Migraine Headaches

What are Migraine Headaches?

Migraine headaches often affect one half of the head; they are pulsating in nature and last from 2 to 72 hours.  Associated symptoms can, but do not always include nausea, vomiting, increased sensitivity to light, increased sensitivity to sound and the pain is generally made worse by physical activity.  Up to one-third of people with migraine headaches have an aura which is a transient visual, sensory, language, or motor disturbance which signals that the headache will soon occur. Occasionally an aura can occur with little or no headache following it.

Migraines are believed to be due to a mixture of environmental, genetic factors and complications from some neurological diseases.  Two-thirds of cases run in families.  Hormone levels may also play a role, as migraines affect slightly more boys than girls before puberty, but about two to three times more women than men.  Migraines decrease during pregnancy.  The exact cause of migraines are not known.  It is  believed to be a neurovascular disorder. The primary theory is related to increased excitability of the cerebral cortex and abnormal control of pain neurons in the trigeminal nucleus of the brainstem.

Migraine ranks in the top 20 of the world’s most disabling medical illnesses. Amazingly, over 10% of the population, including children, suffers from migraine. Nearly 1 in 4 U.S. households includes someone with a migraine disorder. For some, they and not disabling, but for many, headaches and migraines are extremely disabling and interfere with the ability to carry out day-to-day life.

Migraines also have triggers and these may include foods we eat, different types of stresses including emotional stress, lack of sleep and physical stress.  Migraines are also triggered by pain in close by places, such as mechanical factors in the neck and spine, neck joint injury or arthritic disease, jaw pain such as TMJ, stresses on the eyes caused by straining vision and sinus pain.

Our Clinic provides Migraine Headache Therapy

The most effective treatment results when there is an effective partnership with the patient.   An effective partnership allows the treating doctor to address all causes and possible treatment of a patient’s migraine headache.  Therapy can be optimized through a management program that encompasses education, behavioral treatments, physical therapy, diet modification, treatment of sleep and anxiety as well as medication management.  Controlling migraine headaches involves two types of treatment, treating the pain of the migraines when they happen, and stopping the triggers or factors that lead to migraines.   Treating the pain when it happens allows you to live a normal life, but, preventative treatment the causes allows us to develop a life-long strategy to keep migraines from coming back, and, is the approach we prefer to take at ROI, through our coordinated team approach.  We do this through education and correction of all triggers

Acute treatment

Acute treatment most commonly involves the use of medications and reduction of factors that will aggravate the symptoms when a migraine occurs.  Sometimes we need to use an abortive drug to stop a migraine when it happens.  Numerous abortive medications are used for migraine. The choice for an individual patient depends on the severity of the attacks, associated symptoms such as nausea and vomiting, comorbid problems, and treatment response.

Simple analgesics alone or in combination with other compounds have provided relief for mild to moderately severe headaches and sometimes even for severe headaches.[84] Acute treatment is most effective when given within 15 minutes of pain onset and when pain is mild.[85]

Simple pain relievers Tylenol, NSAIDs, and narcotic analgesics (eg, oxycodone, morphine sulfate).   For more severe pain, a class of drug known as triptans and/or opioid analgesics are used, either alone or in combination with drugs such as Compazine.  The use of abortive medications must be limited to 2-3 days a week to prevent development of a rebound headache phenomenon.   Toradol is also an effective alternative agent for the relief of acute migraine headache in an urgent situation.   Triptans include drugs such as Sumatriptan, Rizatriptan, Frovatriptan etc and can be used orally, through nasal inhaler, injected under the skin or into muscle.   Triptans are most effective when taken early during a migraine.  There are novel combination drugs such as a triptan and an NSAID, Treximet.

Prevention Medications

Our prevention or approach of the treatment for migraines is to not only treat the symptoms using medications and common household interventions, such as reducing too much stimulation, including noise and light. Other investigations for the catalysts are to focus on identifying the triggers neurological disease or emotional stress if these are prevalent in an individual.   Medications to prevent migraines are generally divided into a class of beta blockers, calcium channel blockers, tricyclic antidepressants, standard SSRI antidepressants and seizure medications.   Botulinum toxin injections into the muscles that spasm with migraines are also an extremely effective technique to prevent migraines. Unfortunately, Botox is required every 3 to 4 months to be injected into the muscles of the skull in order to continue to prevent migraines. For those who respond to Botox, 70 to 100% relief is commonly reported after the successful Botox injection. These injections are performed routinely at ROI.  At ROI, however, we do not believe in lifetime use of Botox rather, it is a tool to reduce headache intensity while a more effective preventative strategy is developed as below.

Understanding and treating Triggers

Perhaps one of the most effective and satisfying approaches to treating migraine headaches is to understand the factors that either bring them on or make the body more sensitive to developing migraine headaches.   This is an area where ROI excels managing migraines as we feel that the best way to treat migraine is to keep it from ever happening again.

Following is a typical screening approach that the team at ROI uses to assess and treat any triggering or predisposing factors that might make a person develop a migraine in the first place.  Many of these factors are closely connected to each other, so is most effective if we start treatment of all of these factors together. In this way, when a person is treated correctly, they can graduate from our clinic with the tools needed to manage their migraines independently.


Sleep problems have been shown to both increase a person’s sensitivity to developing a migraine to studies that show that a bad night’s sleep can actually trigger a migraine.  The same has been shown with the treatment of chronic pain. One of the first steps in treating migraine headaches is to improve not just sleep duration but sleep quality.   One reason for waking with migraines is that REM sleep is most powerful just before awakening.  Sleep problems can then trigger migraines by causing instability of serotonin and a lowering of dopamine levels.  Antidepressants, specifically the selective serotonin reuptake inhibitors (SSRIs), may help stabilize serotonin membranes and block migraines. These medications are sometimes used as migraine treatment.

Sleep can be treated through a number of methods, medications, reducing stress, specialized sleep evaluations looking for sleep apnea and other causes for poor sleep

Neck problems

There is a significant connection between those who have upper neck pain and those who suffer from headaches. Those who suffer from migraines will generally experience greater migraines when their neck pain flares. Successful treatment of migraine headaches requires a careful assessment of upper cervical neck pain. This often involves special physical therapy exercises to stabilize the posture, looking at work and home ergonomics and sitting methods as well as improving how a person sleeps.   Sometimes injections in the neck can provide valuable diagnostic information as to the causes of migraine headache pain. This will also allow the medical team to understand the types of therapies that will be most effective.   Many people sit with poor posture particularly given more jobs at require long hours and computer and many workplaces often do not automatically assess ergonomics.  Chronic poor posture can lead to stresses in the upper cervical neck joints as well as chronic muscular strain and both of these are either a cause of headaches or a trigger for person already has a migraine problem

Anxiety and behavioral treatment

When we are anxious, we tense our muscles and when we tense our muscles then they become tight and stiff and the ends of these muscles, the tendons, will often become inflamed. Many people carry their stress and anxiety in their neck musculature and many of these muscles start under the skull and the upper cervical neck joints. When these muscles get inflamed, they radiate pain into the skull.  This pain can cause or trigger a migraine headache. Anxiety also interferes with sleep.  Some people that already have anxiety suffer from a problem known as hypersensitivity, which is when they are overly aware of every sensation in their body to such a degree that when they feel any change they experience a rush of anxiety and possibly a panic attack. Not all migraines cause headaches, and many may have other symptoms as well. That sensitivity may lead to severe anxiety, as the person is overly aware of the sensations and possibly experiences fear as a result.  Other behavioral strategies include more regular sleep patterns, improvement in diet, and the addition of an exercise program.  Patients should be encouraged to participate in behavioral modification programs that have been proven to be successful. These include cognitive-behavioral therapy, stress management, relaxation training, and biofeedback therapy.

Diet and Nutrition

It is well known that some foods may trigger migraines. There are a few different hypotheses on why such as different foods affect the release of certain brain chemicals which could lead to migraines, different types of foods cause different amounts of blood-vessel constriction or dilation which could lead to headaches and last certain foods directly stimulate specific areas of the brain leading to migraines.

Although studies are inconclusive, it is possible that some amino acids (the building blocks of protein) are linked to migraine frequency. Other compounds in food, both natural and artificial, can contribute to migraines including Tannins (found in tea and coffee), Sulfites (added to dried fruits and canned vegetables) and Nitrites (used as a preservative in processed meats like hotdogs).

There is a long list of possible food triggers including some common ones like chocolate, caffeine, sugar and Monosodium Glutamate (MSG). The variability of food triggers is huge and depending on the individual can range from different fruits and vegetables to dairy and alcohol. Keep in mind each person is unique and what may be a trigger for some won’t cause migraines in others.

A first step in discovering your food triggers is keeping a detailed food dairy including food, beverages, physical symptoms and meal timing. Once you discover a pattern between diet and migraines you may try eliminating the food from your diet to see if you have a reduction in symptoms.

Introducing calming, anti-inflammatory foods into your diet is also a good idea. Temporary inflammation is part of the healing process while long-term inflammation eventually harms the body and can cause health problems.  When a migraine comes on, various physiological processes start to happen which only adds to the overall inflammation in the body.  Fortunately, incorporating anti-inflammatory foods may help in the recovery process by reducing inflammation.  Eating foods known to decrease inflammation also promotes a calmer, less stressful state of being.  Since stress can trigger migraines, anti-inflammatory foods may help to prevent migraines.


Healthy exercise is a key to managing migraines.

The finding could help explain the links between sleep problems and migraines. It also should make it easier to find new drugs to treat migraines, researchers say.

We can be contacted for an appointment by clicking here or calling 425-394-1200 number to put you on the road to a healthy pain free life.

 Migraine Headaches

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