A migraine is not just a headache; it is considered a common chronic brain disorder that affects approximately 12 percent of the US population. Migraine sufferers experience “attacks” which include moderate to severe pain, gastrointestinal symptoms and sensory disturbances such as sensitivity to light, sound, movement and smell.

The exact cause of migraine is not known, but clinical history and genetic studies suggest that migraine runs in families. However, experts describe migraine as a neurovascular disorder in which neurons (brain cells) trigger change in blood vessels. The hallmark feature of a migraine attack is the abnormal activation of the trigeminovascular system, a part of the brain that is responsible for picking up sensation from the face and the head. Both the environment and genes probably play important roles.

Migraine Facts

• Women are three times more likely to have migraines than men, and one out of four women will experience migraine in their lifetime.
• Not all migraines have aura, which is marked by visual changes such as seeing flashing lights, zigzag or wavy lines, or spots.
• 10 percent of children have migraines and half of all migraine sufferers have their first attack before the age of 12.
• You are more likely to suffer from migraines if one of your parents had them.
• Moderate to severe pain that lasts from 4 hours to 3 days
• Migraines often go undiagnosed and many people who suffer from them do not seek out medical care.
• More than 4 million adults have chronic migraine and experience 15 or more headache days per month. This means that people with this condition have a migraine more often than not.

Phases of a Migraine Attack

Premonitory Phase: Symptoms include fatigue, frequent yawning, neck stiffness, changes in appetite or mood, and sensitivity to sensory stimulation. It is the pain-free phase right before the migraine attack and is associated with brain changes and changes in pain perception. Patients who are able to identify the premonitory phase may have an advantage in being able to treat the attacks more quickly.

Headache Phase: The headache phase may start gradually or abruptly and typically lasts 4–72 hours.

Postdrome Phase: The pain-free period after the attack has resolved. People usually do not feel fully back to normal and may have a sense of feeling hungover or fatigued.

Common Triggers

Migraine attacks can be “triggered” by weather changes, menstruation, skipped meals, lack of sleep or too much sleep, acute stress or stress letdown, intense physical exertion, strong odors, and bright lights or loud sounds. Alcoholic beverages, often including red wine, chocolate, excessive caffeine intake, processed meats, aged cheese, and processed foods containing a lot of artificial additives or MSG are a few common food triggers. In many cases, triggers are unknown as patients have an inherent tendency to have migraine attacks.

Experts recommend keeping a headache diary or using an app to track headaches to narrow down what may be triggering your migraines.

Tests

Migraine Evaluation
Your neurologist will ask you questions about your migraines, including when they occur, where they cause pain in your head, and what makes the pain subside.

Magnetic Resonance Imaging (MRI)
Your doctor may order an MRI to rule out some causes of migraine, such as issues with the central nervous system.

Computed Tomography (CT) Scan
Computed tomography is a type of X-ray that takes a series of images of your brain to help your doctor look for any irregularities.

Treatments

When you see a migraine specialist they will likely speak to you about your headaches, review your family history and do a physical examination. They may also perform diagnostic tests to rule out other medical conditions. Once a diagnosis is made your doctor will discuss both treatments for attacks and preventative measures. Treatment is most effective when delivered early, when the attack is mild. Ice, menthol, and sleep may also help.

Migraine Education
Your neurologist may ask you to keep a journal about your migraines. The journal may reveal triggers of your migraines that you can work to avoid in the future.

Over-the-Counter Medications
Treatments may include nonsteroidal anti-inflammatory drugs (like ibuprofen or naproxen) or simple analgesics such as acetaminophen.

Migraine Specific Medications
For moderate to severe attacks, physicians usually prescribe a class of medications known as triptans. Triptans can be taken in several ways, including tablets, oral disintegrating pills, nasal sprays, and injections. Another acute headache medication, dihydroergotamine, can be delivered by nasal spray or injection.

Preventative Measures
These include lifestyle modifications such as getting good sleep, reducing stress, exercising, avoiding triggers in the workplace (computer glare, florescent lights), and avoiding common food triggers.

Botox® Injections

Some people find migraine relief with regular Botox injections into their foreheads. The injections block nerve signals, preventing migraine pain. Botox is FDA-approved for migraine treatment.

If migraines are frequent or severe your doctor may recommend acupuncture, yoga, biofeedback, cognitive behavioral therapy, and neurostimulation of the supraorbital nerves. They may also prescribe pharmacologic treatments which include nutraceuticals (magnesium, feverfew, coenzyme Q10, riboflavin), blood pressure medications, anticonvulsants, antidepressants, and onabotulinum toxin A (Botox) for chronic migraines. In 2018, 3 novel drugs, monoclonal antibodies to calcitonin gene related peptide (CGRP) or its receptor, became the first drugs specifically designed for migraine prevention. Newer FDA approved devices include a non-invasive vagal nerve stimulator, a transcutaneous supraorbital stimulator, and a transcranial magnetic stimulator.

Why Choose UHealth?

Specialized headache services. We specialize in headaches, so you know you are getting neurologists with specific experience. When you meet with our specialists, they obtain an accurate diagnosis and develop a headache care plan that emphasizes prevention, risk reduction, safety, and return to well-being. Consultation and referral services are enriched with patient education and interdisciplinary referrals when appropriate.

A top-rated neurology team. Did you know that 30 percent of people who are sent to specialized centers for difficult seizures find out they were misdiagnosed?  An inaccurate epilepsy diagnosis could mean years of costly and unnecessary medications. The expert physicians at our state-of-the-art International Comprehensive Epilepsy Center (ICEC) provide you with a comprehensive medical evaluation, so you get the right diagnosis and the right treatment the first time you are evaluated.

High case volume. Our neurologists are experienced and knowledgeable. The number of patients our department has cared for is impressive; as an example, there are about 2,500 patients with movement disorders, 2000 patients with multiple sclerosis, 1000 patients with cognitive impairment, 1500 with stroke and about 300 patients with amyotrophic lateral sclerosis (ALS).

Experts in pediatric neurology. The pediatric neurology specialists at the University of Miami Miller School of Medicine, in affiliation with Holtz Children's Hospital and Nicklaus Children’s Hospital, are committed to the diagnosis and treatment of childhood-onset neurologic disorders.