More than 38 million people in the U.S. are affected by migraines, a neurological disorder that causes intense headache episodes. That’s about 12 percent of the country’s population. And despite the availability of effective treatment options, it’s estimated that at least half of people with migraine are undertreated – and most don’t seek help from a doctor.
"At least half of people with #migraine are undertreated – and most don’t seek help from a doctor.” via @MedStarWHC
Migraine causes a range of symptoms beyond headaches. These symptoms often are debilitating -- more than 90 percent of people with migraine are unable to work or function normally during an episode.
Migraine symptoms can include:
- Throbbing or pulsating pain
- Light, smell and sound sensitivity
- Blurred vision
As a headache specialist, people often tell me they’ve tried over-the-counter (OTC) medications and various remedies to find migraine relief, to no avail. I assure them that there are other options, and that they don’t have to accept painful, debilitating migraines as a regular part of their lives. But for every person who seeks treatment from a specialist, there are countless others who choose not to.
Why is that the case? For one thing, many people aren’t aware they’re having migraines. They’ve never been diagnosed, and they’re hesitant to seek care when they think they “just have a headache.”
And going to the doctor takes time. It’s faster to stop by the pharmacy and pick up an OTC headache medication. But that time you saved won’t mean much if you’re laid up with migraine symptoms later when the OTC medication doesn’t work. Neurologists like me can prescribe more effective treatments than you’d find at the drug store.
When to see a headache specialist for migraines
The frequency, length and severity of migraine episodes vary – some people have migraine headaches that last a few hours, while others are cooped up in bed with debilitating symptoms for days at a time.
With so much variance, it’s difficult to give a broad recommendation on the symptoms that indicate when you should seek migraine treatment. But here’s a good rule of thumb: If your migraines are frequent or severe and proper use of OTC medications isn’t helping, it’s time to seek treatment from a specialist.
By “proper” use of OTC medications, I mean that you should take the recommended dosage as early as possible during a migraine episode. If you wait to see how bad the migraine will be before you take medication, it’s less likely to work.
Some people with migraines find relief from OTC medications. Yet many people aren’t satisfied with the results or suffer such severe symptoms that OTC drugs don’t help. Additionally, if you rely on migraine medications too heavily, they actually can make migraine symptoms worse.
This condition – known as rebound headache – occurs when the effects of a medication dose wear off, and people take more medication. If these people take medications too often, they can begin to trigger headaches instead of relieve them. Some people with rebound headaches have near-constant migraines, one melding into the next without relief.
If someone suffers from migraines that last more than four hours at least 15 days per month, we consider them to have chronic daily headaches. Though chronic daily headaches affect a smaller portion of people than migraines – less than five percent of the U.S. population – the condition can be debilitating and damaging to mental health. We can prevent chronic daily headaches by treating migraines before they get worse.
Advanced migraine treatments
Migraine treatment falls into two categories: abortive and preventive. Abortive treatments usually are designed to stop migraine symptoms after they start, while preventive treatments aim to reduce the frequency or severity of migraines.
Typically, we try to treat migraines first with abortive treatment. Any abortive treatments we provide should be taken as soon as you notice migraine symptoms. If severe, frequent and long-lasting migraines persist, we’ll look at preventive treatments.
My migraine patients have access to a range of abortive and preventive treatments, including:
- Botox therapy: Botulinum toxin injections are an effective treatment for chronic daily headaches.
- External nerve stimulation: An egg-sized device placed on the forehead stimulates the trigeminal nerve, producing a sedative effect that can help reduce the frequency of migraines.
- Medications: A variety of prescriptions, such as antidepressants, anti-seizure medications and painkillers, can improve migraine symptoms.
- Nerve blocks: A medication is injected near the occipital nerve in the back of the head to reduce migraine pain.
- Surgery: People with migraines who also have chronic daily headache may benefit from surgery to reduce pressure on certain nerves.
- Transcranial magnetic stimulation: A special device held against the back of the head delivers a magnetic pulse to stop migraines as they start.
With these advanced treatments, we’re able to give many people with severe migraines the relief they’re looking for. And with promising new types of migraine medication on the horizon, people with debilitating migraines soon might have even more options available.