Migraines: How to Treat Them

Millions of migraine sufferers do so needlessly
By Emma Weiskopf, M.D., and Kay Hanley, F.N.P – B.C. 

Migraine is the third most prevalent and sixth most disabling illness in the world, affecting some 39 million people in the U.S. alone. And yet, fewer than 20 percent of chronic migraine sufferers are being properly diagnosed and treated, which means that millions are needlessly enduring the debilitating effects of this widespread neurological disease. What feels like hopeless agony is actually highly treatable. That’s why primary care doctors and neurology specialists everywhere are stepping up efforts to diagnose and prescribe treatment for this often brutal, but quite manageable condition.

Anyone who has ever experienced migraines, or knows someone who has, is painfully aware of just how excruciating and incapacitating the attacks can be.  It’s not just one of those nagging tension headaches that goes away after taking a couple of ibuprofens. A migraine comes on hard and doesn’t let up, unfazed by over-the-counter pain relievers. It’s characterized by moderate to severe throbbing pain or a pulsing sensation, like an endless drumbeat, usually on one side of the head. The pain may worsen with activity, like walking upstairs. Migraines often are accompanied by nausea, vomiting, and extreme sensitivity to light and sound. About a third of migraine sufferers also experience what’s called an aura, with flashing lights or zig-zag lines, difficulty speaking, and weakness or some loss of sensation in parts of their body. Most migraines can last anywhere from four to 72 hours.

While most sufferers experience attacks once or twice a month, more than four million people in the U.S. have chronic daily migraine, with at least 15 migraine days per month. More than 90 percent of migraine sufferers are unable to work or function normally during the ordeal. Even performing the simplest physical task or trying to think clearly can be overwhelming.  The resulting lost work performance, lost pay, lost family and recreational time, and overall reduction in the quality of life greatly compound the distress of the disease.

Migraines, which are three times more prevalent in women then mem, tend to run in families. The condition sometimes presents itself during childhood, but most often in early adulthood. The headaches sometimes lessen later in life, but can strike at any time. While migraines can be triggered by a number of factors including alcohol, certain foods, caffeine, environmental causes such as temperature or pressure changes, hormonal changes, hunger, or lack of sleep, they are most commonly triggered by stress, as are tension headaches.

The key to treating a migraine is to act on it as early as possible, within 15 to 30 minutes of the onset of symptoms. A family of prescription-strength drugs called triptans has been specifically designed to treat migraines.  They come in pill form and are taken as needed as soon as the patient senses the warning symptoms.  The goal is to get rid of the migraine within two hours and not allow it to recur. Special injection treatments, performed by a primary care doctor or neurologist, also have been developed to prevent the onset of migraines in chronic sufferers.

So relief is at hand for people with migraines. It’s really a matter of properly diagnosing and treating them.  Studies have shown that approximately half of the people who experience migraines have never been diagnosed by a physician, and less than half of those who have been diagnosed use prescription medication to deal with the pain.

For those of us in the medical field, migraine is a disease that can appear more painful and debilitating than most anything else we encounter. But knowing pharmacological treatments are readily available to mitigate and end that suffering, we find it very rewarding to help patients emerge from their needless affliction and resume active, healthy lives.

Emma Weiskopf, M.D., and Kay Hanley, a board certified Family Nurse Practitioner, are migraine specialists with Neurology Professional Services at Berkshire Medical Center.