Migraine Awareness

June is Migraine Awareness Month and as a Certified Headache Specialist it is important to me to spread awareness about this disabling Neurologic condition. I have worked at the University of Colorado Headache and Facial Pain Clinic for the past 7 years and have seen hundreds of patients struggling with chronic migraine and facial pain syndromes, often for decades before getting a proper diagnosis or the right treatment. Unfortunately, fewer than 5% of those with migraine have been seen by a healthcare provider, received an accurate diagnosis and obtained appropriate care. 

Migraine is not “just a headache,” it is a disabling Neurologic condition that is characterized by severe pain and multitude of other possible symptoms. Migraine is one of the top 10 most disabling medical illnesses on earth according to the World Health Organization and it impacts people during their most productive years of their life. Migraine impacts 27 million men, women and children in the US and 148 million people worldwide. Migraine is 3x more common in women than in men. And one more statistic that really deserves attention: migraine costs for than $20 million each year in the US due to direct medical expenses and lost productivity. 

Migraine Basics

A migraine attack is classically defined as a moderate to severe, unilateral headache with pulsating characteristics that is accompanied by nausea and light and sound sensitivity. However, it can be much more than this and symptoms vary from person to person. Some people experience debilitating dizziness, vomiting, visual disturbances, mood changes, sensitivity to smells, fatigue and more. Some individuals experience an aura preceding the migraine attack which commonly consists of  visual disturbances such as bright sparkly lights and spots in the visual field but can also consist of numbness, tingling, weakness, ringing in the ears and more. 

Episodic migraine is when there are defined attacks that occur 14 days or less per month and chronic migraine occurs 15 or more days per month, and can often be daily. 

Treatment Basics

Acute treatment or rescue medication is taken at the onset of a migraine attack. The goal is to take it as early as possible to abort the migraine attack. These include the classical migraine medications or the “triptan” family, the newer rescue medications such as nurtec, ubrelvy and reyvow as well as over the counter medications like excedrin, tylenol, ibuprofen/aleve. There can be too much of a good thing and for the most part treatment with rescue medications more than 10 days per month over several months can lead to what is called Medication Overuse Headache or a rebound type pattern. 

For patients who have chronic migraine or even high frequency episodic migraine where attacks are interfering with their daily functioning, it may be recommended to start a preventive medication. Traditionally migraine was treated with medications borrowed from other medication classes such as: blood pressure medications, anti-seizure medications and antidepressants. Now we have newer medications such as Botox (approved in 2010) and the calcitonin gene related peptide (CGRP) antagonists that come as a once a month injection, every 12 weeks infusion, and most recently, an oral pill that are migraine specific therapies. 

There are also a handful of devices on the market that are nerve stimulator type devices that can be used for prevention or acute rescue use for a migraine attack. 

As part of Migraine Awareness Month, next week we will cover an Integrative Approach to Migraine Treatment and discuss supplements for migraine prevention as well as lifestyle factors that can make a big difference! For more information on Migraine Awareness, to learn more or get involved, visit Miles for Migraine to find an event near you or virtually. There is a Denver Miles for Migraine 5k to raise migraine awareness locally coming up on July 29!

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