BACK BY POPULAR DEMAND: The American Migraine Foundation brought 3 headache specialists to answer your questions about acute migraine treatment (but also anything else). They’ll be answering questions from 3 p.m. to 6 p.m. ET, so ask them anything!
About Your Hosts
Dr. Teshamae Monteith is currently the chief of the Headache Division, director of the headache fellowship, and chair of both the wellness and diversity committees within the Department of Neurology at the University of Miami, Miller School of Medicine. She has published in a number of prominent journals in headache medicine and neurology and lectured nationally on topics such as headache disorders and migraine. 3-4pm ET
Dr. Angeliki Vgontzas is an instructor in the department of neurology and clinical director for outpatient general neurology at John R. Graham Headache Center, part of Brigham and Women’s Hospital/Harvard Medical School (BWH/HMS). Dr. Vgontzas’s research on sleep and migraine is reflected in numerous peer-reviewed publications She is a board-certified neurologist. 4-5pm ET
Dr. Thomas Berk is a neurologist and headache specialist at NYU Langone Health. He focuses on the treatment of headache disorders and is involved in clinical trials for the next generation of migraine therapies. He has a passion for migraine advocacy as well and was recently recognized as an “Emerging Leader” of the American Headache Society. 5-6pm ET
The American Migraine Foundation (AMF) is a non-profit organization dedicated to the advancement of research and awareness surrounding migraine, a disabling disease that impacts more than 39 million men, women and children in the United States. The AMF was founded in 2010 to provide global access to information and resources for individuals with migraine as well as their family and friends.
Learn more at https://americanmigrainefoundation.org/
Disclaimer: Information shared during this AMA should not be considered personal medical advice, nor is it intended to replace an in-person consultation with a qualified medical professional.
What percent of people that say they get migraines are actually having migraines (and not just a headache)?
Migraine is by far more likely to be underreported! If a person has a recurrent and disabling headache syndrome, migraine is most likely assuming secondary conditions are ruled out.
I have heard numerous times that headaches are pretty untraceable. Is this true or no?
Also I get pretty severe migraines and my wife thinks it's related to my lack of ability to breathe through my nose properly is that a thing?
If what you mean is difficult to detect with diagnostic testing, that is certainly true for migraine. Some other causes of headaches can be evaluated by brain and neck imaging, physical exams, and laboratory tests.
It is true that some breathing disorders such as obstructive sleep apnea can cause headaches. Obstruction of the airway passages can some times be a cause, but things like a deviated septum are often incidental findings. Please get an evaluation.
Why do I see weird spots or distorted areas when I'm having a migraine?
About 25% of patients with migraine, may have transient symptoms, most often visual disturbances, called an aura. Not only spots, but zig zag lines, tunnel vision, flashes of light, or complex figures can also be seen.
I’m a 29 year old chronic migraine sufferer who has had migraine since childhood. I have two questions for you:
Will evidence soon be available on whether CGRP treatments, both preventative and acute, are safe for pregnant and/or nursing women and babies?
Are there any new treatment options being discovered or explored at this point in time?
Thank you for doing this AMA.
Great questions - there are many new medications being developed, and even just this past year we have had a few new medications come to market.
The CGRP antagonist medications - both oral and injectable - are not considered safe in pregnancy now, we don't yet have enough data on the oral medications in breastfeeding but the injectables are not recommended.
Ever since I was pregnant 11 years ago, I get ocular migraines that turn into full migraines.
My Dr has tried multiple medications and nothing stops it dead in its tracks like medical marijuana.
But getting high mid day isn't helpful except it stops the headache in its tracks
Do you have any other advice?
There are many effective acute treatments for attacks of migraine with aura. There are non-specific treatments such as naproxen, migraine specific treatments known as the triptans or gepants, and some anti-nausea medications that actually help migraine. Some regimens are used effectively in combination.
How does one identify a migraine and differentiate between a migraine and a random headache?
There are hundreds of different headache disorders - they all vary based on characteristics including what the pain feels like, how long it lasts, where it is located and what other symptoms you develop along with the headache.
Here is a link from the American Migraine Foundation that helps review different headache types:
What are your thoughts on visual migraines? Causes, changes in frequency and possibly indicative of some other condition?
Migraine with aura typically should last between 5-60 minutes but often occurs for about 15 minutes. The aura can vary to some degree, but if you develop persistent symptoms that does not resolve it needs to be checked out. The cause of aura is not fully known but thought to be associated with a process in the brain called "cortical spreading depression".
Help!! I'm suffering from a headache right now because there is someone nearby wearing perfume and I'm allergic.
Is there anything I can do to alleviate the problem now? Is there anything I can do to prevent this from continuing to happen?
Many people with migraine note that they are sensitive to strong smells (like perfume or gasoline), which is different from an allergy. If you are experiencing a sensitivity to smell and the headache has started, you can try taking as needed headache medicines and if possible getting away from the smell that is bothering you. Sounds like it may be a good idea to talk to your primary care doctor about whether this is migraine and if migraine-specific medications are right for you.
*Note, if this is really an allergy, you should seek medical care for that
I have occular migraines occasionally. To best of my memory sometimes it’s been one eye only, sometimes both.
I think I read somewhere that one type is innocuous, the other can be quite serious. Is that correct? And which is the type to worry about?
Visual aura often often one side of the visual field (technically both eyes). When occurring strictly in one eye only, it is called a retinal migraine (often called ocular migraine). Both are benign, when presenting as a lifelong recurring problem in the absence of neurological problems or eye disease.
What can I do to shorten a migraine once it starts?
Acute attacks can be treated with ice, menthols, relaxation techniques, sleep, and medications for migraine. Some of the better treatments include triptans, gepants, in combination with non-steroidal anti-inflammatories.
There are a few devices out of the market that may also help: Cefaly device, gammacore device, and the nerivio device.
If you migraine attacks last more than 4-6 days per month, you may want to consider a preventive option.
Once a month, I have a really bad headache. It lasts for several hours and it’s so bad that my eyes hurt as well. Is it an illness or just regular migraines?
It is hard to give a diagnosis on this site, but recurrent headache with pain in the eyes could certainly be a migraine. Migraine is more than a pain disorder, patients may have intolerance to noise/light, and nausea. There are other conditions that can mimic a migraine; you should discuss this with your primary care doctor.
I get awful menstrual migraines, even with an IUD. Is there a birth control that works better for reducing headaches?
Low doses of estrogen containing contraceptives may help prevent migraine and should generally be avoided in smokers, patients with a history of blood clots, and migraine with aura. In some patients, unfortunately hormones can make migraine worse.
How do I know whether I have a tension headache needing ibuprofen or something else needing acetaminophen?
Have neck whiplash issues and constantly something hurts
Did you headaches start after a whiplash injury? That is a common pattern.
I recommend you consider seeing a neurologist that can evaluate the cause of your headaches and treat them.
Have your team researched psychedelics and their potential treatment of chronic headaches?
Are there any long term side effects (confirmed or suspected possible) for using Nurtec ODT in chronic migraine patients?
While Nurtec (rimegepant) is a new drug, no long term side effects have been identified.
Hi! And thanks for addressing this topic!
I've been dealing with migraines for the last 20 years, they started when I was about 10 years old.
Lately, I've been seeing a different pattern in my migraines. I seem to get stiffness and pain in my upper back and neck that leads to a tension headache. Somehow that tension headache turns into a full migraine attack. Does that seem likely?
It is quite debilitating as I get attacks weekly and they seem to last longer than ever before. I've been trying to use a foam roller for my back. I've tried stretching. But the migraine attacks just keep happening.
Migraine can be very debilitating. Many people with migraine also experience tension type headaches. There are many medications that can be used as needed early on into an attack that might prevent it from becoming a full attack. Depending on the frequency, a daily medication to prevent these may also be considered. Sounds like this would be a good question to bring up with your doctor (you can start with your primary care doctor). Check this resources out for more info: https://americanmigrainefoundation.org/resource-library/how-to-establish-good-relationship-with-your-healthcare-professional/
Dear Drs . Many thanks for answering our questions 😊. I have had daily headache for almost 5 years . They started about 2-3 weeks after I had L4/5 lumbar decompression ( facetectomy). I had episodic migraine prior to that . MRI Brain reported as normal. Neurosurgeon was sure there was no leak when I was readmitted to hospital . Headaches usually bad first thing in the morning, improve a bit & then worsen again in afternoon. No response to multiple oral meds , Botox or Ajovy . Would the surgery have anything to do this ? Could CSF fluid be low or high post surgery ? Would there be another reason that could cause the shift to chronic migraine post op ? My neurosurgeon was excellent & not here to assign blame but just would love to find a treatment to get some relief . Many thanks.
Tough problem. I don't know your case, but yes a CSF leak is something we want to definitely rule out and it may be hard to detect. Brain imaging can be normal. Medications to treat body pain can sometimes turn on headaches, stress, or other unrelated factors. Given your persistent symptoms, you should be seeing a headache specialist. Good luck.
Hello and thank you for this AMA I suffer from chronic migraines that can last several days at a time, which no preventative medicine seems to help. I avoid my known triggers, but things like light (sunlight during the day, car lights/streetlamps/traffic lights at night) or any kind of sound/music (car base/loud engine/doorbell) make it almost unbearable to go outside. Other than sleeping right, drinking water, avoiding triggers and limiting my light/sound exposure, are there other venues I can go down? I feel like I am missing out on my life, always at home in the dark nursing a migraine. I have had MRIs and neurological tests but according to my doctors there is nothing physically wrong with me. Thank you
I am sorry to hear about your disability from migraine. You may want to check out some of these resources which describe traditional and complementary treatments for migraine: https://americanmigrainefoundation.org/patient-guides/
I have been getting headaches more frequently since a mild head injury in Nov, but they aren’t head-splitting. No light or sound sensitivity. And since then I’ve also experienced vertigo with greater frequency that lasts for longer periods (a week compared to a day in the past) and head pain wearing a ponytail, wearing a hat or laying on a pillow (which affects my sleep) though not every day. Migraine runs in my family. Is it possible that I could have migraine if the headaches aren’t that bad? And if so, what kind of doctor do I need to see?
AfterI initially got hurt, I tried to go to a concussion clinic a week or so later for headaches (they used to be more painful) but they treated me with skepticism on the phone because I hadn’t gone to a doctor right after the injury happened, so I didn’t end up going. Thanks in advance for any advice!
Hi there! It sounds like it would be a good idea for you to first talk to your primary care doctor (if you haven't) and then a neurologist.
Is there any truth that over time, migraine medications tend to lose effectiveness over time? If so, any research into why they do?
We don't feel that is usually the case. Although rarely we do have to switch medications, it is more often the case the if you find a safe and effective treatment you can continue that treatment for a long time.
If you do use certain acute medicines for migraine too often - this is more than 2 or three times weekly - you can develop "rebound" or medication overuse headache. It's not that the medication doesn't work, or loses effectiveness, rather it's that your brain becomes too dependant on that individual medication. For this reason, we may recommend adding a preventive medication or alternating acute medications if your migraines are more frequent.
Hi , I have constant osmophobia with daily headaches etc . My headache specialist advised it should settle with treatment, but so far no treatment has worked . The osmophobia is very stressful as there are smells everywhere( I can smell other peoples clothing detergent & get smells when no one else can ) . Have you had any success with any particular preventative or any strategy to treat this ? Thanks a lot
Really great question.
Migraine, by definition, has pain and non-pain symptoms. We typically see improvement in the pain symptoms before the non-pain ones. There really aren't specific treatments for smell sensitivities, but we may consider increasing or adjusting your preventive medications based on your other symptoms.
Can you explain the concept of the "weekend headache" in detail?
Some people report they are more likely to get headaches on the weekends. Some scientists think this might reflect "stress letdown", so once people are winding down from a stressful week at work, they are in the window to get more migraine (which is unfortunate!). That may not be the only explanation (for example, if you miss your daily coffee on saturday, you may actually be getting headache as a sign of caffeine withdrawl)
Is there any new research on cluster headaches and the effectiveness of psilocybin as a treatment for them?
I agree that is something that needs to be studied for effectiveness and safety, but I have not seen any new studies published.
Hey there! Not sure if I've missed you guys or not, but I have been dealing with migraines for about three years now with increasing frequency. I do have a diagnosis of post truamatic brain injury.
My neurologist has me on progesterone and wants me to start Topamax.
The issue is im allergic to a sulfa compound and the side affects seem absolutely scary, is there not any other type of medication that I could ask for other than that?
The migraines seem worse from Nov to Feb (which are the winter months for us here in Texas.) Is a year round medication really needed or one that works instantly for something seasonal?
There are so many great options that you could potentially consider with your doctor that can help prevent migraine.
Many people notice worsening migraine with weather or seasonal changes. Many times good preventive therapy can help with that too. Definitely talk to your neurologist about a good alternative migraine medication
I am working on identifying other triggers, but my main one is weather. The preventive I am on ( nortriptyline) has helped with stress related migraine but not much with the barametric pressure ones. Are there specific preventive that work better for weather related migraine?
Hello! There is no specific preventive for preventing a migraine that the person feels is induced by a particular trigger (weather or otherwise). However, sometimes doctors can try increasing the dose of a preventive, changing to another or adding another preventive. The other option is to reach out to your doctor and work on acute (as needed) treatment for your weather-related migraines. Here's some information on migraine medications.
Worst part about my migraines is if I sneeze the day after. It feels like that blinding stab of pressure in the middle of my head will surely burst and kill me someday. Much worse and more worrisome than anything that goes on during headache day.
So, is that a legitimate fear? Will my blood vessels weakened or tired from migraine someday pop and I'll be dead before I hit the floor?
Having a migraine can be a very debilitating experience and it can get worse with simple activities like bending over or walking. However, it's important to run this by a doctor to make sure nothing else is going on especially if this is new for you. Migraine itself should not lead to worrisome medical events. You may want to check out this guide: https://americanmigrainefoundation.org/resource-library/what-is-migraine/
I have migraines 4 or 5 times a year, but once it seemed morelia the symptoms of a cluster headache (I really just wanted to die, and I couldn't stop walking around at 5am) is it more common for migraine sufferers to get cluster headaches or am I just getting a migraine with different presentation?
Cluster headache is a different type of headache disorder that is less common than migraine. You are right, that some of the core features of it include restlessness and excruciating pain. More commonly, cluster occurs in cycles (aka "clusters") during which people will have a headache several times a day or every other day for several weeks or months. Hope that information is helpful. Here's a resource to read more: https://americanmigrainefoundation.org/resource-library/cluster-headache-2/
I sometimes get killer headaches for about a week at a time, but then it stops and goes away, often for months or sometimes I dont get them at all for about a year
What in the world is this, and is there anything I can do to treat/prevent this when I feel it coming on?
Fantastic question - it might be migraine, it really depends on the character of the pain, location and associated symptoms.
Here is a link that can help determine this - you should also discuss this with your doctor:
What are your go-to resources for migraine and migraine treatment information that's accessible to migraine sufferers? It's sometimes hard to sort through the internet of things to find the facts.
Also, thanks for answering questions today!
It's definetely important to get information from a trusted source. I (along with the other docs on this thread) review content for the American Migraine Foundation, which has lots of good trusted resources. Check out this link to start: https://americanmigrainefoundation.org/living-with-migraine/migraine-essentials/
IIH.... many of the recommended migraine relievers don't seem to work for those with IIH. What are the differences between the 2 conditions? What would you recommend for IIH head pain? Thank you
IIH or Idiopathic intracranial hypertension is a different disorder that is typically diagnosed by dilated eye exams and spinal tap/lumbar puncture and is treated with different types of medications and typically weight loss. People with IIH are more likely to have migraine in addition to IIH. Once the IIH has resolved, we tend to focus on treating migraine and use all the migraine medications.
How much of a contributor is eye strain to headaches/migraines? I’m concerned my career of staring at computer screens is taking a toll on me.
Eye strain is something I think we are hearing more during the pandemic. Dry eye may contribute to headaches as well, in addition to the light coming from the computer screens. Often eye strain if over diagnosed, and not the cause of migraine. Having said that, make sure to check your vision and protect your eyes.
What is the best one can do to prevent a menstrual migraine?
Depending on how often and how severe, menstrual migraine can be treated with long acting triptans (naratriptan, frovatriptan) or zolmitriptan if no contraindications. Magnesium and non-sterioidal anti-inflammatory drugs may also help. If you known when your cycle is going to happen, you may want to treat prophylactically. For some patients, low dose hormones containing estrogen may help.
Thank you for doing this AMA! I'm an audiologist, and I'm considering vestibular migraine more and more often in the diagnostic process. Are there any patterns linking migraines and vertigo? Any treatments?
Vestibular migraine is a subtype of chronic migraine and can be very difficult to diagnose or treat.
Classically, vestibular migraine will present with some degree of dizziness with superimposed migraine attacks.
Why's my head hurt in the morning after half a bottle of vodka?
Vodka and other types of alcohol can lead to hangover headaches, that may occur immediately or the next day. This occurs more in individuals with migraine.
I’ve had migraines for 30 years, but since Jan 21 I’ve been dealing with chronic Vestibular Migraines. Did something change in my body to bring this on? Is my brain suddenly broken? I figured out my triggers long ago and avoid them like the plague (except the inevitable weather change), but now I can’t walk the dogs around the block or go to the supermarket without getting dizzy which leads to another headache. I’ve had an MRI and CT scan come back clean (nothing growing or exploding) and have recently started Toprimate under the care of a neurologist.
Your brain is definitely not broken! Vestibular migraine is very common actually, more so in women. You should also consider seeing an ENT doctor to make sure other causes a ruled out. If due to migraine, continue to treat and do not give up.
Hi! I'm a student who is in all extremely advanced classes. I put a lot of pressure on myself and I think it may be part of the reason why I frequently get headaches. They aren't exactly migraines per say but none the less having a headache most evenings is highly frustrating. I know you all aren't giving specific medical advice per say but is there anything you all have seen work in these sorts of situations other then just drinking more water and taking an ibuprofen or something? Thanks!
Many people identify stress as a trigger to their headaches and migraine. It sounds like you may also be identifying this as a contributor to your headaches, which then may be making you more stressed out. Check out this guide for migraine's contributing factors. If you are able to think about health activities you can start which might help (exercise, mindfullness or other activities that help reduce stress) on a regular basis, that is a good start. Therapists/psychologists can be very helpful as well. https://americanmigrainefoundation.org/patient-guides/
I feel like I've tried every migraine treatment out there. Are there any newer ones I might not have heard of?
It really depends on what you have tried. I have never found a patient that has truly tried everything! For example, as of 2020 there are 4 new migraine specific injectable therapies for migraine prevention. There are a number of other treatments in late stage development. Supplements, devices, infusions, lifestyle changes, and behavioral interventions may all help.
This is my second question I’m submitting because someone else’s comment made me think of this:
During my last pregnancy, I experienced an increase in migraine severity and frequency. Around 16 weeks pregnant I received a prescription of Reglan after being treated with Reglan (among other things) in the ER. I began taking the Reglan every day as a preventative measure, and my migraines completely disappeared. It was miraculous and life changing.
I have read that irreversible tremors can be a side effect of Reglan use...
When I have brought this up subsequently with my doctors, I’ve been told that Reglan isn’t typically used to treat migraine / isn’t a known treatment method.
Do you have any experience with, studies, or thoughts on using this medication to prevent migraines?
Additionally, do you have any thoughts or evidence on how gut health is related to migraine?
Hello, Reglan is not recommended as a daily preventive medication for migraine, although can be effective on an as-needed basis. Here is some more information on migraine medications that may be useful: https://info.americanmigrainefoundation.com/understanding-migraine-medications-download
Never had a migraine till I was diagnosed(after the first migraine put me in the ER) with hyperthyroidism. Migraines were less severe and less frequent while that was treated. Now they are very mild and at most 3/4 per year.
Is there a direct link or coincidence?
WHY DID THEY STOP MAKING sumavel dose pro??? That was a miracle drug for me. I would usually fall asleep within 5-10 minutes, 15-25 minute nap and wake up 95% better straight into the hangover.
Headaches may be a symptom of thyroid dysfunction. I do have several patients whose migraine got worse when their thyroid function was off. So, it's possible that was the case with you. Glad you are better.
Despite being on multiple preventatives (topamax, verapamil, emgality) and having a clean bill of health (MRI, CT) I routinely get migraines that become "stuck" on. The longest lasted nearly four months, with others often lasting multiple weeks. I'm curious what causes some of these migraines to get "stuck" when normal migraines will dissipate within 12 - 72 hours? Why does my brain seemingly want to be in a migraine state?
Great question - migraine, by definition, is a prolonged type of headache - it lasts at least 4-72 hours, and there is a specific term we use for really prolonged migraine - status migrainosus.
Some people will have these kinds of severely prolonged migraine attacks - everyone's brain is different, and there isn't a great explanation as to why your brain would be in a more prolonged migraine state. That said, you and your doctor might consider a short course of stronger medication that helps break up prolonged migraine attacks. Theses can be longer-lasting anti-inflammatories, steroids, or anti-nausea type medications. Some doctors try nerve blocks or IV medications in this situation too.
Why haven't you cured headache?
That would be a dream, a difficult one! Headache is complex symptom associated with several conditions as well as due to primary headache disorders. Conditions like migraine is both environmental and genetic. There are endless triggers, some patients are not able to identify. While the brain is complex, our treatments are getting much better but still no cure!
One of my migraine symptoms is that I start to experience a metallic taste in my mouth- Why is that?
Edited to also ask if there is anything that I can do to prevent it or any other specific migraine symptoms, or is prevention simply a way to minimize the occurrence of migraines entirely as opposed to minimizing specific symptoms?
Thanks for doing this AMA!
There are many preventive medications for migraine. You may want to check out this resource: https://info.americanmigrainefoundation.com/understanding-migraine-medications-download
Migraine should not leave any tender spots. You may want to start by checking with your doctor about that area that still feels off.
Two migraine aura questions:
For people who get alice-in-wonderland symptoms or other more extreme visual perception issues with their aura what is actually happening with the brain?
Why do some people always get "silent" migraines or migraines with only aura without headache?
Aura is explained by a phenomenon called "cortical spreading depression or CSD" in which there is a transient change in how ions move in and out of cells on the outer layer of your brain. When it happens in the visual area of your brain, it causes you to see an "aura". We don't know why some people get migraine with aura without the headache. Scientists are trying to figure out how the CSD then triggers headache pain (which works by another mechanism).
My question is: can migraines be related to puberty? My brother and I both got them between the ages of about 15 and 20, and neither of us have had one since that age. Always wondered if it was an age thing
Great question - most people first develop migraine around puberty, and hormonal changes are common triggers for migraine.
Is there anything that makes hereditary migraines distinct? I’ve heard the theory that they may be related to mitochondrial dysfunction disorders and would love to hear your thoughts.
If you have a family member with migraine, you are 2-3x more likely to have migraine. However, migraine is also quite common. Migraine is secondary to combined contributions from >100 genes (that we know of so far). Although there are some rare mitochondrial disorders of which migraine is one feature, that is not very common.
Are migraines related to the feeling of losing balance or like having the head under the water? Are they related to sickle cell disease?
Some people with migraine feel off-balance during a migraine attack. Headaches are common in people with sickle cell disease and there can be a number of causes. If you have both migraine and sickle cell disease, let your doctor know, as there may be effective treatments for your headaches.
You can find more information here: https://info.americanmigrainefoundation.com/understanding-migraine-medications-download
what are your thoughts about ice slushy induced brain freeze to arrest a migraine that is forming?
Most people would find that very uncomfortable! There is also no good evidence to support that. There are many effective as-needed medications specific for migraine, some of which have been out for many years. https://info.americanmigrainefoundation.com/understanding-migraine-medications-download