Managing Migranes

If you suffer from severe, often debilitating migraines, there is hope on the horizon.

BY CYNTHIA MCFARLAND

Migraines have plagued Cara Donn*, a longtime Marion County resident, since her teens.

“I usually get an aura about an hour before the headache sets in,” says Cara, adding that she’ll often feel nauseous.

“The only thing that really seems to work for me is lying down in a dark room with no stimuli to try and sleep,” she says. “It helps to have an ice compress on my head and the back of my neck. For me, a typical migraine lasts 12 hours or more; the worst ones last a couple days.”

After decades of dealing with chronic migraines (She’s been diagnosed by a neurologist.), Cara has learned which specific triggers tend to bring on a migraine. Her triggers include barometric pressure changes, bright lights/glare and/or abrupt changes in lighting, stress and dehydration.

“If I’m really upset and don’t get it out of my system, that stress can bring on a headache,” she notes. “Since I’ve started paying close attention to my water consumption, which is something I can control, my headaches are less frequent.”

Unfortunately, Cara is not alone.

“Migraine[s are] an extremely common disorder a ecting over 36 million people in the United States alone. This is only counting those people who are diagnosed, not those yet to be diagnosed,” observes Dr. Lance Kim, an expert in migraine care who has practiced at Florida Neurology Center in Ocala since 1998.

“Migraine[s cause] a significant economic burden to society, costing this country about $11 billion a year in both direct and indirect care cost, including treatment and loss of productivity,” he adds.

Dr. Kim is a multiple board-certified neurologist, and one of his subspecialties is migraine headaches. He is one of only about 200 doctors in the country who are board certified in headache medicine.

Dr. Kim finds that migraine headaches are a very common complaint, but patients often don’t get a proper diagnosis in a timely manner and delay receiving helpful treatments. Many patients end up with ine ective or wrong treatment, which is a common reason for undue su ering with a debilitating headache. Seeking help from a physician who is well-versed in migraines is strongly recommended in order to get the correct diagnosis and treatment.

A number of published scientific papers have shown that many people go to the emergency room because their headaches are so severe and end up leaving with a prescription for narcotics, which is the wrong medication to treat migraines, because it could paradoxically worsen the headache. In addition, narcotics have highly addictive properties, which can make it hard for a person to get o that wrong medication in order to then take the proper medication.

Family History

Cara’s mother also su ered from migraines, which is not unusual.

“Migraine[s are] a hereditary neurological disorder,” says Dr.Kim. “People prone to migraine[s] are born with brains that are hyper-excitable, meaning their brain cells are more easily excited than those without migraine.”

In other words, their brains are biochemically di erent from the brains of people without a migraine disorder.

And although it might seem unfair, approximately 70 percent of migraine su erers are women.

Dr. Kim explains that in boys and girls who su er from migraines, it occurs equally in both sexes. After puberty, though, migraines become twice as prevalent in females. By middle age this prevalence only increases.

“This is attributed to estrogen, which plays an important role in migraines, because it’s known to increase the amount of nitric oxide (a chemical known in the pathogenesis of a migraine) in the brain,” says Dr. Kim. “As a woman’s body produces more estrogen, more of this nitric oxide is also produced in the brain.”

This explains why, for many women, their headaches are associated with hormonal changes around menstruation and pregnancy. Migraine intensity and frequency generally improve after menopause, likely due to the sharp decrease in estrogen.

Effective Treatment

Once someone has a clear diagnosis of migraine, there are two types of medication that can help.

“Group one” medications (such as Topamax) are prophylactic drugs taken to prevent migraine.

“If you have bad migraine[s] more than four days a month, you need a proper preventative medication,” says Dr. Kim. “There are many medications that can be used, but treatment needs to be targeted to each individual because other medical issues you may have, and other medications you’re on will determine the preventative medication you can take.”

“Group two” medications (such as Triptans) are taken only when a person is actually experiencing a migraine.

“Acute abortive medications (e.g. Triptans or Ergots) are known to work well for those people whose migraines are diagnosed early and treated promptly,” says Dr. Kim. “Migraine[s are] a timesensitive condition; there is a window where it responds well to treatment, but if you miss this window, you’ll have less success in treating [the migraine].”

It’s important to understand that group one and group two medications work in very di erent ways, so they cannot be used interchangeably.

“Preventative treatments have a high degree of success, but for patients who have tried all the preventatives but still have migraines, we often consider Botox injections given in the muscles of the forehead and neck on average every three to four months,” says Dr. Kim. “This is not the first line of treatment, and its mechanism of action for migraine is not completely understood. My opinion is that Botox aborts peripheral sensitization (temporarily denervates the peripheral nerve endings in the head).”

Good News

Although it’s been about 27 years since the last major migraine treatment was released, that’s about to change.

“The FDA is releasing a medication that is a completely new class of drug that was developed as a result of new science technology and over 20 years of research,” says Dr. Kim, noting that this drug could be available as early as late May 2018.

“This medication class, a CGRP antagonist, is going to be a true gamechanger for migraine su erers and will revolutionize the way we treat patients with debilitating migraine headaches,” he states.

Dr. Kim says the medical community is excited about the release of this new medication in light of the grave impact migraines currently have on our society. He’s extremely hopeful this new treatment option will have a powerful positive impact, not only on patients’ lives but also in reducing the financial burden of migraine on society as a whole.