Health Care

More Than Just a Bad Headache: Migraine Treatment

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It’s an understatement to say that migraine headaches can be debilitating. Migraines are a neurological condition, one that should be evaluated by an expert.

“Headache is only one symptom of a migraine,” says Hind Kettani, MD, a fellowship-trained neurologist at AdventHealth Neuroscience Institute. She says that an initial headache often predicts that a migraine is coming on, but the condition often involves sensitivity to light and sound, dizziness, fatigue and changes in smell. “The episode can occur in multiple phases,” continues Dr. Kettani.

Sometimes one of those phases is called aura – resulting in vision changes, numbness and even confusion not unlike that experienced during a stroke or seizure. Often people who experience migraines feel as if they cannot move. They may prefer to lie down or sit in a dark room.

“The process reminds me a little of seizures,” says Dr. Kettani, who is also an expert in epilepsy and other seizure disorders. “The brain doesn’t feel well.”

What Causes Migraines?

A doctor can diagnose migraines based off clinical symptoms such as the ones described above. However, what triggers a migraine varies from person to person. There may be genetic factors, and migraines tend to run in families. However, physical conditions such as head trauma and even the change of seasons can lead to migraine. Other people are triggered by strong smells such as chlorine bleach or processed foods – preservatives such as nitrites, MSG and those found in wine and aged cheeses are common culprits. Still others experience migraines caused by hormonal changes such as those around menstruation or puberty.

Dr. Kettani advises people to keep a migraine diary so that patterns can be identified. In many cases, the exact factors that personally cause migraines for them can be discovered.

“I ask patients to pay attention to what was happening before and after they had the migraine,” says Dr. Kettani. “What did you eat beforehand? A lot can be done without medication,” she stresses. By identifying the specific cause or causes of a person’s migraines, they can avoid these things and reduce the number of migraines they experience.

Adopting a Healthy Lifestyle to Manage Migraines

Avoiding your migraine triggers is an example of preventive medicine. Dr. Kettani says it is also important to lead a healthy lifestyle: getting enough sleep and exercise, eating a healthy diet and using relaxation techniques such as breathing well. Simply breathing out as much carbon dioxide (CO2) as possible can help improve blood flow to the brain, which could mean longer stretches of time without a migraine.

Advanced Treatment for Migraine

When avoiding triggers and adopting healthy lifestyle changes aren’t enough, there are other treatment options. These fall into two categories: treatments that prevent migraines and treatments that stop a migraine attack as it is happening.

Some patients are helped by prescription medications that prevent migraines. There are multiple types, and the right one might depend on a patient’s other medical conditions. Beta-blockers, anti-depression medications, anti-convulsion drugs and a newer class of medications called CGRP inhibitors are some of the ways that migraines can be prevented. Botox injections also prevent migraines for some patients, but insurance usually won’t cover them until a patient has tried and found that several other medications don’t work. Even so, Dr. Kettani stresses the value in finding comprehensive migraine care that doesn’t rely too much on drugs.

“It doesn’t make sense to put someone on medications every day,” she says. A comprehensive center such as the AdventHealth Neuroscience Institute can help migraine sufferers connect with other treatments such as cognitive behavioral therapy and learning biofeedback. This way, as soon as someone feels a migraine coming on, they can respond in ways that will relax their brain and arrest the migraine in its tracks.

However, if it becomes necessary to treat a migraine during the throes of an attack, there are several medication and non-drug options. Dr. Kettani says that migraines have become better understood in recent years. For most of the 20th century, scientists believed that migraines were caused by the blood vessels that feed the brain. Now, however, they have evidence that migraines begin in the central nervous system itself. This has led them to new treatments. The newest medications approved by the FDA in 2020 are ditans and gepants. Unlike conventional treatments such as triptan, ditans and gepants do not constrict blood vessels, making them an option for people with diseases that affect the heart or blood vessels.

Non-drug treatments include external devices that stimulate the brain with magnets or electricity. The handheld transcranial magnetic stimulator (TMS) device can be placed on the back of the head to deliver a current to the brain. For about half of patients, a single use of the device each day reduces the number of migraines by a third. It can be used both to arrest the migraine and as a preventive measure. In late 2018, the FDA approved the VNS (vagus nerve stimulator) – initially an epilepsy treatment – for migraine. This device delivers a mild electrical current to the vagus nerve on the neck. Patients who used the device for epilepsy were the first to notice it decreased the number and severity of their migraines.

“If migraines are not treated properly, they get worse,” says Dr. Kettani. “The brain remembers the pain, and the increase in sensitivity to these attacks can lead to chronic, daily headaches,” she says. Therefore, she advises anyone who suffers from migraines to see a neurologist soon. During that appointment, they should insist on asking for help to make the necessary lifestyle changes that can prevent most of their future migraines.

If you or a loved one experiences migraines, get the comprehensive care you need from the team at the AdventHealth Neuroscience Institute. For an appointment with a neurologist, call 844-396-3030.

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