriate adjustments in their preventative program. This is an essential management tool. We expect to see certain gradual changes in the headache pattern over time and must make adjustments if they do not occur. The use of the calendar will be explained to you.
Many journal articles have been written about "the migraine personality". These individuals tend to be achievers, perfectionistic, and appear to have a problem with their biological clock. These characteristics tend to get them into trouble with their headaches.Some common triggers are oversleeping, lack of sleep, and arising at different times of the day. It is important to keep a regular schedule. You should go to bed and get up at the same time each day. By keeping a regular schedule, you can overcome the problem with your biological clock.
Depression can often be present with migraine. Depression is always present with Chronic Daily Headache. If you feel depressed frequently you should definitely let us know. An anti-depressant and counseling can be effective in gaining control of your headache. Frequently, when people find out that something can be done for their headaches, their depression lifts with very little need for treatment.
An understanding of sleep cycles is important. It has been shown that awakening from deep sleep can trigger a migraine. During sleep we go through cycles from light sleep to deep sleep and vice versa. Each sleep cycle lasts about ninety minutes. If we put five cycles together it amounts together it amounts to seven and one half hours. That is about as long as we should sleep. If, on weekends you want to sleep in, get up at the usual time, get some orange juice to support your blood sugar, go to the bathroom, and then sleep for one more cycle (one and one half hour).
Other things that are important for migraine patients are: learn stress management, try to avoid emotional conflicts, and avoid being too rigid and unyielding. Remember, migraineurs tend to be perfectionistic which can be a continual trigger for migraine.
Menstrual migraine is sometimes difficult to prevent. A sudden drop in the estrogen level just prior to menses brings on the attack. Supporting the estrogen level can lessen the severity of the headache. Sometimes we will use an estrogen skin patch, which will support the blood level enough to make the headache more treatable.After the full effect of prophylaxis develops usually the menstrual migraines are more controllable. Amerge can be very effective if it is started two days before the headache at ˝ pill twice a day for six days. Frova can be used in a similar fashion.
Abortive treatment refers to the medication taken at the early stage of an attack in order to relieve the migraine symptoms. It should relieve all of the symptoms, pain, nausea, light and sound sensitivity. The key is that the migraineur must treat it early. Many patients "wait to see if it really is a migraine". The attack then gets away from them and they use more doses and do not get complete relief.Remember that the pain begins when the blood vessels dilate. Shortly after that the blood vessels can begin to leak a protein fluid into the surrounding tissues which increases the inflammation. Shortly after that the attack can become untreatable. The result can be an emergency visit for shots and a non-functional status.
In spite of good prophylactic treatment, some migraine attacks will still occur from time to time. It is important that you keep your abortive medication with you and available at all times. In order to effectively stop an attack, the abortive medication must be taken within ten to fifteen minutes after the first symptom. If you wait for other symptoms, such as throbbing or light sensitivity, it may be too late to successfully treat the attack.
Abortive treatment refers to the medication taken at the early stage of an attack in order to relieve the migraine symptoms. It should relieve all the symptoms, pain, nausea, light and sound sensitivity. The key is that the migraineur must treat it early. Many patients “wait to see if it really is a migraine”. The attack then gets away from them and they use more doses and do not get complete relief.Remember that the pain begins when the blood vessels dilate. Shortly after that the blood vessels can begin to leak a protein fluid into the surrounding tissues, which increases the inflammation. Shortly after that the attack can become untreatable. The result can be an emergency visit for shots and a non-functional status.
In spite of good prophylactic treatment, some migraine attacks will still occur from time to time. It is important that you keep your abortive medication with you and available at all times. In order to effectively stop an attack, the abortive medication must be taken within ten to fifteen minutes. If you wait for other symptoms, such as throbbing or light sensitivity, it may be too late to successfully treat the attack.
A wide variety of medications are used to stop migraine attacks. Each type of migraine pattern has medication that is appropriate to provide relief. Some of these medications need to be avoided with certain patterns of migraine.
The ideal abortive medication should have the following characteristics. It should function by blocking one or more of the steps in the migraine cascade. It should not cause a rebound headache when the effect wears off. It should be non-addicting, non-habit forming, and non-sedating and should not cause adverse vascular effects elsewhere in the body. Finally, abortive medication should not have side effects that interfere with patient function as much as the headache does.
There a few medications available today that meet all of these criteria. The Serotonin Agonists (Triptans) come closest to this ideal. These include Imitrex, Zomig, Maxalt, Amerge, Axert, Relpax, Frova and Treximet. It is critical that these meds be taken within the first two hours because they do not work when used after that time.
This class of drugs comes close to the ideal. These drugs are often used to treat arthritis. They function by preventing the dilatation of blood vessels and stopping them from leaking. This action fits perfectly with what is needed to treat migraine. If we can stop the blood vessel from leaking we will have a very short migraine attack. In addition, these medications are non-addicting and non-habit forming. The only problem is that they can cause stomach irritation and on occasion, ulcers. Since migraine patients have a 20% incidence of ulcer disease, these medications need to be closely monitored.Some of the medications that we use include: Fenaprofen, Indocin, and Celebrex. Celebrex has less stomach irritation. There are some types of headache, such as “ice pick headaches” that only respond to Indocin.
Often there is a considerable amount of anxiety that goes along with a migraine attack. This is understandable considering that the patient knows what is ahead of them. Sedative-Pain medications include: Fiorinal, Esgic and others. These medications can contain aspirin or Tylenol and caffeine. Care must be taken in using these medications because if they are used more often than two days a week for a long enough time they will cause rebound headache which can transform migraine into Chronic Daily Headache. When this happens, prophylactic treatment becomes blocked and no improvement can occur.
Ergotamines function by constricting blood vessels. It helps headaches by constricting blood vessels that are dilated during a migraine attack. It is often combined with caffeine and a sedative to cover some of the other migraine symptoms. Nausea, however can limit its use. IF they are used to frequently they can lead to a condition called ergotism, which is a persistent spasm of many blood vessels in the body after the drug effect has worn off. This can have a bad effect on circulation. Although it is extremely rare, this persistent spasm can lead to gangrene of the feet. If used properly and infrequently, this medication is usually safe and effective. Long term use of ergotamines can lead to the development of fibrous tissue in the abdomen and chest. We almost never use these drugs today because of the availability of the Triptans, which are much safer.
This is a very effective drug to abort a migraine attack. It is also a misunderstood medication. DHE stand for dihydroergotamine. Part of the misunderstanding stems from a requirement by the FDA for “generic labeling”. This requirement states that all drugs in the same class have the same labeling. Although this drug was developed from an ergotamine 50 years ago, it does not function like one. DHE has two actions that enable it to sometimes quickly stop a migraine attack. First it works on seven different receptors in the head, two of which are the 5HT-1D and 5HT 1B receptors, which is active in migraine. Secondly, DHE-45 stops the leaking of the blood vessels. Because it works on several receptors, it can also increase the nausea associated with a migraine attack. It does not constrict the blood vessels the way other ergotamines do. DHE-45 also does not lead to fibrous tissue formation like the ergotamines do.We use DHE in four different ways. First, in severe attacks that will not break (status migrainosus) we use it intravenously for several days in the hospital. Second, for severe attacks seen in the office we use it intramuscularly combined with Vistaril or Compazine nausea. Third we will give it alone under the skin, like an Insulin shot. Giving it this way seldom intensifies the nausea and we can teach patients to give it to themselves when an oral agent is ineffective. Finally, it is available in a nasal spray formulation when oral agents are not tolerated or not effective.
The Triptans are an important class of drugs in the treatment of migraine. Dr. Kirchner was involved in the development of these drugs. These compounds were designed to target the specific receptor responsible for a migraine attack, the 5HT 1D and 5HT 1B receptors. Their action is quick and unlike many other migraine medications, they are also effective in controlling nausea, vomiting, light and sound sensitivity. There are eight drugs available in this class: Imitrex, Zomig, Amerge, Maxalt, Axert, Relpax, Frova and Treximet. There is 20% non response rate to the Triptans. Fortunately, if a patient does not respond to one, they will usually respond to one of the others. Patients usually are relieved of their symptoms in one to two hours.These medications work by activating the 5HT 1D and 5HT 1B receptors in the head. These are not “pain” mediations, they are receptor agonists. Receptors, in general, produce a change in the body when a stimulus is sensed. These receptors control blood flow within the head. While the body is filled with many receptors that control many functions, the 5HT 1D and 5HT 1B receptors are primarily in the head with a smaller number on the coronary arteries and the gut. Because there are receptors on the coronary arteries, these drugs should not be used by people who have coronary heart disease. One hypothesis is that one of the inherited defects in migraine is that migraine patients have three to five times more receptors than non-migraine people.
When the blood vessels leak a protein fluid during an extended full blown migraine attack, a considerable amount of inflammation develops along the blood vessel. Sometimes the body does not clean up the inflammation from one attack when a new attack develops. In this way, the inflammation from the new attack piles on top of the inflammation from the previous attack, this prevents a break between attacks. Even though this is theoretical, the use of steroids seems to be of benefit in this situation.
Narcotics do not work in the treatment of migraine. Countless patients have told me that they have been given a shot of Demorol, gone home and slept for a couple of hours then awoke with the same pain, if not worse, than they had prior to the shot.Often, if the patient sleeps long enough, a patient will obtain relief from a migraine attack. This leads to the conclusion that it is the sleep, not the narcotic that provides the relief from the migraine. It is well know that the sleep center in the brain is near the area where the migraine process develops. Thus, this is another piece of evidence that it is likely that sleep helps stop the attack. In addition, research has indicated that the pathways of the pain nerves involved in migraine do no pass through the area of the brain where narcotics work.
Narcotic addiction is not a problem, which a migraine sufferer needs to deal with, in addition to their migraine. This clinic will not use injectable or prescription narcotics to treat you migraine headaches.
Chronic Daily Headache will occasionally need narcotics in addition to other medications. Close control and monitoring will be necessary.
Your first visit to begin treatment will last about 1 1/2 hours. Several important things will be completed during this visit. A careful examination of your headache history will reveal the diagnosis and you individual pattern on head pain. Laboratory examinations will be done for baseline values and to determine if there are any contributing factors present in your headaches. An EKG will be done to rule out heart disease and to be sure that there will not be any problems with your heart rhythm from the migraine medication. A physical exam will exclude other conditions.Next, considerable time will be spent in educating the patient about their headache condition. Since very few people know much about headache, the patient must learn as much as possible. The more the patient understands what is going on in their heads, the more they can react to the early signs and intervene. We invite family members to come with you so that they also may learn about migraine and other headaches so that they better support you in your efforts to improve.
The effective control of migraine headache takes time and effort. As most migraine patients know, we cannot go to the “headache pill bottle” and obtain relief. Thus, we must use preventative treatment in order to control our attacks. Be prepared as it often takes three months, or longer before we get full effect from the preventative treatment.
The rewards for sticking to it and having patience during the first few months can be enormous. In most headache sufferers the severity of their headaches becomes manageable, the frequency progressively decreases, and the few headaches they do have are controllable with the abortive medications.
Our mission is to help you to stop missing time from work and personal lives and our intent is to work with your to achieve this goal!! Do not neglect your health.
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