Migraines are painful, often debilitating headaches usually accompanied by nausea, vomiting, and light sensitivity. Migraine treatments include a combination of pain relievers, anti-nausea drugs, and/or preventive medications and treatments, including neuromodulator injections to the forehead and neck and shoulders.
What is a migraine?
Migraine is a chronic neurological disease that manifests in long lasting, moderate to severe headaches that occur weeks or months apart. Migraine causes are not known, although they are associated with telltale symptoms affecting the autonomic nervous system. According to the Migraine Research Foundation, migraines affect about 10% of the population – and nearly 1 in 4 U.S households includes someone who suffers from migraine headaches. Roughly 1 in 5 women and 1 in 15 men are affected.
The National Health Service of the U.K. lists migraines amongst the top 20 health conditions notorious for causing severe pain.
Symptoms of migraine headaches
A migraine headache usually affects one side of the head and the pain is often described as “pounding”. Associated migraine side effects can include nausea or vomiting, and sensitivity to light, sound, or smell. Here are the 4 phases of migraine (not all people experience all phases):
- Prodrome: symptoms of hyperactivity or depression, which occur hours or days before the headache
- Aura: visual or auditory disturbance, which immediately precedes the headache
- Pain phase
- Postdrome: feelings of exhaustion or elation after the headache
A migraine can last from 2 to 72 hours.
What causes migraines?
Genetics: Approximately 2/3 of migraines are known to run in families. This genetic relationship is stronger for migraines with aura than for migraines without aura.
Triggers: A migraine sufferer may encounter a trigger about 24 hours prior to the onset of symptoms. Following are some common migraine triggers:
- Stress, hunger, and fatigue – the most reported migraine triggers.
- Extreme physical exertion can cause migraine in some people.
- Sleep disturbances caused by insomnia, shift work and jet lag can trigger a migraine and increase the frequency and severity of the condition.
- Psychological stress (reported by 50 – 80% of people).
- Post-traumatic stress disorder and past abuse are associated with migraine.
- Hormonal influences, such as menstruation, oral contraceptives, and perimenopause, are associated in migraine without aura, and migraines usually diminish during pregnancy.
- 12 – 60 % of people report foods as migraine triggers.
- Air quality and lighting may be a factor.
Treatment for migraines usually starts with pain relievers such as ibuprofen and acetaminophen, anti-nausea medications, and the avoidance of triggers. Stronger pain killers such as triptans (e.g. Imitrex, Maxalt, Zomig) or ergots (usually a combination of Ergotamine and caffeine), may be used if needed.
Other medications used to prevent migraine attacks include: anti-seizure medications (e.g. Topamax and Depacon), antidepressants and beta blockers.
A relative newcomer to the list of medications used to treat migraines is Botox.
Neuromodulators for migraines
Neuromodulators have also been shown to be helpful in treating and preventing chronic migraine headaches in adults. Anti-Aging Medical & Laser Clinic in Vancouver BC, Canada, administers neuromodulator treatments for migraine. This treatment for migraines was first approved in July 2010 by the Medicines and Healthcare products Regulatory Agency (MHRA). It’s been shown to be effective for both migraine and cluster headaches (an equally severe headache pattern with slightly different symptoms).
In the mid-90s, according to the Migraine Trust Fact Sheet, patients using neuromodulators for other reasons noticed an improvement in their headache symptoms. Several clinical trials followed to assess whether neuromodulators were the cause of reduced migraine symptoms.
The most positive study was the Phase 3 Research Evaluating Migraine Prophylaxis Therapy or PREEMPT trials. In the trials, 1384 people with chronic migraine headaches were treated with either neuromodulators or placebo. The neuromodulator patient group suffered 20 days of headache each month (on average). Those receiving neuromodulators were given injections every 12 weeks for 56 weeks. At six months, the neuromodulator patients reported having 8 fewer days of headaches each month, and, after 12 months, 70% of those treated with neuromodulators had approximately 50% fewer the number of headaches.
The migraine study concluded that neuromodulators (Onabotulinumtoxin) “resulted in significant improvements compared with placebo in multiple headache symptom measures and significantly reduced headache-related disability and improved functioning, vitality and overall health-related quality of life. Repeat treatments with onabotulinumtoxinA were safe and well tolerated.”
- Neuromodulators are most effective for those who suffer 6 or more migraines per month.
- Treatments involve neuromodulator injections into the muscles of the affected areas of the head and neck.
- Most people need neuromodulator injections every 12 weeks and treatments can be reduced to twice per year.
More about migraine treatments
If you have questions about migraines, contact our private medical clinic in Vancouver, BC.
Learn more about migraine treatments.
Dr Frame and his staff have changed my life! I suffer from debilitating migraines. In November 2012 after a 16 day migraine I went to see Dr. Frame about neuromodulator injections to relieve my migraines. Dr. Frame was thorough and extremely knowledgeable about the topic, and he took time with me during the consultation. I was nervous the first time but they held my hand and it all went well. The next day I woke up with out a headache for the first time in for as long as I can remember!! I still get migraines but they are now a headache which I can cope with. I no longer loose days or weeks of my life. Thank you Dr. Frame!