By Wendy Levinson, Tufts Medical Center Staff
About one out of seven Americans suffer from migraine headaches. According to the National Institutes of Health, migraine and headache are leading causes of outpatient and emergency department visits and remain an important public health problem, particularly among women during their reproductive years. While research has not shown migraines to be dangerous, they are a significant cause of disability. Migraine headaches usually present with throbbing pain on one or both sides of the head, often at the temples or behind one eye or ear. Light and sound sensitivity, nausea and vomiting can accompany migraines. Women are more likely to have migraine headaches than men. For some, the pain can last for hours, even days.
“Many emergency departments aren’t set up to handle headaches, so often there’s no benefit for people with severe headaches to wait long hours in a noisy ED,” says Stephanie Goldberg, MD, Headache Specialist and Neurologist at Tufts Medical Center. “It’s critical to educate headache patients about their unique condition and what lifestyle changes, coping strategies and treatments might help.”
Researchers believe a migraine is a neurological disorder involving nerve pathways and brain chemicals. While migraine often runs in families, experts say the environment can trigger the pain. These include stress, bright or flashing lights, loud noises and strong smells. Skipping meals or getting too little or too much sleep can also prompt a migraine, as can the change of seasons.
“Some patients are at wit’s end when they see me,” noted Dr. Goldberg. “Headache specialists need to be good listeners in order to understand the type of headache someone is having and get them started with treatment.”
Promising new therapy
While there is no miracle headache drug, a number of advances in the past decade or so have made it easier to halt migraine. A class of drugs called Triptans can successfully treat moderate to severe migraines when taken at the first sign of pain. In addition, in 2018 a new class of medications, known as monoclonal antibodies against calcitonin gene related peptide (CGRP), came on the scene, with the first such drug, an injectable called Aimovig, approved by the US Food and Drug Administration (FDA). The medication blocks CGRP, a protein fragment overproduced in people with chronic migraines. In 2019, the first oral form of CGRP, brand name Ubrelvy, was FDA approved. Dr. Goldberg notes, that while promising, these new drugs aren’t right for everyone.
“There’s no one size fits all when dealing with headaches. Some find immediate relief with certain medications, lifestyle changes or coping strategies while others don’t find any,” said Dr. Goldberg. “Unfortunately, many of these medications also come with side effects.”
Although most of Dr. Goldberg’s patients have migraines, not every severe headache is a migraine. Cluster headaches, more rare, can also be very debilitating.
Another kind of headache develops from using too much over the counter or prescribed pain medicine. Dr. Goldberg warns about using these daily to relieve symptoms because they could make the underlying headache worse.
Her advice is to find out the kind of headache you have and start trying different treatments to get relief.
To make an appointment with a headache specialist at Tufts Medical Center, call 617-636-5848.
Updated: January 2020
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