Dr. Pooia Fattahi, a board certified neurologist in Waterbury, Connecticut, took some time to talk with us about migraine types and treatments. Dr. Fattahi and his physician practice, Waterbury Neurology, have been affiliated with Chase Medical Research since 2013. He and his partners, Drs. Kenneth Kaplove and David Tkeshelashvili have been physician investigators on a number of research studies with Chase Medical Research.
Here is just some of the great information that he shared with us about migraines and their treatments -
A headache is not always just a headache. There are types of headaches that require different types of treatment. The primary headache types are tension, migraine, trigeminal autonomic cephalalgias-and other. Migraine headaches, a particularly debilitating type of primary headache, have different subtypes.
In this post, I'll explain more about the types of migraine headaches and potential treatments.
A migraine headache is a common, but disabling, headache disorder that ranks as the third most prevalent disorder worldwide. In fact, migraines are the seventh-highest specific cause of disability in the world.
A patient suffering with migraines can have a migraine without aura, migraine with aura (and there are different types of auras), migraine with weakness or numbness in a certain part of the body, chronic migraine or status migrainosus.
1. Migraine Without Aura
A migraine without aura lasts between 4-72 hours and presents with some or all of certain characteristics. Those include throbbing pain on just one side of the head, increased intensity during physical activity, nausea and/or vomiting, and sensitivity to light or sound. This type of migraine accounts for up to 80% of all migraines.
2. Migraine With Aura
A migraine with aura is less common, and is accompanied by aura “signals” that let the patient know the migraine is present. Visual aura symptoms vary, but can present as blind spots in the field of vision, the appearance of zigzag patterns in the patient’s sight, the presence of flashing lights and in some extreme cases, hallucinations. Other aura symptoms can occur in the motor functions, speech center and olfactory senses. These symptoms usually occur about a half an hour before the pain begins, but can continue during the migraine itself.
3. Migraine with Brainstem Aura
A rare form of migraine, migraine with brainstem aura, or MBA, presents with aura that consists of sensory, speech/language and/or visual symptoms with at least two of the brainstem symptoms of tinnitus, vertigo, dysarthria, hypoacusis, diplopia, ataxia or loss of consciousness. This migraine type is also classified by two or more of the following symptoms:
- One or more aura symptom spreads slowly over five minutes or so, or two or more symptoms occur subsequently.
- Each aura symptom lasts 5 minutes to an hour.
- At least one aura symptom occurs on one side only.
- The aura is followed by or accompanies a headache.
This is the rarest form of migraine with aura.
4. Other Migraine Types
Two other types of migraines also exist. A chronic migraine is a headache that has a frequency of at least 15 occurrences per month for a three month or longer stretch, with at least 8 of the monthly headaches possessing characteristics of a migraine. A Status Migrainosus is a migraine that lasts longer than 72 hours. This type of migraine often occurs with overuse of medication.
Even though there are many different types of migraines, the treatment is generally the same across the subtypes. The American Academy of Neurology recommends certain treatments in the form of medication.
1. Anti Seizure Medications
Topamax, Depakene and Depakote are three anti seizure medications that are often prescribed for migraine sufferers. They are taken as a preventative to ward off headaches, rather than a drug to treat a symptom. In one study, it was shown that this type of drug treatment reduced the frequency of migraines by half in 50% of the patients in the test group.
2. Beta Blockers
Also used to prevent migraine occurrences, beta blockers like Lopressor, Toprol- and Inderal are prescribed with about the same success rate as the anti seizure medications. Patients taking a beta blocker should avoid grapefruits and grapefruit juice, as they can interfere with the body’s absorption of the medication.
There is also evidence that antidepressants are effective for the treatment of migraines. Medications like nortriptyline and amitriptyline have shown in studies to possibly be effective in preventing migraines. Doctors will often prescribe these medications "off-label" as a treatment and preventative medication for migraines.
4. Acute Treatments
Medications used to combat the symptoms of a migraine after its onset include triptans, which are serotonin receptor agonists that constrict the blood vessels in the brain. Other acute migraine treatments include over the counter and prescription pain medication, and in severe cases, corticosteroids.
When to Seek Urgent Care
It is important to talk to a neurologist about whether a head MRI or CT Scan should be performed to rule out a tumor or a space occupying lesion. These tests cannot “see” a migraine, but they can rule out other causes for headache. Imaging is usually recommended when the patient gets headaches every day or has a headache so severe that the doctor suspects there is a different underlying cause for pain.
Alternative Treatments for Headaches
The FDA has recently approved Botox as a treatment for chronic migraine. Botox is injected in specific sites including the neck, forehead, and temporal region of the head.. So far, studies have shown that the patient will start to experience relief soon after the injection with the most effect after the third round of treatment, and can see a 50% reduction in headache days. The patients studied also experienced less severe headaches when migraine occurred.
Another new treatment is Cefaly, a headband device that sends an electric current into the skin to stimulate nerves. It is too soon to tell if it is an effective therapy, but certain migraine experts are encouraged by the development of treatments that are new and innovative.
What to Expect from Migraine Treatment
Patients should understand that treatment results vary, and they can take time to develop. Each patient is different, so it is important to communicate with the physician to develop a personalized, comprehensive treatment plan. Patients should also track their headache frequency and severity, as well as their medication intake, and share that with their physician.
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