Migraine headache is a very common and debilitating condition affecting many Americans yearly. Approximately 18% of women and 6% of men have had at least one migraine attack in the previous year. Migraine headaches result in significant impairment in a multitude of aspects such as: work performance, social activities, and family life. The World Health Organization (WHO) has listed migraine headaches as one of the world’s most disabling medical illnesses.
The phases of migraines
Migraine symptoms can be variable depending on the patient. The presentation of migraines can be described by certain phases: “premonitory,” “aura’’ and “resolution” phases.
Premonitory symptoms occur hours to days before onset of headaches. Those symptoms include depression, cognitive dysfunction, food cravings, fatigue, difficulty concentrating and neck stiffness.
The migraine aura consists of focal neurological symptoms that precede, accompany, or follow (rarely) a migraine attack. Aura symptoms typically lasts less than an hour and can result in visual, sensory, and/or motor manifestations.
The headache phase can vary in frequency, duration and location. The typical headache is unilateral, throbbing and worsened by movement.
The resolution phase occurs after the headache, and the patient may experience fatigue, mood changes and difficulty concentrating.
Migraine treatment plans
Establishing a diagnosis is essential in regards to developing the most appropriate treatment plan. Patients should discuss with their primary care physicians if there is suspicion for possible migraine headaches. Once a diagnosis of migraine headache has been established, discuss testing various medications with your doctor at that time in addition to requesting a consultation with an interventional pain management specialist for further evaluation. During that consultation, patients can also be evaluated for other causes of headache pain.
An interventional pain management physician can also discuss botulinum toxin administered by intramuscular injection as a potential preventative modality for migraine headaches. Patients who have not responded adequately or are intolerant of commonly prescribed oral migraine treatments may consider botulinum toxin injections. Botulinum toxin is administered to at least 31 injection sites across seven head and neck muscles. Treatment should be repeated every three months.
If you are suffering from any of these conditions, make an appointment with a pain management physician to find out what treatment is best for you.
Learn more about pain management at Ochsner.