A migraine is a headache so intense it can cause nausea, vomiting and sensitivity to light and sound. About 3 times more common in women than in men, migraines can last 4-72 hours. Nearly 12% of people in the United States experience migraines. The condition can be a challenge to diagnose and manage without expert help. We offer leading migraine treatment at The University of Kansas Health System in Kansas City.
Migraines affect 39 million people in the United States and up to a billion people worldwide. These severe headaches are most common among those aged 25-55 and tend to run in families. More than just a bad headache, a migraine is considered a neurological disease and carries with it serious symptoms. Often, warning signs – like visual disturbances and auras – precede the migraine itself. Migraines may occur in stages.
Properly treating a migraine depends upon accurately diagnosing it. Migraines are different from other headaches. They last longer than 4 hours and include at least 2 of the following:
- Moderate to severe pain
- Pain that's more intense on one side of the head than throughout
- Pulsating and/or throbbing
- Causing the avoidance of daily activities
The migraine must also meet 1 of the following criteria:
- Causes nausea and/or vomiting
- Causes intolerance of light and/or sound
Finally, the headache must not be caused by something else. This often presents the greatest challenge. Some red flags suggesting other causes are:
- Headaches with high fever
- Headaches in people who have cancer or are pregnant or immunocompromised
- Sudden onset of headache at age 50 or older
- Headaches that wake you from sleep, are worse when lying down or are associated with focal neurological signs
- Pain described as the worst headache of your life
These situations suggest the possibility of a tumor, infection or intracranial hypertension. For these cases, the interdisciplinary approach we practice can be valuable in determining the cause of pain.
Upon diagnosis, many patients benefit from these recommendations:
- Sleep at consistent times every day
- Get 6-8 hours of sleep each night
- Stay hydrated by drinking at least 6 glasses of noncaffeinated liquid per day
- Limit daily caffeine to 1-2 drinks per day
- Avoid processed foods
- Get regular, moderate exercise
- Keep a headache diary, noting length of the attack, days per month, associated symptoms and dietary or environmental triggers
Treatment options may include a variety of medications, including over-the-counter drugs containing aspirin, acetaminophen and caffeine. In some cases, steroids may be helpful. In others, Botox injections may be effective.
For patients who experience:
- More than 2 attacks per month that significantly affect daily activities
- Attacks more than 4 times per month
- Poor response to acute therapy
- Sensitivities or allergies to acute therapy
- Needing to use acute therapy more than 2 times per week
We will likely recommend preventive therapy, such as antihypertensives, antidepressants or antiepileptic treatments. Additionally, some patients find relief with relaxation training, acupuncture, massage, physical therapy or biofeedback conducted by a pain psychologist.
Botox® is one treatment innovation that shows tremendous promise. It has been approved by the FDA for preventive treatment of migraines. It is generally used for patients with chronic migraines, defined as headaches of more than 4 hours each occurring more than 15 days per month for greater than 6 months. The therapy entails multiple injections every 12 weeks and has been shown to reduce migraine frequency by an average of 8 days per month.
Another advanced treatment is FDA-approved Aimovig™. This preventive treatment of migraine in adults is an injection given once a month. It can be used for both episodic (4-14 migraine days per month) and chronic (15 or more headache days per month with at least 8 migraine days) migraines. It is an excellent option for patients who may not have found Botox effective, who prefer not to receive Botox or who do not experience enough migraines to qualify for Botox treatment. As compared to daily oral medication, Aimovig injections provide more flexibility for patients with limited side effects.
We also offer the innovative gammaCore™, a portable, handheld vagal nerve stimulator device. It allows patients to apply treatment at the first sign of impending migraine.
Learn more about our leaders in migraine treatment and research.