Migraine, the number two cause of disability in the world, affects nearly one in four U.S. households and has the potential to severely impact the sufferer’s quality of life. Yet, migraine is often misunderstood as ‘just a headache,’ and some sufferers lack adequate support and empathy from healthcare professionals, their family or even employers.
“A migraine attack is a headache along with other debilitating symptoms that last at least four hours and can go up to 72 hours,” said Abby Metzler, MD, a neurologist with University of Minnesota Physicians (M Physicians). “In addition to a headache, migraine attacks can also cause nausea or vomiting, or sensitivity to light and sound. A migraine attack affects someone’s ability to think and function and worsens with routine physical activity, like going up and down stairs.”
Migraine attacks aren’t a one-time event and typically happen the same way each time, with certain emotional states, diet or events acting as triggers. After five occurrences, a physician may officially diagnose a migraine attack.
“About one-third of people with migraine experience migraine with aura,” Dr. Metzler said. “Aura is a neurological disturbance that leads to a headache and other symptoms, including seeing zig zag lines, flashing lights, blind spots, numbness, tingling or more.”
Dr. Metzler looks for several features when evaluating someone for secondary causes of headache, or headaches that are not caused by a headache disorder itself. The acronym “SNOOP4” can be used to review signs that might require more investigation:
Systemic signs – fever, weight loss, history of cancer
Neurological exam abnormalities – facial drooping, weakness, numbness or other neurological sign that isn’t typical for the person
Older than 50 – developing new headaches after age 50
Onset is acute – pain level goes from zero to 10 in less than a minute; Someone experiencing a headache that comes all of a sudden and is very severe should go to the emergency department
Pattern change – change in frequency, intensity, or symptoms usually associated with someone’s headaches
Progressive – getting worse despite treating it how they normally do
Positional – headache only when standing up or laying down
Precipitated by valsalva – only happens with bearing down, coughing, or sneezing
For those who are diagnosed with migraine, a modified lifestyle may help reduce the number of triggers or attacks, sometimes in combination with medications. Maintaining a healthy sleep schedule, exercise, diet and stress management can sometimes help, along with keeping a diary of symptoms. While these strategies might reduce migraine and symptoms, there’s no way to truly prevent one.
“It’s important to note that people with migraine do not cause their migraine attacks, which are caused by a genetic neurological disorder,” Dr. Metzler said.
Thankfully, there are a host of novel acute and preventative treatments available for patients suffering from migraine attacks. A new class of drug called CGRP (calcitonin gene-related peptide) inhibitors are approved for migraine prevention and include erenumab, fremanezumab, galcanezumab and eptinezumab.
“They are monoclonal antibodies and are administered via monthly injections, except eptinezumab, which is administered via an infusion every three months,” Dr. Metzler said.
Another emerging preventative option for chronic migraine is Botulinum Toxin (Botox) injections. People who use this method receive a set of injections over the head, neck and shoulders every 12 weeks.
As soon as someone realizes they have a migraine attack, they can take rimegepant and ubrogepant, CGRP inhibitor pills that treat migraine. They also have the option to take these pills daily for prevention. Finally, there’s lasmiditan, a serotonin agonist pill that treats migraine when it occurs.
“It may be a good option for patients who cannot take triptan medications,” Dr. Metzler said.
Patients can find out which option is right for them through the M Health Fairview Headache Care Program, which incorporates expertise and emerging research from the University of Minnesota Medical School Department of Neuroscience. Dr. Metzler, who practices at the M Health Fairview Clinics and Surgery Center - Minneapolis in the Neurology Clinic, integrates a team of multidisciplinary physicians into the care process to provide the right treatment backed by cutting-edge science.
“There’s a huge lack of headache care in the country, and there are not a lot of physicians who have specialty training. So, there’s a huge need, and not all patients are being offered treatment,” Dr. Metzler said. “It’s an exciting time to be in headache medicine because there have been so many updates in the last decade.”
Read this 5Q to learn more about migraine symptoms and treatment.