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Saturday, November 26, 2022

Migraine Sufferers Have Treatment Options: A Neurologist Explains Options Beyond Painkillers

Migraine headaches currently affect more than a billion people worldwide and are the second leading cause of disability worldwide. Nearly a quarter of American households have at least one member who suffers from migraines. It is estimated that each year 85.6 million work days are lost as a result of migraines.

However, many migraine sufferers dismiss their pain as just a headache. Instead of seeking medical attention, the condition often goes undiagnosed, even when other disabling symptoms occur along with the pain, such as sensitivity to light and sound, nausea, vomiting, and dizziness.

Researchers have found that genetics and environmental factors play a role in the migraine condition. They happen when changes in the brain stem activate the trigeminal nerve, which is a major nerve in the pain pathway. This signals your body to release inflammatory substances like CGRP, short for calcitonin gene-related peptide. This molecule, and others, can cause blood vessels to swell, leading to pain and inflammation.

For some, medication has its limits.

A migraine can be debilitating. Those who experience one are often huddled in a dark room accompanied only by their pain. Attacks can last for days; life is put on hold. Sensitivity to light and sound, coupled with the unpredictability of the disease, causes many to give up work, school, social gatherings, and time with family.

Numerous prescription medications are available for both prevention and treatment of migraines. But for many people, conventional treatment has its limitations. Some people with migraines have a poor tolerance for certain medications. Many can’t afford the high cost of medications or endure side effects. Others are pregnant or nursing and cannot take their medications.

However, as a board-certified neurologist who specializes in headache medicine, I am always amazed at how open and enthusiastic patients become when I discuss alternative options.

Your brain sends you warning signals, like fatigue and mood swings, to let you know a migraine may be on the way.

Together, these approaches are called complementary and alternative medicine. It may be surprising that a traditionally trained Western doctor like myself recommends things like yoga, acupuncture, or meditation for people with migraines. However, in my practice, I value these non-traditional treatments.

Research shows that alternative therapies are associated with better sleep, feeling better emotionally, and a greater sense of control. Some patients may be able to avoid prescription medications along with one or more complementary treatments. For others, non-traditional treatments can be used in conjunction with prescription medications.

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These options can be used one at a time or in combination, depending on the severity of the headache and the cause behind it. If neck tension is contributing to the pain, then physical therapy or massage may be more beneficial. If stress is a trigger, perhaps meditation is an appropriate place to start. It’s worth talking to your provider to explore which options might work best for you.

Mindfulness, meditation and more

Because stress is a major trigger for migraines, one of the most effective alternative therapies is mindfulness meditation, which is the act of focusing your attention on the present moment without judgment. Studies show that mindful meditation can reduce the frequency and severity of headaches.

Another useful tool is biofeedback, which allows a person to see their vital signs in real time and then learn how to stabilize them.

For example, if you are stressed, you may notice muscle tension, sweating, and a rapid heartbeat. With biofeedback, these changes show up on a monitor and a therapist teaches you exercises to help you manage them. There is strong evidence that biofeedback can decrease the frequency and severity of migraines and reduce headache-related disability.

Yoga is derived from traditional Indian philosophy and combines physical postures, meditation, and breathing exercises with the goal of uniting mind, body, and spirit. Practicing yoga regularly can be helpful in reducing stress and treating migraines.

Meditation is an alternative therapy that could help with your migraine.

Manipulative based therapy

Physical therapy uses manual techniques such as myofascial and trigger point release, passive stretching, and cervical traction, which is a gentle tug on the head with an expert hand or medical device. Studies show that physical therapy with medication was superior in reducing migraine frequency, pain intensity, and pain perception compared to medication alone.

By reducing stress levels and promoting relaxation, massage can decrease the frequency of migraines and improve sleep. It can also reduce stress in the days after the massage, adding further protection against migraine attacks.

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Some patients are helped by acupuncture, a form of traditional Chinese medicine. In this practice, fine needles are placed in specific places on the skin to promote healing. A large 2016 meta-analysis article found that acupuncture reduced the duration and frequency of migraines, regardless of how often they occur. The benefits of acupuncture are maintained after 20 weeks of treatment.

What’s also fascinating is that acupuncture can change metabolic activity in the thalamus, the critical brain region for pain perception. This change correlated with a decrease in headache intensity score after acupuncture treatment.

Vitamins, supplements and nutraceuticals

Herbal supplements and nutraceuticals, which are food-derived products that may have therapeutic benefit, can also be used to prevent migraines. And there is evidence to suggest that vitamins work reasonably well compared to traditional prescription drugs. They also have fewer side effects. Here are some examples:

Devices can be beneficial

The Food and Drug Administration has approved several neurostimulation devices for the treatment of migraine. These devices work by neutralizing pain signals sent from the brain.

One is the Nerivio device, which is worn on the upper arm and sends signals to the pain center in the brain stem during an attack. Two-thirds of people report pain relief after two hours, and side effects are rare.

Another device that shows promise is the Cefaly. It provides a mild electrical current to the trigeminal nerve in the forehead, which can decrease the frequency and intensity of migraine attacks. After one hour of treatment, patients experienced a nearly 60% reduction in pain intensity, with relief lasting up to 24 hours. Side effects are rare and include drowsiness or skin irritation.

These alternative therapies help treat the person as a whole. In my practice alone, many success stories come to mind: the college student who once had a chronic migraine but now has rare occurrences after a vitamin regimen; the pregnant woman who avoided medication through acupuncture and physical therapy; or the patient, already on numerous prescription medications, who uses a migraine neurostimulation device instead of adding another prescription.

Of course, alternative approaches are not necessarily miracle therapies, but their potential to alleviate pain and suffering is remarkable. As a doctor, it’s really gratifying to see some of my patients respond to these treatments.

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