October 22, 2018
Margaret R. Frey, D.O.
Vice Chair, Department of Neurology at Memorial Healthcare
Director, Memorial Institute of Neurosciences, Muscular Dystrophy Association and ALS Clinic
Co-Director, Michigan State University Muscular Dystrophy Association and ALS Clinic
ABPN Board Certified Clinical Neurophysiology ABPN Board Certified Neurology
Migraine is a major health concern and source of disability worldwide aﬀecting about 20% of women and 10% of men. It is characterized by variable intensity of throbbing pain, which is often, but not always, severe. There are typically symptoms of sensitivity to light, odors, sound and motion as well as fatigue, nausea and sometimes vomiting. Migraine may occur with or without an aura which manifests prior to or during the pain and vary in form. Migraine auras are often visual with a kaleidoscope-like blind spot that is present when eyes are open and closed and seen with both eyes. The migraine aura may also produce confusion, speech diﬃculty, or stroke like numbness and weakness. Often patients will note tingling in the face or hands or blurred vision during migraines. Migraines usually last several hours, but may last days or weeks when severe and are often alleviated by sleep.
Migraine aﬀects people of all ages, but is most disabling typically in the adolescence and early adulthood from 15 to 40 years of age. Migraine suﬀerers often have a family history of the disorder or history of head injury. The family history is not always readily evident and is often misdiagnosed as sinus headache.
There are many treatment options for migraine management utilizing preventative and abortive medications. The term abortive refers to medications we use to make the migraine stop and preventative medications reduce the number of migraines a patient has overall.
Abortive medications include things like sumatriptan (Imitrex), rizatriptan (Maxalt), Migranal nasal spray, or pain medications. Use of abortive medications alone is recommended for patients with three or less migraines per month. For patients with four or more migraines per month a preventative medication is usually prescribed.
Caution must be taken with abortive or analgesic (pain) medications because taking them more than 3 days per week on average can lead to analgesic overuse headache. Analgesic overuse headache can be severe and will last for several months even after the medication has been stopped. This is often the underlying reason for gradually worsening intensity and headaches that are more frequent.
Over the counter dietary supplements can be helpful to reduce migraine as well. These include CoQ-10, riboflavin, and magnesium oxide. This is useful in patients who have relatively few migraines, to complement prescribed preventative medications or for patients trying to avoid prescription medications. These should be discussed with your primary care provider or neurologist to ensure they are safe for you. Peppermint oil has been reported to help some patients to abort or reduce the intensity of their migraines as well.
There are lifestyles modifications that can also help reduce migraine. Food triggers can be identified by keeping a food diary and writing down the foods eaten that day prior to the start of a migraine. Adequate sleep and hydration can also help to reduce migraines. Neck pain and tension are often migraine triggers and themselves can be addressed with physical therapy or stretching and relaxation techniques.
There are many diﬀerent types of preventative medications that are chosen to suit a patient’s particular health needs. This includes oral medications like topiramate (Topamax), propranolol (Inderal) and many others as well as injectable medications such as onabotulinum toxin A (Botox) and the newest available medication erunumab (Aimovig).
Botox and Aimovig are injectable medications used for patients with frequent or chronic migraine who fail to improve with oral treatments. Both of these medications are safe, eﬀective and well tolerated. Migraine is termed chronic when it is present more than 15 days per month, lasting more than 8 hours per day and has been such for over 3 months.
Botox is the same medication we use for cosmetic purposes to reduce wrinkles and this is what it is best known for. However, Botox has been used for chronic migraine treatment for over 10 years and has an excellent safety profile.
Aimovig was released to the United States market after FDA approval May 17, 2018. This is a first in class monoclonal antibody designed to block the CGRP receptor in the brain which is part of the migraine formation pathway. Aimovig is the first drug ever to be specifically designed for the prevention of migraine and did very well in the clinical trials leading to its FDA approval. Aimovig is a once monthly medication the patient injects themselves at home. Because Aimovig is so new to the market, direct experience with the use of this medication is yet to be had, though if it performs as well in the real world as it did in clinical trials it will be a powerful tool in our arsenal to control migraine and improve quality of life for our patients.
It is extremely important to have any persistent headache evaluated by your primary care physician and if appropriate a neurologist to ensure that other serious causes of persistent headache aside from migraine are not missed. If your migraines or headaches are changing in quality or diﬀerent than usual, this should be evaluated by your physician as well.
There are many treatment options for migraine. Whether your migraines are rare and occur only a few times per year or you have had a migraine every day for the past 30 years, we can help.
For more information contact the Institute at (989) 723-1390.