Heading for a Migraine? You’re Not Alone

June is Migraine and Headache Awareness Month – a time dedicated to migraine specialists and other health care providers, patient advocates and the migraine community to unite and advocate for migraine recognition and research.

We spoke with Dr. Juliette Preston, Director of the OHSU Headache Center, on some helpful tips to recognize symptoms of migraine and other headache disorders, avoid common triggers and in general, live a healthier lifestyle. Check out the Q&A below, or scroll to the bottom for some additional headache resources.

  1. How are migraine headaches diagnosed?

There are more than 200 sub-types of headaches, but migraines are most represented and seen in the clinic. A migraine is only diagnosed when a patient presents with at least five severe headaches in a lifetime. What to look for: throbbing or pulsating pain that is moderate to severe lasting more than four hours, paired with nausea and vomiting, and also movement or sound sensitivity.

There are a lot of people walking around with what they think is a headache, but it’s actually a migraine. The most helpful thing to do is keep track of the frequency of the headache (i.e. “headache days”) in a diary and bring that to your first appointment.

  1. When should I be concerned that a headache is more than just a headache?

If you’ve never had a headache before, and start having them at the age of 50, it’s a red flag because it can be a sign of other underlying health problems (i.e. vascular, tumor, etc.) If you have double vision, weakness, or any other symptoms that are neurological, it’s a red flag.

If you’re pregnant, or diagnosed with autoimmune disease or cancer, it’s more likely that it’s secondary headache, which means something underneath is causing the headache. Headaches can be great mimickers. Many conditions present as headaches at the start, but you should seek a professional opinion if you’re unsure.

  1. Are there common triggers for migraines?

The number one trigger for migraine is stress. Ahead of perfume, sleep deprivation, wine, aged cheese, dark chocolate, and many other things. Also common is biometric pressure change – when the clouds come in and change the air pressure in the region. Sometimes this can be seasonal, which means the spring/summer can be a difficult time for migraine sufferers.

Dehydration is another factor. This applies to everyone, but drink plenty of water, at least 36 to 64 ounces per day. For women during specific times of the month, when estrogen is either up or down, you can also be more prone to migraines.

  1. What are some great tips/techniques to manage a migraine?

Stick to a routine. It’s very important for a migraine patient to go to bed at same time every night, and sleep for six to eight hours. Any more or less, you’re more likely to wake up with a headache.

Exercise at least three times a week for 40 minutes each. For your overall health in general, but also for brain health. Mindfulness activities are also great because they help decrease your body’s response to stress. Better response to stress means you’re less likely to get a headache.

  1. How do patients and providers determine a migraine treatment plan?

I like to start by asking two main questions: How severe is the headache, and how aggressive do you want to address it?

Treatments can range from a vitamin supplement to medications and injections. Last year, a new class of drugs designed for specifically for migraine was approved by the FDA. We currently have about 300 patients that take migraine preventative CGRP monoclonal antibodies (mAb) for episodic migraine. This has been a very successful treatment.

There are also non-drug, non-invasive neuromodulations, the two most common being Cefaly and a hand-held Vagal nerve stimulator. These work to send precise micro-pulses to the upper branch of the trigeminal nerve to either relieve or prevent a migraine attack.

Ultimately, the patient remains the captain of the ship! We work together to find a solution that works best for you and your lifestyle.

  1. What is the OHSU Headache Center?

Our clinic is dedicated to providing the best possible treatment plan for your headache syndrome. In addition to seeing patients and teaching at OHSU and in the community, we are involved in research aimed to further understand headache and facial pain as well as providing the most advanced treatment plans.

We work very closely with other departments at OHSU to provide multi-disciplinary care to our patients. For example, if you need to see a doctor for an urgent migraine visit at the ER, we can fast track you to our hospital neurosciences inpatient unit to receive an infusion treatment.

We also have a monthly multi-disciplinary orofacial pain clinic, a collaboration with the OHSU School of Dentistry to cross-pollinate expertise for better diagnosis and treatment. Working together, we catch a lot of trigeminal neuralgia and TMJ disorders. You can read more in the 2018 Innovations in Neuroscience book.

  1. Can you talk a little bit about virtual visits for headaches at OHSU?

We started virtual visits in March and as of today, we have seen close to 100 patients virtually. For established patients, they can sign into their MyChart account and schedule a virtual follow-up visit. The process is very simple and if patients run into any issues, IT support is always available to help.

The majority of our headache patients are working adults, so it is very difficult to take time off work to come to OHSU. This has solved that issue and also expanded our ability to see and treat more patients.

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