Pain Management

Migraine Headaches

Migraine headaches cause moderate to severe throbbing. You may also experience nausea, 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.

More than four million people have chronic migraines, according to the Migraine Research Foundation. Migraines tend to affect women more than men. 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 lunch meats, for example) and monosodium glutamate (MSG). Caffeine or caffeine withdrawal and skipping meals or fasting can also trigger a migraine
  • Hormonal changes, such as menstruation
  • Sensory overload, such as bright lights and glare, loud sounds, and strong smells
  • Stress and/or anxiety
  • Weather changes, such as storm fronts, changes in barometric pressure, strong winds, and changes in altitude

Migraine Stages

Migraines progress through four stages. They are:

  • 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
  • Stage 4: Post-drome is after the attack and is also called “migraine hangover.” You may feel tired, nauseated, achy, or sensitive to light. Symptoms can last anywhere from a few hours to a few days

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. Biofeedback can also help determine your triggers.

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

  • Exercise regularly
  • 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

Treatments We Offer

We cannot cure migraine headaches, but we can treat the symptoms and help you feel better. We may use 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