When to See a Pain Management Doctor
Migraine headaches are often undiagnosed and untreated. If you regularly experience signs and symptoms of migraine attacks, keep a record of your attacks and how you treated them. Then make an appointment with your doctor to discuss your headaches and decide on a treatment plan. Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different.
Medications can help reduce the frequency and severity of migraines. If treatment hasn't worked for you in the past, talk to your pain management doctor about trying different migraine treatment including invasive procedures to relieve the pain or even undergo required surgery.
See your doctor immediately or go to the emergency room if you have any of the following signs and symptoms: An abrupt, severe headache like a thunderclap. Headache with fever, stiff neck, rash, mental confusion, seizures, double vision, weakness, numbness or trouble speaking. Headache after a head injury, especially if the headache gets worse. A chronic headache that is worse after coughing, exertion, or straining.
Symptoms
Migraine headaches often begin in childhood, adolescence or early adulthood. Migraines may progress through four stages — Prodrome, Aura, Attack and Postdrome — though you may not experience all the stages.
Prodrome
One or two days before migraine, you may notice subtle changes that may signify an oncoming migraine, including: Hyperactivity, Irritability and Neck Stiffness, Depression, Food Cravings, Constipation, Diarrhea.
Aura
Most people experience migraine headaches without aura. Auras are usually visual but can also be sensory, motor and verbal disturbances. Each of these symptoms typically begins gradually, builds up over several minutes, then commonly lasts for 10 to 30 minutes. Examples of aura include: Visual phenomena, such as seeing various shapes, bright spots or flashes of lights. Vision loss. Pins and needles sensations in an arm or leg. Speech or language problems.
Attack
When untreated, a migraine typically lasts from 72 hours, but the frequency with which headaches occur varies from person to person. During a migraine, you may experience: Pain on one side of your head. Pain that has a pulsating, throbbing quality. Sensitivity to light, sounds and sometimes smells. Nausea and vomiting. Blurred vision. Lightheadedness, sometimes followed by fainting.
Postdrome
The final phase — known as postdrome — occurs after a migraine attack, when you may feel drained and washed out, though some people report feeling mildly euphoric.
Migraine Headache Triggers
Whatever the exact mechanism of the headaches, a number of things may trigger them. Common migraine triggers include:
Hormonal Changes
Fluctuations in estrogen seem to trigger headaches in many women with known migraines. Women with a history of migraines often report headaches immediately before or during their periods. Hormonal medications such as oral contraceptives may also worsen migraines.
Food
Some migraines appear to be triggered by certain foods. Common offenders include alcohol, especially beer and red wine; aged cheeses; chocolate; aspartame; overuse of caffeine.
Post-Traumatic Headache
Triggered by significant head trauma or injury to the head or neck. The accompanying muscle contraction and vascular changes compounded by emotional reactions may rise to a vascular headache that can pulsate.
Sensory Stimuli
Bright lights and sun glare can induce migraines, as can loud sounds. Unusual smells — including pleasant scents, such as perfume, and unpleasant odors, such as paint thinner and secondhand smoke — can also trigger migraines.
Changes in Wake-Sleep Pattern
Either missing sleep or getting too much sleep may serve as a trigger for migraines in some individuals, as can jet lag.
Physical Factors
Intense physical exertion, including sexual activity, may provoke migraines. A change of weather or barometric pressure can also prompt a migraine.
Commonly Asked Questions
How can I make an appointment with one of your migraine specialists?
Prior to meeting with Dr. Elena Ocher and Dr. Kaveh Alizadeh, we have our patients fill out a detailed migraine questionnaire to help determine if you are a surgical candidate and to help us create a treatment program specific for you.
Who is a good candidate for migraine surgical treatment?
New York Migraine Association Group surgeons will consider surgical treatment for migraine patients who respond well to injectable treatments. Injectable treatments are used to temporarily 'freeze' the muscles with migraine-causing nerve constriction helping to identify trigger sites. If trigger sites are successfully pinpointed, a patient may move forward with surgery to permanently release the compression of those muscles to provide long-term relief of symptoms.
How is the migraine surgery performed?
Migraine surgical solutions vary from patient to patient depending on the offending muscles identified through injectable treatment methods. The muscles that are most likely correlated with migraine headaches are the forehead, temple, back of head or deviated septum. In the case of forehead muscles, a small segment of facial muscle over the nerves is removed through small hidden incisions near hair bearing skin. This procedure will also smooth the forehead. In the case of temple muscles, the nerves are detached but not removed. In the back of the head, muscles that encapsulate the nerves may also be removed. When a deviated septum contributes to migraine pain, a septoplasty, or straightening of the septum, is performed along with removal of the turbinates in the nose.
What are the risks and side effects of migraine surgical treatment?
Although uncommon, some complications may include: discomfort, mild bruising and swelling. There can be a temporary hollowing of the temple, numbness in the forehead and scalp as well as infection and bleeding. Phlebitis may also occur causing a deep vein thrombosis or pulmonary embolus (a blood clot to the lungs). There may be a shift in brow appearance and movement and localized hair loss in the temporal areas. With septoplasty and turbinectomy, a dryness and a whistling sound from the nose can occur after surgery. Lastly, migraines may continue as there is no guarantee that a surgical treatment will be 100% effective.
Does insurance cover migraine treatment?
In some cases, insurance companies will cover injectable treatments for migraines such as Botox which was FDA approved in 2010 for the treatment of migraines. Migraine surgery may be covered by insurance. Our team of experts will help you through the insurance process. For more information please visit: newyorkmigraineassociation.com