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Chronic Migraine Treatment in New York

What is chronic migraine?

We define Chronic Migraine as suffering from 15 headache days each month, with headaches with migraine features for at least 8 days for more than 3 months. Chronic migraines are different than episodic migraines and require different management. Similarly, it is easy to mistake new daily persistent headaches or medication over use headaches as chronic migraines. Elucidating specific headache patterns, frequencies, intensities, duration of headache days, association of autonomics symptoms, association of aura, and presence of nausea/vomiting are the key to making the correct diagnoses.

Who gets chronic migraine?

Three to Five percent of the United States Population suffers from Chronic Migraines. Transformation of episodic migraine to chronic migraine each year is found in approximately three percent of people.

What causes chronic migraine?

In chronic migraine, number of episodic headaches steadily increases over time due to a number of factors:

  • Obesity
  • Snoring, sleep apnea
  • Mood disorders, especially anxiety and depression
  • Ongoing disrupted sleep pattern
  • History of severe emotional (stressful life events) or physical trauma

What symptoms separate episodic migraines from chronic migraines?

Episodic Migraine and Chronic Migraine have almost the same symptoms. The major difference is in frequency of the headaches.

Typical migraine symptoms include:

  • Moderate to Severe in intensity pain in head, worsened by physical activity or movement.
  • Pain in one side of the head, can be both sides as well
  • Pressure-like pain or Throbbing pain
  • Sensitivity to sound, light & smells
  • Vomiting or Nausea
  • Dizziness

Signs showing episodic migraine transforming to a chronic migraine:

  • Growth in the number of migraine attacks
  • Increase in the intake of medication due to growth in number of attacks

Chronic Migraine Treatment

Chronic Migraine Treatment includes lifestyle management. It also includes managing headache triggers, migraine attacks and working for preventive treatments to reduce migraine attacks.

Some lifestyle changes include:

  • Weight reduction if you are overweight
  • Initiating doctor approved exercise plans
  • Stress management: Practice techniques to manage stress such as yoga, meditation, mindful breathing & relaxation training
  • Following a routine regimen regarding snacks & meal timings & not to skip any meals
  • Avoid de-hydration & staying well hydrated
  • Treating any existing mood disorder (including depression & anxiety or sleep problems)

The typical Chronic Migraine Treatment includes:

  • Management of an acute migraine attack remains the same with Triptans, Motrin/Tylenol, Hydration, and Reglan
  • The key to treatment is daily preventative medications: there are multiple options to choose from and they are selected based on patient’s comorbid medical history (e.g., other medical problems, kidney function, liver function, history of asthma/lung function, heart function)
  • These preventative agents include: beta-blockers, certain anticonvulsant drugs, calcium channel blockers, among many others
  • Of the many medications available to treat chronic migraines, Onabotulinumtoxin (Botox) is very popular and has been clinically shown to be effective in randomized control trials
  • New agents such as CGRP- antagonists, which can once month injections are also gaining popularity
  • All medications have side-effect profiles which need to be considered before starting any specific treatment, including these two relatively new and very effective options
  • The biggest fear with chronic migraines is overuse of over-the-counter medications or initiation of opioids incorrectly
  • Use of opiates should be avoid for migraines
  • Other treatments such as transcranial magnetic stimulation and transcutaneous supraorbital nerve stimulation are also options to consider in cases of unrelenting migraines
  • In addition to medical interventions, lifestyle medications, such as regular exercise, healthy diet, excellent sleep habits, and stress management, are the key to a headache life.

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