Migraines Patient Education
Migraines – Patient Education Overview
Migraines are neurological disorders causing intense headaches and nausea. They are three times more common in women. One-third of sufferers have an aura (with sensory or visual impairment). Read more in our patient education guide.
There are usually triggers that can increase the incidence of migraines. They are:
- Hormone (estrogen) levels
- Sleep deficiency
- Food allergies
- Caffeine withdrawal
- Certain medications
Symptoms of a migraine can include one or several of the following:
- Tension headaches, usually one side of the head
- Pulses of pain, which can last 4-72 hours
- Sensitivity to light (photophobia)
- Temporary impairment of visual, sensory, or motor impairment
Doctors Who Treat Migraines – Patient Education
Initial migraine consultations with healthcare providers will most likely be with the physicians you have an ongoing relationship with. These can include:
- General Practitioner - Deals with prevention, discovery and treatment of illnesses in all age categories
- Internist - Focuses on diagnosis, treatment and prevention of adult illness
- Gynecologist - Deals with female health
- Gerontologist - Deals with senior or elder health
- Nurse Practitioner - Focuses on prevention, wellness and education of patients about health and health choices
Once the diagnosis of migraines has been made, a team approach may be established. The team typically consists of:
- Headache Specialist - Educates patients on how to alter their lifestyle and home environment to suppress migraines by:
- Pinpointing triggers and avoiding them
- Finding activities that decrease the risk
- Implementing coping methods (like biofeedback and meditation) to cope with pain
- Allergist - Specializes in the diagnosis and treatment of immune system diseases, allergic diseases and asthma. This doctor can isolate allergens or substances that causes reactions and can trigger symptoms including migraines.
- Nutritionist/Dietician - Devises meal plans that avoids food sensitivities responsible for headache attacks and which foods are helpful in decreasing the headache occurrence.
- Neurologist - Deals with the diagnosis and treatment of nervous system disorders involving the brain, spinal cord and peripheral nerves.
- Radiologist - A doctor who uses imaging techniques to diagnose and treat diseases seen in the body. The radiologist will rule out any causes of migraines such as aneurysms, tumors, growths and abnormal blood flow to the brain.
- Alternative/Complementary Practitioner - A physician who integrates conventional medicine with a focus on the interactions between the mind and body including yoga, acupuncture, meditation, deep breathing exercises, hypnotherapy, aromatherapy, herbs, guided imagery and tai chi.
- Anesthesiologist/Pain Management - Doctors who progress to specialize in treatment of pain, including trigger point injections, nerve blocks, pumps and oral medications.
- Physiatrists - Rehabilitation doctors who treat pain with therapy involving physical and occupational therapy, devising exercise plans to treat headaches. Some may also use medication pumps, nerve blocks and implant stimulators.
- Psychiatrists - Doctors who may offer behavioral therapies, hypnosis, biofeedback techniques and family or group counseling
How to Prepare for Your Migraines Doctor Visit
Having made your appointment with a healthcare provider, there are certain actions that you need to take in order to maximize the benefit of your migraine doctor visit. They are listed below in this patient education guide:
- Bring a diary of frequency and severity of headaches as well as anything that seems to bring them on.
- Bring a family history list and a past medical history list along with any medications being taken. This includes supplements or herbs.
- Prior to any migraine screening tests, inform the doctor if you:
- Have allergies to drugs, especially iodine dyes
- May be pregnant or have an IUD
- Have a heart problem
- Have asthma or other breathing problems
- Have claustrophobia
- Have diabetes
- Suffer from kidney problems
- Have a pacemaker or insulin pump
- Have Sickle Cell disease
- Have clotting problems or taking blood-thinners
- Arrange for transportation to and from the examination if sedation will be given.
Questions to Ask Your Doctor About Migraines
From your initial diagnosis throughout your treatment and care, you will have questions about your migraine headaches. This patient education guide lists helpful questions for you and your doctor to discuss so you can make informed decisions about your condition.
Question About My Diagnosis
- How can you tell whether this headache is a migraine or other type?
- Will the incidence of migraines increase over time?
- Can the headaches go away in the future?
- Can they be prevented?
- Will having migraines lead to other medical conditions?
Questions About My Treatment
- Are non-prescription medications sufficient for treatment?
- Are there prescription medications for prevention that I can take?
- What are the side effects of the drugs for migraines?
- Are there vitamins or herbs that can treat or prevent migraines?
Questions About My Lifestyle & Family
- What should I track in my headache diary?
- Can acupuncture, biofeedback and hypnosis help?
- Which exercises would help prevent headaches?
- Does smoking affect frequency of headaches?
- Is there a special diet that affects frequency or intensity of migraines?
- Do migraines run in families? What can they do to prevent them?
Common Tests or Labs to Diagnose Migraines
Migraine headaches are usually diagnosed on the basis of typical symptoms, medical history and physical exam. However, intense, atypical or sudden headaches will prompt the doctor to order additional tests to rule out other causes of the pain. Read more in this patient education guide.
|Sedimentation Test (ESR)||Indicates:*inflammation
|After a tourniquet is applied to the upper arm, the puncture site of skin is swabbed with alcohol pads and a needle punctures the skin. Blood is then drawn into a syringe for analysis.The test tube that received the blood is assessed in one hour. The more red blood cells that settle into the bottom of the tube, the higher the sedimentation rate and the higher the inflammation.|| Under Age 50(in mm/hr)
Over Age 50
|Lumbar Puncture (spinal tap)||Purpose is to:-Find symptom caused by infection (e.g. meningitis), cancer or hemorrhage
-Measure pressure surrounding the spinal cord
-Diagnose conditions of the nervous system (e.g. multiple sclerosis or Guillain-Barre syndrome)
-Inject pain medication into the spinal cord
-Inject therapeutic drugs to treat cancer and leukemia
|You will lie on the bed in a fetal position or leaning forward while sitting on a chair with head and chest tucked in toward your knees.The back is cleaned with alcohol and draped with sterile pads or towels. Local pain medication is injected into the site for puncture.
A long (spinal) needle is inserted into the spinal canal and once in place, the solid core of the needle is withdrawn. If no spinal fluid is obtained, another puncture site may be used.
A device called a manometer is attached to the needle measuring the CSF. After fluid samples are obtained, the needle is removed and the site is cleansed and bandaged.
|Color: clearPressure: 90-180 mm
WBCs: 0-5/mm cubed
Glucose: 60% of blood glucose
|Magnetic Resonance Imaging (MRI)||Looks for:-Hydrocephaly (water on the brain)
-Abnormalities of nerves to eyes and ears
-Pituitary gland problems
-Symptoms of head injury
-Blood flow, clots or active bleeding in the brain
-Signs of stroke
|You will be asked to remove all jewelry, dentures, clips, artificial limbs, braces, hairpins, hearing aidsYou will then lie on the table (possibly having received sedation) which slides into a tunnel-like space.
Earplugs or headphones with music may be given to mask the tapping noises during the scan.
If needed, contrast material may be given in the IV line inserted into a vein.
|No visualization of growths, tumors, bleeding.No signs of inflammation.
No abnormalities of the brain, nerves, and surrounding areas.
|CT Scan||Looks for:-Brain tumors,
-Abnormalities of sinuses
-Eye and optic nerve problems
-Auditory nerve and middle ear problems
-Abnormalities of facial, jaw and skull bones and joints
|You will be asked to remove jewelry, hearing aids and glasses.You will lie on a table and straps will be applied to your head to keep it steady. Sedation may be given.
The table slides into a round opening of the scanner, which then moves around your body, taking pictures. Buzzing can be heard during this process.
If contrast material is needed, it will be inserted into an IV in a vein (of the arm or hand)
The test takes 30 min.
|Images show no bleeding,No foreign objects, no tumors or growths, no fractures.
The skull, face, joints, jaw are normal in shape, size and position.
Common Medications and Treatments for Migraines
In addition to dietary and lifestyle changes, patients may need medication to help with pain and associated symptoms. Medication falls under two categories: symptom-reliving medications and preventative medications.
Symptom Relieving Medications
The following medications listed in this patient education guide provide relief from the symptoms patients experience with the on-set of a migraine.
How it Works
|Ergot||-Forms-pill, injection, nasal spray-Decreases pain|
|Triptans||-Decreases pain-Relieves light and sound sensitivity-Decreases nausea|
|Opiates||Narcotic to decrease pain|
|Corticosteroids||-Decreases pain-Decreases inflammation|
|Anti-nausea drugs||Decreases risk of nausea|
Preventive Therapy may be necessary if:
- Typical treatments in above chart don’t work
- Prolonged weakness and numbness
- Two or more attacks per month
Preventive medications decrease the frequency, intensity and length of migraines. It may also facilitate the effect of symptom-relieving drugs.
How it Works
|Beta Blockers||-Decreases intensity of headaches-Decreases frequency of pain|
|Calcium Channel Blockers||Decreases symptoms of the aura|
|Tricyclic Antidepressants||Affects serotonin level to decrease headaches|
|Botox||Decreases chronic headaches|
|Antihistamines||Alters serotonin levels to decrease headaches|
|Anti-Seizure Drugs||Decreases frequency of migraines|