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 BRAIN HEALTH GUIDE: Migraine  

Learn about

  • The neurological condition

  • Triggers, Symptoms, Red Flags

  • Diagnosis

  • Benefits-Risks of FDA regulated medical products

    • Drugs​

    • Medical Devices

  • ​Cost

  • Supportive lifestyle practices

  • Environmental safety protection

  • Choosing right options

  • Community Resources 

  • References 

The Neurological Condition 
 

More than a bad headache - and more common than you think    

Intense head pain, often only on one side, that may occur with other symptoms such as nausea, vomiting, or sensitivity to light, sound, and smells

​

Linked to abnormal brain activity that affects nerve signals, chemicals, and blood vessels within the brain​​

1 in 6

live with migraine

Some people have

8 migraine days per month

A leading cause of disability worldwide in

young and middle-aged adults

Women

are three times more likely than men

Can affect

children

Can be

treated, prevented

 TRIGGERS 

  • Not enough sleep, exercise
    ​

  • Not eating well
    ​

  • Skipping meals
    ​

  • Not drinking enough water
    ​

  • Stress
    ​

  • Being around bright lights,  uncomfortable noise
    ​

  • Hormonal changes
    ​

  • Weather changes 

 SYMPTOMS 

Headaches with intense pulsing or throbbing pain in one area of the head

​

Nausea, vomiting 

​

Sensitivity to light and sound

​

Aggravated by physical activity

​

May be with or without ‘aura’ - visual disturbances such as dots, flashing lights or a blind spot 

​

Some may experience both types 

​

Can last 4 - 72 hours when untreated

 RED FLAGS 

Get medical care right away 

​

đźš© Starts suddenly

​

🚩 Comes with weakness​

​🚩 Causes confusion

​

đźš© Comes with fever

​

đźš© Follows head injury

 DIAGNOSIS 

Chronic migraine: Migraine headache features occurring on 15 or more/month for more than 3 months

​

Episodic migraine: Intermittent, recurrent episodes occurring on 14 or fewer/month 

Drug Treatments 

FDA regulated
​
For Acute Treatment or Preventive Treatment 
​
Can be Prescription or Nonprescription 
​
Can be taken orally (by mouth), intranasally (inhaled through the nose), or injected by a health care professional​​

Colorful Pills Assortment

 Acute Drug Treatments 

Prescription

Triptans

Such as sumatriptan, zolmitriptan
 

Target serotonin receptors in the brain, constricts swollen blood vessels and reduces the release of pain- and inflammation-causing substances from nearby nerves

Ergots

Such as ergotamine, dihydroergotamine

​

Target serotonin receptors, reduce the processes that trigger migraine pain

Getpants

Such as injected/ infused (eptinezumab, erenumab, fremanezumab,

galcanezumab) or taken orally (ubrogepant, rimegepant)

​

Block calcitonin gene-related peptide

(CGRP) protein which dilates blood vessels and transmits pain signals causing migraine

Ditans

Such as lasmiditan

​

Block pain signals in the brain

Nonprescription (Over-the-Counter)

Pain Relievers

Such as ibuprofen, acetylsalicylic acid, acetaminophen

​

Can ease headache pain

Nausea relief medicines

Such as chlorpromazine, metoclopramide


Can treat nausea

 Preventive Drug Treatments 

Prescription

CGRP monoclonal Antibodies

Like erenumab, fremanezumab, galcanezumab, eptinezumab

​​

Block CGRP receptor 

Gepants

Such as rimegepant

​

Also approved for preventive treatment

Botulinum toxin type A

Temporarily blocks acetylcholine release, preventing nerve signals from reaching muscles

Anticonvulsants

Can lower abnormal nerve signaling that trigger migraines

​Beta-blockers and calcium channel blockers

Can stabilize nervous system and lower brain's response to migraine triggers

Some antidepressants

Can change how the brain processes pain

Image by Bermix Studio

Benefit - Risk of Drug Treatments 

Benefits

Acute Treatment: Relief of pain and most bothersome symptoms

  • Pain freedom

  • Relieve nausea, vomiting

  • Relieve light and sound sensitivity​

  • Work and function normally

Preventive Treatment: Benefits depend on intensity and frequency of episodes

  • Lower monthly migraine days

  • ​Lower monthly migraine medication days

  • Lower impact on everyday activities

Common Risks (varies by drug)

  • Drug-Drug interactions with other medications that are taken together which can lower efficacy or increase side effects

  • Warnings and Precautions like ischemia, blood circulation problems, stroke, changes in color or sensation in fingers and toes, hypersensitivity reactions

  • Side effects like stomach and intestinal problems, nose irritation (if inhaled), injection site swelling (if injected), sleepiness

  • Restrictions during pregnancy, nursing

  • Controlled Substances like ditans can cause dependency

  • Medication Overuse Headaches with increase in migraine episodes due to overuse of migraine medications​​​

Talk to your doctor, pharmacist about risks & restrictions 

​Read the Patient Medication Guide that describes the risks and provides use directions for the drug to be fully effective

​

For serious reactions, stop taking medication, call doctor or 911

Medical Device Treatments 

FDA regulated
​
Noninvasive neuromodulation devices, software-only (mobile App) devices
 
Acute Treatment and Preventive Treatments
 
Prescription and Nonprescription
 
Use alongside other migraine treatments 
 
Use at home

Circular Metal Device

 Medical Device Treatments 

Transcranial Magnetic Stimulator

Delivers external brief, rapidly alternating, or pulsed, magnetic fields to discrete regions of the brain to reduce hyperactivity that leads to migraine 

Transcutaneous Electrical Nerve Stimulator

Applies electrical current to a patient's cranium through electrodes placed on the skin

Vagus Nerve Stimulator

Activates the vagus nerve with electrical stimulation through the skin to block pain signals

Computerized Behavioral Therapy

Manages cognitive and behavioral components including behavior modification, risk-factor optimization, medication and adherence - via a mobile App

​Cold Packs

Provide cold therapy to soothe pain

Smartwatch On Charger

Benefit - Risk of Medical Device  Treatments 

Benefits

Acute and Preventive Treatments

  • Reduces migraine severity, frequency

  • Drug-free option, fewer side effects

  • At-home use, wearable, App-controlled

Common Risks (varies by device)

  • Contraindicated for patients with conductive metal implants in the head and neck, or any other implanted medical device that stimulates the body or uses signals from the body.

  • Restricted for those with history of seizures

  • Misapplication can cause skin burns, allergic rashes, muscle spasms, worse pain 

  • Side effects like lightheadedness, tingling, tinnitus (ringing in the ears)

  • Improper use can reduce efficacy, increase safety concerns

  • Improper maintenance can reduce efficacy, increase safety concerns

  • Software malfunction can lower device performance

  • Connectivity and cybersecurity risks can interfere with App function​​

Talk to your doctor about risks and restrictions for device 

Read device label, follow use and maintenance instructions

​

For serious reactions, stop using device, call doctor or 911

Costs

  • Insurance typically covers most prescription drugs - depends on the specific drug class and diagnosis​

  • Prescription device coverage is dependent on several requirements - check with your doctor

  • Nonprescription drugs and devices usually require out-of-pocket payment 

  • May be eligible for reimbursement through Health Savings Account (HSA) or Flexible Saving Account (FSA).

Supportive Lifestyle Practices​

Can help preventing and managing triggers and episodes

Discuss options with doctor, healthcare professional

Decide what’s right for you and your Quality of Life

 Hydration, Caffeine, Alcohol 

  • Hydration prevents brain, body tissues to contract, lowers risk of an episode

  • Caffeine can narrow brain blood vessels to relieve pain; however, too much (more than 200 mg/day) can be a trigger 

  • ​Alcohol may be a trigger in some, check if there is a link

 Omega-3 Foods 

  • Can reduce headache hours

  • ​Consume omega-3 rich foods: Oily fish, seeds, nuts

  • ​Limit omega-6 rich foods: Corn, cottonseed, peanut, soybean, sunflower oils

 Healthy weight, Regular sleep schedule 

  • Extra weight may contribute to inflammation 

  • ​Underweight can lead to more episodes

  • ​Both not enough and too much sleep can be triggers

 Supplements 

  • May reduce episodes. CAUTION: Efficacy, Safety not FDA reviewed

  • ​Magnesium: Specially for migraines with auras

  • ​Riboflavin (Vitamin B2): Can have a minor side effect of  bright yellow urine

  • ​​Coenzyme Q (CoQ10): Also helps to overcome tiredness

  • ​​Melatonin: Also regulates sleep-wake cycles

  • ​Parthenolide (Feverfew): May cause gastrointestinal side effects, not recommended during pregnancy 

Environmental Safety Protection ​from Triggers

Brimmed hats to block light

CPSC regulates for flammability, material quality​

Sunglasses to block light

FDA regulates for impact resistance, optical clarity, UV radiation blocking

ear with earplug graphic

Ear plugs to block noise

EPA regulates for Noise Reduction Rating

Choose what is right for you

You may need to try different drugs and devices or combination 

Keep a Headache Journal

  • The time of day when it happened

  • How intense it was and how long it lasted

  • Hoe long did it limit your activities - a day or more

  • Any sensitivity to light, smells, or sound

  • Any activity right before the headache started

  • Any medicines taken, including both prescription, nonprescription

  • Any supplements taken

  • Any medical devices being used, including implants

  • The quality and length of previous night’s sleep

  • Any stress or strong emotions before developing symptoms

  • The weather or changes in daily routine

  • Food and drinks consumed in the previous 24 hours

  • Any other health conditions such as high blood pressure, liver problems, kidney problems, risk factors for heart disease.

Check if treatment will work for you

  • Treatment that works for one, may not work for another

  • Use Migraine Journal as a guide for discussion with doctor

  • Include personal goals like acute treatment vs. prevention or both, speed and duration of relief, returning to normal activities

  • Specific benefits of treatment vs. your goals

  • Individual risks, restrictions with each treatment and how to manage

  • Adherence to route of administration, dosing instructions, duration of treatment and planning daily activities around them 

  • Treatment cessation (stopping) requirements like tapering down slowly, withdrawal symptoms 

  • Cost 

  • Access to nonprescription options

  • Need for referral to a migraine specialist​​

Smiling Woman Interaction
Smiling Confident Man
Know your rights as a patient

  • Collaborative, respectful relationship with your doctor

  • Courtesy, respect, dignity, and timely, responsive attention to your needs

  • Receive information and be able to discuss benefits, risks, costs of a treatment, optimal course of action - prescription, nonprescription, supportive lifestyle

  • Ask questions about health status, recommended treatment

  • Help you make decisions about recommended treatment

  • Respect for your privacy and confidentiality

  • Get copies or summaries of your medical records

  • Get a second opinion

  • Know about conflicts of interest your doctor may have

 RESOURCES FOR YOU 

Avoid misinformation

  • Supplements claiming migraine cures

  • Online headache forums lacking medical, healthcare expertise

  • Untested ‘holistic’ treatments

  • Oversimplification of condition; advice to ‘push through’

Get reliable, current information

  • American Headache Society 

  • American Academy of Neurology and Brain Health Initiative for overall brain health

  • Academic medical centers

  • Reliable advocacy groups

Consider work accommodations

  • Environmental adjustments: Light, sound, scents

  • Schedule and task flexibilities

References for this guide

  • Food and Drug Administration (FDA)

  • Consumer Product Safety Commission (CPSC)

  • Environmental Protection Agency (EPA)

  • National Institutes of Health (NIH)

  • Centers for Medicare & Medicaid Services (CMS)

  • American Academy of Neurology

  • American Medical Association

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