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Migraines 101: From Diagnosis to Treatment

Migraines—a neuro-inflammatory state of the brain—affect nearly 39 million people in the U.S. each year. To help us learn more about migraine triggers and at-home relief techniques, we spoke with Brad C. Klein, MD, a neurologist at Abington – Jefferson Health.

Q: How can you tell if you have a migraine or a headache?

Dr. Klein: Headaches typically represent just one symptom of a migraine. While tension headaches may go away with over-the-counter medicine, like acetaminophen or ibuprofen, migraines may be more difficult to control and have a few more characteristic symptoms like nausea, vomiting, fatigue and sensitivity to light. For example, someone with a migraine may prefer to be in a dark quiet room and may be less inclined to go up and down the stairs. These are just a few of the more common symptoms.

Q: How are migraines diagnosed clinically?

Dr. Klein: The difficulty with diagnosing migraines is that symptoms are not necessarily visible to others because they affect the brain, and people may not want to talk about how they are feeling. As a provider, the real challenge is getting the right information. Unlike diabetes where elevated sugar levels or blood pressure give healthcare providers data about the condition, migraines are a bit more difficult to pinpoint. If you’re not sure if you should seek medical care, err on the side of caution. Ask yourself:

  • How frequent are my headaches?
  • On a scale of 1 to 10, how severe are my headaches?
  • How long do my headaches last?
  • Do headaches interfere with my everyday activities?

If your answers range anywhere from one headache or more a week and are inhibiting you from doing daily activities, speak with a healthcare professional.

Q: Are there different levels of migraine management?

Dr. Klein: There are three levels of migraine management. The most conservative approach is understanding and adjusting your environmental triggers, and from there we may move to rescue medicines and preventive care.

With environmental triggers, we emphasize ways to identify patterns in what triggers your migraines and figuring out ways to mitigate those triggers by responding differently—otherwise known as biofeedback training. For example, stress is a common trigger for migraines. Sometimes the solution for a stress trigger is to remove yourself from the stressful environment. But you could also train yourself to respond to stress differently, such as going into a meditative state. In a meditative state, our nervous system changes in a positive way. Instead of engaging the “fight or flight” response when we encounter stress, with the right breathing techniques and meditative practices, you can engage the “rest and digest” response and calm your body and brain down.

If you don’t find behavioral modifications helpful when treating migraines, the next two levels pivot to a medicated approach. Because migraines involve neuro-inflammatory chemicals in the brain, we can use “rescue medications” to stop that process. These rescue medicines vary depending on your specific migraine symptoms and needs, ranging from anti-inflammatory to neuro-anti-inflammatory, anti-nausea and more. If needed, we can use the third level of treatment and add a preventive medication like Botox or nortriptyline to prevent migraines from happening in the first place.

Q: How can you lower your overall migraine risk profile?

Dr. Klein: Because migraines are typically genetic, we cannot cure them. So when dealing with migraines, our approach is to manage and empower—starting by taking a holistic view of your lifestyle. Is your job causing you stress? Are your headaches caused by changes in hormone levels during menstruation? Are you dehydrated? Are you not sleeping well? These are just a few of the questions to ask yourself about your day-to-day lifestyle.

Now let’s take a look at another important factor: eating a well-balanced diet. This is critical to migraine management. Processed foods, alcohol consumption, caffeine intake and food with nitrates can play a role in migraine development. Fun fact: Chocolate is not a trigger. Actually, chocolate is a common craving people may have right before a migraine develops. Thus, chocolate might actually predict them.

Q: Is there a connection between COVID-19 and migraines?

Dr. Klein: Each person has experienced COVID-19 in their own unique way. On one hand, some people have been debilitated by their migraines for so long that lockdown didn’t feel that much different than their lives pre-pandemic. Conversely, those restricted to being home have been exposed to familial, financial and job stress, all of which increases their migraine risk profile.

COVID-19 has certainly played a role in migraine development and management, but there are still ways to adapt and cope with this “new normal.” For example, having good sleep hygiene significantly decreases your migraine risk profile. If you are working from home, or work predominantly on an electronic device, make sure that your screen is at eye-level to prevent neck tension. Your screen size should be large enough to avoid any eye strain and be sure to shut down your devices at least two hours before you go to sleep. Also, if you wear glasses, make sure they aren’t too tight. Sometimes the tension of the frames can actually compress the arteries and nerves, which cause migraines. So just grab some wider frames and you might be good to go.

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