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Understanding and Managing Headaches and Migraines: Expert Insights from Dr. Pankaj Mehta

Migraine attacks and headaches are often confused, but they are distinct conditions. A headache refers to general head pain and can vary in intensity and duration. Migraines, however, are a specific neurological condition characterized by severe, throbbing pain usually on one side of the head, and are often accompanied by symptoms like nausea, vomiting, and sensitivity to light and sound. 

While patients commonly refer to all head pain as headaches, those experiencing frequent, prolonged, debilitating episodes likely suffer from migraines. As a migraine specialist dealing with chronic headaches, it is crucial to differentiate between the types, allowing for targeted treatment plans and collaboration with neurologists to improve patient outcomes.

What is the Difference Between a Headache and Migraine?

Migraine attacks and headaches are often confused, but they are distinct conditions. A headache refers to general head pain and can vary in intensity and duration. Migraines, however, are a specific neurological condition characterized by severe, throbbing pain usually on one side of the head, and are often accompanied by symptoms like nausea, vomiting, and sensitivity to light and sound. 

While patients commonly refer to all head pain as headaches, those experiencing frequent, prolonged, debilitating episodes likely suffer from migraines. As a migraine specialist dealing with chronic headaches, it is crucial to differentiate between the types, allowing for targeted treatment plans and collaboration with neurologists to improve patient outcomes.

What are the Different Types of Headaches?

Headaches come in various forms, each with distinct characteristics and causes:

  • Tension Headaches: Often triggered by stress from jobs or school, these manifest as a dull, aching pain around the head.
  • Cluster Headaches: Severe, pathologic headaches causing sharp pain around one eye, often with tearing, and can persist for days.
  • Rebound Headaches: Result from the overuse of pain medications.

Condition Specific: Some patients may also experience headaches due to sinus inflammation or TMJ. While the cause is something else, such as TMJ, pain can manifest as headaches.

Are There Different Types of Migraine Attacks?

Migraines can occur with or without aura. An aura includes visual disturbances, sensory changes, or speech difficulties preceding the headache.

A Simple Migraine, often referred to as a common migraine, does not include an aura but has the typical throbbing headache and associated symptoms like nausea and light sensitivity. Understanding these types helps in accurately diagnosing and effectively treating migraine attacks.

Some other classifications of migraines include:

  • Hemiplegic Migraine: Includes temporary paralysis or sensory changes on one side of the body, often accompanied by aura symptoms.
  • Retinal Migraine (Ocular Migraine): Characterized by temporary visual disturbances or blindness in one eye, often accompanied by headache.
  • Status Migrainosus: A severe migraine attack lasting more than 72 hours, resistant to typical treatments.
  • Vestibular Migraine: Involves vertigo, dizziness, and balance problems, often without a severe headache.
  • Basilar Migraine: Affects the brainstem, causing symptoms like double vision, loss of balance, and fainting, often with aura.

Stages of a Migraine

Migraines typically progress through four stages, each with distinct symptoms:

  • Prodrome: This early stage can occur hours or even days before the migraine. Symptoms include mood changes, food cravings, neck stiffness, increased thirst, and frequent yawning. Recognizing these early signs can help in managing the impending migraine.
  • Aura: About 25% of migraine sufferers experience an aura, which involves a series of sensory disturbances. These can include visual changes like seeing flashes of light or zigzag patterns, or experiencing blind spots. Other sensory disturbances may include tingling in the limbs or face, difficulty speaking, and auditory hallucinations. Auras typically last from 20 minutes to an hour.
  • Attack: This is the main phase of the migraine, characterized by intense, throbbing headache pain, usually on one side of the head. It can last from 4 to 72 hours and is often accompanied by nausea, vomiting, and extreme sensitivity to light, sound, or smell. During this stage, sufferers may need to retreat to a dark, quiet room to alleviate symptoms.
  • Postdrome: Also known as the "migraine hangover," this stage can last for a day or two after the headache subsides. Symptoms include fatigue, residual pain, confusion, and moodiness. Patients may feel drained and need time to recover fully, often withdrawing from activities and seeking silence.

Understanding these stages allows patients to better predict and manage their migraines, potentially reducing the severity and duration of attacks.

Common Migraine Triggers

Migraines are highly individualized, and most patients have their own specific triggers. Consulting a migraine specialist can help identify these personal triggers and develop strategies to avoid them. Embracing self-management and education is key. Understanding and owning one's chronic illness can prevent it from taking over one's life. While it varies by individual, some common migraine triggers include:

  • Hormonal Changes: Fluctuations in estrogen levels, such as those occurring during menstruation, pregnancy, or menopause, can trigger migraines in many women.
  • Certain Foods and Drinks: Common dietary triggers include dark chocolate, tannin-based alcoholic beverages, aged cheeses, and processed foods. Caffeine and additives like aspartame and MSG can also be culprits.
  • Stress: Emotional stress is a significant trigger for many migraine sufferers. Managing stress through relaxation techniques, exercise, and therapy can help reduce migraine frequency and severity.
  • Sleep Disturbances: Both too much and too little sleep can trigger migraines. Maintaining a regular sleep schedule is crucial for migraine management.
  • Environmental Factors: Bright lights, loud noises, strong smells, and changes in weather can all act as triggers.
  • Neck Issues: Abnormal cervical positioning or “tech neck”, often from prolonged use of cell phones with the neck bent forward, can strain the cervical spine and cause headaches. Educating patients on proper posture and neck care can help alleviate this issue.

Treatment options

There are several treatment options available for managing migraines, often involving a combination of pharmacologic and non-pharmacologic approaches. At PSA, we work closely with neurologists to devise a pharmacological treatment plan, as they have extensive knowledge of the medications used for both chronic and acute migraine attacks.

Pharmacologic Treatments:

  • Preventive Medications: Taken daily to reduce the frequency and severity of migraines.
  • Acute Medications: Used during a migraine attack to relieve symptoms.

Non-Pharmacologic Treatments:

At PSA, we take a conservative and multimodal approach to chronic pain management, ensuring all non-invasive treatment options have been exhausted before moving on to other options. Nerve blocks and ablations can play a huge role in relieving chronic headaches and migraines, and have no adverse effects regardless of age. Additionally, stress management and lifestyle changes can play a huge role in migraine pain relief. Each patient is unique, requiring individualized treatment plans, but some common options include:

  • Nerve Blocks: Administered starting from the back of the head (occipital nerve blocks) using a local anesthetic, sometimes with or without a small dose of steroids. This can dampen nerve firing and reset the pain cycle.
  • Cervical Radiofrequency Ablation: A technique where the nerves of the neck, which contribute to headaches, are ablated (burned) to reduce pain. This involves a test injection first, followed by the ablation if effective.
  • Stellate Ganglion Block: Used for cluster headaches and certain types of facial pain, this block resets the nerves associated with the pain.
  • Sphenopalatine Ganglion Block: Targets tiny nerves in the front of the head to alleviate facial headaches.
  • Neurostimulation: Devices like spinal cord stimulators (SCS) or other neurostimulators can be considered for chronic, refractory cases.

Treatment effectiveness varies, with some patients needing periodic nerve blocks (e.g., three times a year) and others benefiting from annual ablations. These procedures typically have minimal adverse effects, making them suitable for patients of all ages. While migraines may not be completely cured, these treatments can significantly improve the quality of life by reducing the frequency and severity of attacks.

3 Common Myths About Migraines

Migraines, like many chronic illnesses, are surrounded by myths that can hinder effective treatment and management. Here are three common myths about migraine attacks

"Headaches are not serious; you can just ignore them."

When people start experiencing headaches, they often dismiss or justify them (I’m dehydrated or I didn’t sleep well), thinking they are not a serious issue. However, headaches, especially migraines, are a chronic illness that can significantly impact one's quality of life. Recognizing and understanding your headache patterns is crucial for effective management. Migraines should be taken seriously, just as much as other conditions like diabetes or chronic back pain.

 "You have to live with migraines because they run in the family."

A prevalent myth is that if migraines are common in your family, you’re also stuck with them. While there can be a genetic predisposition to migraines, it doesn't mean you have to suffer without relief. There are many treatment options available, and seeking help from a migraine specialist, such as interventional pain physicians who run headache programs, can lead to effective management and improvement in quality of life.

"You need to take opioids to manage migraine pain."

Another common misconception is that managing migraines requires constant use of opioids. This is not true. There are many non-opioid treatments available, including preventive medications, nerve blocks, and other non-pharmacologic therapies. It's essential to consult the right migraine specialist who can provide evidence-based, effective treatment options without relying on opioids. Education and appropriate intervention can help patients manage their migraines effectively without the risks associated with long-term opioid use.

These myths can prevent individuals from seeking proper treatment and managing their condition effectively. By debunking these misconceptions and promoting science-based interventions, we can help each other achieve better health outcomes.

Work with Dr. Mehta and Restore Your Quality of Life

If you're seeking relief from migraine and chronic headache pain, PSA, with our comprehensive pain management programs, offers hope and solutions. 

Dr. Pankaj Mehta, a distinguished expert in pain management, spearheads these efforts across multiple locations, including Temple, Killeen, and Georgetown, as well as at The Pain Relief SurgiCenter and PSA Surgery Center of Killeen. You can also find other migraine specialists near you by browsing our locations. 

With a focus on personalized medicine, advanced treatment modalities, and cutting-edge research, Dr. Mehta and the team at PSA provide tailored strategies to address various pain conditions. PSA is dedicated to improving your quality of life and helping you find lasting relief from migraine and chronic headache pain.