Migraine Clinic

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Managing Migraines

This is general information on managing migraines, but keep in mind that it's important to consult with a headache specialist for personalized advice. Some common strategies for managing migraines.

Identify Triggers – Keep a migraine diary to track potential triggers such as:

• Food
• Stress
• Lack of sleep
• Hormonal changes
• Other actions that seem related to your headaches

Avoid known triggers when and if possible.

Lifestyle Changes:

• Maintain a regular sleep schedule
• Manage stress through relaxation techniques, such as meditation or deep breathing
• Stay hydrated and maintain a balanced diet
• Engage in regular physical activity, as it can help reduce the frequency and severity of migraines

Biofeedback and Relaxation Techniques – Biofeedback and relaxation exercises can help manage stress and tension, potentially reducing the frequency of migraines.

Alternative therapy – Some people find relief through alternative therapies like physical therapy, acupuncture, chiropractic adjustments, or massage.

Pharmacological Management – Medical management for migraines involves a combination of acute treatments to relieve symptoms during an attack and preventive measures to reduce the frequency and severity of migraines over time. It's important to consult with a headache specialist for personalized advice. Some common medical management strategies include the following.

• Acute Treatments
  • Over-the-Counter Pain Relievers: Non-prescription medications like, Excedrin, ibuprofen, naproxen sodium, or acetaminophen can be used for mild to moderate migraines
  • Triptans: Prescription medications like sumatriptan, rizatriptan, and others are specifically designed to relieve migraine symptoms by narrowing blood vessels and reducing inflammation.
• Preventive Medications:
  • Beta-Blockers: Medications such as propranolol or timolol may be prescribed to reduce the frequency and severity of migraines by regulating blood vessel dilation
  • Antidepressants: Certain antidepressants, such as amitriptyline, nortriptyline, or venlafaxine, may be used for migraine prevention
  • Antiepileptic Drugs: Medications like topiramate or valproic acid can be effective in preventing migraines
  • Calcium Channel Blockers: Verapamil is an example of a calcium channel blocker that may be prescribed for migraine prevention
  • CGRP Monoclonal Antibodies:
    • Monoclonal antibodies targeting calcitonin gene-related peptide (CGRP), such as erenumab, fremanezumab, and galcanezumab, have been developed for migraine prevention
  • Botulinum Toxin (Botox) Injections:
    • OnabotulinumtoxinA injections are approved for the treatment of chronic migraines
  • Hormonal Therapies:
    • For women whose migraines are associated with hormonal fluctuations, hormonal therapies like birth control pills or hormone replacement therapy may be considered

Interventional Management for Migraine – Interventional management for migraines involves procedures or techniques that aim to provide relief from migraine symptoms. These interventions are typically considered when other forms of treatment, such as medications and lifestyle changes, have not been effective. It's important to consult with a headache specialist to determine the most appropriate intervention for your specific situation. Some common interventional management options for migraines include the following.

• Nerve Blocks:
  • Occipital Nerve Block: Injection of a local anesthetic and sometimes a corticosteroid around the occipital nerves at the back of the head.
  • Supraorbital and Supratrochlear Nerve Blocks: Injections around the forehead area.
• Botox Injections – OnabotulinumtoxinA (Botox) injections are FDA-approved for the prevention of chronic migraines (15 or more headache days per month)
• SPG (Sphenopalatine Ganglion) Blocks – A procedure where a local anesthetic is applied to the SPG, a nerve bundle associated with migraines, usually through a nasal spray or injection
• Radiofrequency Ablation – This involves using radiofrequency energy to create lesions on certain nerves in the face or neck that may be contributing to migraines
• Neuromodulation Devices
  • Non-invasive neuromodulation
    • Transcranial Magnetic Stimulation (TMS): A non-invasive device that delivers magnetic pulses to the brain to interrupt or modulate migraine activity
    • Non-Invasive Vagus Nerve Stimulation (nVNS): A device that stimulates the vagus nerve through the skin, potentially preventing migraines
  • Minimally-invasive neuromodulation - Placement of electrodes near the occipital nerves or other nerves in the face with a neurostimulator device to modulate pain signals
    • Occipital Nerve Stimulation
    • Cranial Nerve Stimulation

Surgery

In rare intractable cases, surgical procedures may be considered for certain types of migraines. For example, decompression surgery may be performed to relieve pressure on specific nerves.

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Migraine Facts 

By Age – who have experienced migraine or severe headache over the past three months

• 18.7% of Americans aged 18-44 
• 15.7% of Americans aged 45-64  
• 9.3% of Americans aged 65-74  
• 6.1% of Americans aged 75+ 

Research has shown that migraines are most common among young adults between 30-49 years of age. As people age, migraines generally become less common, meaning the prevalence decreases. For example, for many women, migraine is related to hormones; when they go through menopause, their migraine may improve or goes away. This would be one reason prevalence decreases with age.

By Sex – who have experienced migraine or severe headache  

• 21% of women. That is 1 in 5 U.S. adult women
• 10.7% of men. That is 1 in 10 U.S. adult men

By Race and Ethnicity – who have experienced migraine or severe headache 

• 16.7% of White people 
• 15.6% of Black people 
• 9.1% of Asian-American and Pacific Islanders  
• 22.1% of Native American/Alaskan Native  
• 16% of Hispanics   

Diagnosis Rate

• 40-50% of people who have migraine disease are undiagnosed