A healthy living blog from Marshfield Clinic Health System

Migraine management: Warning signs, auras and treatment

Migraine management can help you manage pain and frequency. Migraines are distinct from headaches because of the duration, severity and symptoms. A migraine is often associated with a warning sign or auras. This includes nausea, sensitivity to light, sound and odor, difficulty concentrating or thinking clearly and vertigo. It can also include neurological problems such as visual disturbances, numbness, speech and language impairment or weakness.

Deeper Dive about Migraines 4-24 inside, migraine management, auras

Migraines are unique for everyone. A starting place for treatment is working to understand your triggers. Then you can adopt lifestyle modifications to reduce migraine frequency.

“There are certain widely held myths about migraines that can be harmful or demoralizing to the patients in their search for the best treatment and care,” said Dr. Mayur Chalia, headache specialist with Marshfield Clinic Health System. “Even worse, they can also foster widespread misunderstanding and perpetuate false information about the disease.”

Migraine auras or warning signs

Migraine auras are a series of sensory disturbances or disruptions to language that usually happen shortly before a migraine attack. It is experienced by 25% to 30% of people who have migraines. These migraine auras may include:

  • Double vision
  • Loss of peripheral vision
  • Spots in your visual field
  • Flashes of light
  • Ringing ears
  • Numb or tingling extremities

“Migraines can be easier to treat for people who have these symptoms because they can take medication right away and possibly prevent a headache,” Smith said.

Not everyone gets migraine auras along with a migraine. Some people have symptoms like irritability and fatigue that are harder to connect to the onset of a migraine.

Treatment and lifestyle modifications

Migraines are unique for everyone. A starting place for treatment is working to understand your triggers. Then you can adopt lifestyle modifications to reduce migraine frequency. This information can pair with recommendations from your provider for a treatment plan unique to you.

A common migraine management technique is to use abortive medications early during an attack. Do this while pain is mild, rather than waiting when the pain is moderate to severe. There is evidence that early intervention lowers pain intensity and can enhance treatment results. “The opportunity to treat early exists for about 50% of all migraine attacks, which offers considerable scope for improving migraine management,” Dr. Chalia said. “Importantly, treating pain early and before it has progressed beyond ‘mild’ meets many of the expectations patients have of their migraine treatment.”

Treatment options can include:

  • Conservative treatments – These include lifestyle changes, like smoking cessation, limiting alcohol/caffeine, regular exercise and maintaining good sleep. These might work solely at times for people with mild headaches, but are combined with other measures for more moderate to severe headaches.
  • Abortive treatments – These include medicines you take when you have a headache for immediate effect. They can be over-the-counter drugs, like acetaminophen and ibuprofen, or complex prescription medications including sumatriptan (Imitrex) and rizatriptan (Maxalt). Take abortive treatments as needed. However, do not exceed the recommended limit of more than 2-3 days a week to prevent medication overuse headache.
  • Preventive treatments – Use these medicines daily basis to prevent headaches. You use them as scheduled, regardless of whether you have a headache at the time. Some examples include propranolol (beta blocker), amitriptyline (antidepressant) and topiramate (antiseizure), which have headache preventive properties as well. Treatment plans are made with many factors in mind, including side effects, costs, patient preferences and pre-existing health conditions.

Find the right migraine management plan

“Headaches can be very complex, and due to their effect on quality of life, choosing the right treatment plan is crucial,” Dr. Chalia said. “Consulting a headache specialist will help you solidify what option is best for you.”

Taking more medication isn’t going to give you more control over your pain. It could trigger more attacks. “Taking a lot of medication to treat an acute migraine attack could lead to more frequent and more severe migraine attacks in the future, which are often more difficult to treat,” Dr. Chalia said.

Pregnancy adds another challenge to treating migraines. Many medications are not recommended due to side effects on baby. However, have a conversation with your neurologist or headache specialist about your options.  “It may be more complicated than it was before you were pregnant, but it can certainly be done,” Dr. Chalia said.

Sometimes it feels like nothing will work. “You’ve tried everything, and now your only option is to ‘wait it out.’ It can be a helpless feeling,” Dr. Chalia said. There are many effective treatment options, with more on the horizon. Work with your doctor to adjust and find the right treatment plan for you.”

For help with migraines, talk to a Marshfield Clinic Health System provider.

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