Migraine Headaches

Migraine headaches cause moderate to severe throbbing. You may also experience nausea or vomiting, and be very sensitive to light and sound. The pain can be so bad that you may not be able to go about your daily routine. Migraines can last anywhere from hours to days. At Mount Sinai, we can help you learn to prevent migraines and manage symptoms when they occur.

According to the American Migraine Foundation, more than four million people have chronic migraines. Migraines tend to affect women more than men, and most people who get migraines have their first one between the ages of 10 and 40.

A variety of factors can trigger a migraine headache, including:

• Fatigue or changes to your sleep schedule.
• Food such as aged cheeses, alcohol, and additives such as nitrates (found in hot dogs and lunchmeats, for example) and monosodium glutamate (MSG). Caffeine or caffeine withdrawal and skipping meals or fasting can also trigger a migraine.
• Hormonal changes, such as those during menstruation.
• Sensory overload, such as bright lights and glare, loud sounds, and strong smells.
• Stress and/or anxiety.
• Weather changes, such as changes in barometric pressure, strong winds, and changes in altitude.

Migraine Symptoms and Stages

Migraine symptoms progress through four stages:

• Stage 1: Prodrome happens a day or two before the migraine hits. You may experience constipation, mood changes, cravings for certain foods, a stiff neck, increased thirst and urination, and frequent yawning.
• Stage 2: Aura appears before or during a migraine. There are several types of auras, but they are usually visual. You may see flashes of light or wavy or jagged lines. In addition, you might find yourself unable to see properly, have difficulty speaking or moving one side of your face or body, hear noises or music, or experience uncontrollable jerking.
• Stage 3: Attack is the migraine itself. You many feel pain on one or both sides of the head. This phase can last from several hours up to three days. This pain can range from mild to debilitating. The migraine attack can include nausea, anxiety, an inability to sleep, and sensitivity to light, smells and sound.
• Stage 4: Postdrome is after the attack and is also called a “migraine hangover.” You may feel tired, nauseated, achy, or sensitive to light. Symptoms can last anywhere from a few hours to a few days.

It is possible to have a migraine without experiencing all of these symptoms.

Preventing Migraines

If you get migraine headaches, you may not be able to prevent them completely, but you can take steps to get them less often. First, determine your personal migraine triggers so you can try to prevent or manage them. To figure out your triggers, we recommend keeping a diary of when, where, and how long your headaches occur. By tracking what prompts your migraines and what helps you feel better, you may be able to see patterns. At Mount Sinai, we offer a treatment, biofeedback, to help determine your triggers by monitoring your body’s response to stress and prompts. This treatment can teach you how to relax under stress and decrease your migraine attacks.

In addition to avoiding your personal triggers, you can try to prevent migraine pain or find migraine relief in these ways:

• Exercise regularly. Aerobic exercises like walking, jogging, running, and cycling are associated with a decrease in migraine attacks.
• Maintain a regular schedule. If you sleep, eat, and exercise on a regular schedule, you may experience fewer migraine symptoms.
• Manage your stress. Decreasing feelings of stress through therapy can help, as can relaxation techniques such as meditation.
• Prepare for menstrual migraines. Women who tend to get migraines around their period can take preventive medicine in advance to help.
• Try prevention devices. Transcutaneous supraorbital nerve stimulation (t-SNS) is a sort of portable headband. This device sends electrical impulses to the trigeminal nerve, which is associated with migraines. The device may cause a tingling or massaging feeling.
• Use preventive medications. At Mount Sinai, we can prescribe medication to help prevent migraines. These can include anticonvulsants, beta-blockers, Botox, calcium-channel blockers, anti-depressants, and calcitonin gene-related peptide (CGRP) inhibitors. We rarely if ever use opioids.

Our Treatments

We cannot cure migraine headaches, but we can treat the symptoms and help you feel better. Treatments are personalized and may include one or more of the following:

• Anti-nausea drugs to treat migraine-related nausea.
• Botox Injections can provide months of relief from migraine pain.
• Nerve blocks such as occipital nerve blocks and sphenopalatine ganglion blocks can tackle difficult-to-treat migraine pain and stop an acute migraine in its tracks.
• Pain relief medications can help you get through the day. If over-the-counter drugs don’t work, we can prescribe something stronger. We rarely if ever use opioids.
• Trigger-point injections can relax tight muscles in your neck and head, a common source of migraine pain.
• Cervical facet joint injections are injections of an anesthetic or medication to relieve or block pain.