Migraine Update | by Jennifer L.W. Fink

Dizzy symptoms

Posted on Sun, Nov 4, 2012

Are you one of the 29.5 million migraine sufferers in the United States? Migraine headaches cause more “lost days” – from work, from any kind of meaningful engagement with life – than almost any other diagnosis, especially when considered over the context of a lifetime.

If migraine headaches steal your joy in life, read on for a quick round-up of the most common migraine treatments. Whatever you do, don’t give up. “Every year, a new treatment or new information comes out,” says Dr. Cori Millen, a headache specialist with BlueSky Neurology in Englewood. “Right now is kind of a big time for migraine headache treatment.”

Lifestyle Changes

Many – if not most migraines – are related to some sort of environmental trigger. Are you getting enough sleep? Under significant stress? Overweight? Addicted to caffeine? It might be time to make some simple changes.

Begin by sitting down with a qualified physician. He or she should discuss your lifestyle with you; perhaps, you’ll be asked to fill out a questionnaire about your habits. That information can help the doctor suggest simple lifestyle modifications that might make a big difference.

Caffeine, for instance, affects pain receptors. Decreasing your caffeine intake might make you less susceptible to headache pain messages from the brain. Decreasing your body mass index (BMI) if you’re overweight can decrease the frequency of your headaches.


Most people with migraines already know that there are two types of migraine medication: preventative therapy, which is taken daily to decrease headache severity and frequency, and abortive therapy, which are meds that are taken as soon as a migraine headache comes on. The goal of abortive therapy is to “abort” the headache before it becomes severe.

The trick is finding the right combination of meds that works for you. “Treatment is very patient specific,” Millen says. “There’s a whole range of approaches. Which one we select depends on what’s important to the patient.”

Bottom line: If your headaches aren’t controlled on your current regimen, or if you’re suffering unpleasant side effects as a result of your migraine meds, see your doctor. It might be time for a new prescription.


Best known as a wrinkle reducer, Botox® (botulism toxin A) is now FDA-approved for the treatment of migraines. The exact mechanism of its action is unknown, but it’s believed that the medication works on pain receptors.

Botox® injections must be given by a trained practitioner. According to Dr. Millen, the injection takes approximately one to two weeks to become fully effective. Patients typically experience relief for 10 to 12 weeks before the effect wears off. Botox injections can be repeated approximately every 12 weeks.

Surgical Techniques

Scientists and physicians today are using (and researching) a variety of surgical techniques to treat migraines. Some of the most promising include:

Occipital nerve stimulation – An electronic unit is implanted into the brain, near the occipital nerve. The unit releases electrical impulses which stimulate the occipital nerve and may decrease headaches. It is not currently approved by the FDA for the treatment of migraines; however, a phase 3 study is underway and may lead to FDA approval.

Migraine trigger release surgery — Some physicians believe that migraines are caused, in part, by the constriction of muscles around sensitive nerves, known as “trigger points.” According to a study published in Plastic and Reconstructive Surgery, 88 percent of patients who underwent surgical deactivation of targeted trigger sites reported at least a 50 percent reduction in the frequency, severity and duration of their migraine headaches up to five years later.

Patent foramen ovale (PFO) repair – Some docs believe that closing the PFO, a vestigial “hole” between the two upper chambers of the heart, may decrease the frequency and severity of migraine in some patients. BlueSky Neurology is currently recruiting patients for a new, national study to assess the use of a mechanical PFO occluder.


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