How to Treat Migraines, and When it is Time to See a Neurologist

As anyone who has experienced a migraine knows, it is much more than a bad headache. It can be a debilitating condition, making daily activities almost impossible and can sometimes leave you bedridden for hours or even days. Fortunately, there are lifestyle changes and treatments that can help manage your symptoms.

What is a migraine?

A migraine is a type of headache with severe throbbing or pulsating pain that usually affects one side of the head. Other symptoms may include nausea, vomiting and increased sensitivity to light, noise and odors.

Researchers are not sure what exactly causes migraines, but it may be the result of nerve-controlled inflammation of the dura, which is the membrane between the brain and the skull. Chemical changes in your brain and genetic factors may also play a part. Migraines can be triggered by a drop in estrogen levels (pre-menstruation), alcohol use, stress, cold weather fronts and sleep deprivation.

There are four phases of a migraine, although not everyone will experience all four phases and others may experience the phases simultaneously.

Stage 1: Prodrome. This stage usually occurs up to 24 hours before the attack and might include symptoms such as mood changes, trouble sleeping and difficulty concentrating.

Stage 2: Aura. Not everyone will experience this phase. It usually occurs between five and 60 minutes before the attack, during which time you may feel muscle weakness, vision changes and ringing in your ears.

Stage 3: Headache. The third phase is the actual attack, which can cause vomiting, severe pain and increased sensitivity to stimuli. This can last anywhere from several hours to several days.

Stage 4: Postdrome. After the headache phase, the final stage of a migraine can last up to 48 hours and may cause fatigue, neck stiffness and trouble focusing.

How can I treat migraines at home?

Migraine medicine and treatment options depend on the type and frequency of headaches you are experiencing. Some patients may benefit from lifestyle changes that minimize or eliminate the triggers of their migraines, such as establishing regular sleep hours, eating consistent meals, exercising regularly and managing stress. Other patients may be able to control their pain with over-the-counter medications. However, patients who consistently use over-the-counter medications for migraines can experience rebound headaches.

Should I go to a neurologist for migraines?

You might be wondering, “When is it time to see a neurologist for migraines?” If you answer yes to any of the following, consider scheduling an appointment:

• Do your headaches last for more than a day or two?
• Does your migraine medicine not provide relief?
• Do your headaches come on suddenly?
• Do your headaches cause changes in your vision?
• Is the headache pain worse when straining?
• Is your headache inhibiting your daily activities?

There are two types of treatment a neurologist can prescribe: acute treatment and preventive treatment.

“Acute migraine treatment is administered when the migraine is present,” said James Pacelli, MD, a neurologist with Penn Highlands Neurology. “Acute treatment can address the pain, side effects like nausea or the underlying triggers. A range of pills, nerve blockers and infusion therapy may be recommended by your provider.”

Dr. Pacelli continued. “Preventive migraine medication has also advanced considerably in the past few years. This can include infusion therapy, injectable monoclonal antibodies, nerve blocks and Botox injections.”

Everyone experiences migraines differently, and while each migraine is temporary, it is a lifelong condition. Your healthcare provider can help you manage the symptoms so that they are less intense and not as long. If you have been experiencing migraines and your current treatment plan is not working, talk to your provider.

Penn Highlands Neurology provides expert care to patients suffering from disorders of the brain and nervous system, including migraines as well as Parkinson’s, Alzheimer’s, stroke, MS, brain injuries, sleep disorders and much more. Penn Highland’s team of top neurologists is focused on providing high quality, consistent care that is close to home. For more information, visit www.phhealthcare.org/headaches.