Neurologist Anne Constantino, MD, on Migraines
April 23, 2018
What causes a migraine?
Migraines have a strong genetic component with 70 percent of patients having a first degree relative with a history of migraines. More women than men suffer migraines, and many associate their migraines with factors such stress, hormonal changes, contraceptive use, pregnancy, ovulation, lack of sleep, head trauma, changes in weather, smoking, ingesting red wine and exposure to computers or bright lights.
What are the treatments you offer?
If you experience the worst headache of your life, you should not delay going to the ER for evaluation. If you experience a headache that is likely triggered by the components mentioned above, it is likely a migraine attack. There are numerous medications that can help, from aspirin to much stronger drugs, including antidepressants, anti-seizure medications or calcium blockers. If a headache cannot be stopped, IV medications may be needed and the patient may need to be hospitalized. Narcotics are never a good treatment for a headache. New innovations in treatment include occipital nerve stimulation, external trigeminal nerve stimulation and the Gammacore handheld device, which all work to relieve migraines by sending electrical stimulation to the brain. New medications for migraines include new drugs and antibody therapies.
What else should we know?
Sleeping in a dark, quiet room, doing relaxation exercises, yoga, acupressure treatment and short courses of steroids have proven helpful to some individuals. Lifestyle change can also help patients with migraines, including avoiding or learning how to deal with stressful situations, eating healthy, and sleeping at least eight hours per night. Of course, avoiding the inciting agent is key. If you have a headache from constant computer exposure, relax your eyes and your brain to prevent progression of the headache. A headache diary may be helpful in documenting what activities/ food/etc. triggers the headache.
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