Experts offer tips on diagnosing, managing, and preventing

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Experts say there are a number of ways to diagnose as well as manage migraine headaches. Javier Sanz/Getty Images
  • About 17% of women and 5% of men in the United States have experienced migraine symptoms.
  • Experts say staying up to date with the latest diagnostic and preventive methods for migraine headaches is key to managing the condition.
  • They add that medications might be the best option for people who have chronic migraine.

Migraine affects more than 10% of people worldwide.

Women are three times more likely to have the condition than men. In the United States, about 17% of women experience migraine symptoms while the same is true for less than 6% of men.

Over the past few decades, methods for diagnosing and preventing these painful headaches have changed significantly.

Modern diagnostic methods may include clinical observation and neuroimaging while preventive methods range from dietary and lifestyle recommendations to pharmacological interventions.

MedicalNewsToday spoke with five experts to learn more about how migraines are diagnosed and how they can be prevented.

Dr. Medhat Mikhael, a pain management specialist and medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center in California says diagnosing migraine is different from other types of headache.

“Migraine is a clinical diagnosis and it has a clinical criterion that differentiates it from other headaches,” he told MedicalNewsToday. “Some of these criteria include being unilateral, throbbing, moderate to severe in intensity, and aggravated by physical activity associated with non-headache symptoms such as nausea, vomiting and/or sensitivity to light and sound- known as photophobia and phonophobia.”

A test known as the ID Migraine Screener looks for three key migraine-associated features, including photophobia, functional impairment, and nausea. A 2003 study that first described this screening tool found it had a sensitivity of 81%meaning it correctly identified people with migraine 81% of the time.

Dr. Megan Tudor Donnelly, the lead neurologist and women’s headache specialist at Novant Health in North Carolina, said the screening test is a sufficient tool for diagnosis.

“The American Headache Society, along with the American Academy of Neurology, recommends against imaging and other testing such as EEG for migraine if the physical neurological exam is normal and there are no red flags, such as the headaches being ‘sudden,’ ‘worse ,’ or occurring with alarming symptoms such as weight loss or known cancer, HIV, or immune suppression,” she told MedicalNewsToday.

When asked how guidelines could be improved, she said: “Since migraine disease does not ‘show up’ on MRI, EEG or other testing, the most important way to improve on diagnosis, is excellent history of taking and listening to the patient.”

“In the future, I suspect that there will be some serum biomarkers ie. a blood test, such as measuring CGRP levels, available for migraines. But for now, this is not available and only theoretical,” she added.

Dr. Romnesh de Souza, a consultant neurologist and interventional neurologist at Health City Cayman Islands, told MedicalNewsToday the best way to prevent headaches is through lifestyle modification.

“Eating on time, preferably small meals at regular intervals, and adequate water intake are recommended. Most patients can identify triggers such as certain foods, eg, dairy products or nuts. Avoid these foods if they negatively impact the patient. Maintaining a headache diary also helps,” he said.

Dr. Jose Posas, the director of the Neurology Residency Program at Ochsner Health, told MedicalNewsToday that exercise may also be helpful to prevent migraines.

“Though a minority of patients have migraines triggered by exercise itself, most of the migraine patients I treat tend to do better when they are able to engage in healthy exercise,” he said. “Exercise does not have to be strength and resistance training and can be things that are less impact related, such as Pilates or yoga. Stretching is another often overlooked component of exercise that can be very helpful for many patients who suffer from migraines.”

Tudor Donnelly added that nutraceuticals such as magnesium, riboflavin (B2), butterbur, and coenzyme Q10 may also help prevent migraines.

She noted, however, that if individuals notice migraine headaches persisting for four or more days per month after taking these measures, prescription preventives are recommended.

Prescription methods for prevention may include pharmaceuticals such as:

  • B-blockers
  • calcium channel blockers,
  • Ani-seizure medication
  • Anti-depression medication

Dr. Pooja Patel, a neurologist and the director of the epilepsy monitoring unit at Marcus Neuroscience Institute at Boca Raton Regional Hospital, part of Baptist Health South Florida, said medications can be useful.

“For most migraine sufferers, medications make up the first line of defense to help prevent and/or ease pain and other symptoms,” Patel told MedicalNewsToday. “For chronic migraine, we usually start with medications from various classes to prevent headaches. If oral medications are not effective, Botox and newer injectable medications that are CGRP receptor antagonists are offered, which are highly effective. Multiple rescue medications can be used to take as needed at the onset of migraine.”

“The best way to manage migraine is to avoid any of the precipitating or triggering factors mentioned above by focusing on routine exercises, healthy diet, adequate and good quality sleep and avoidance of stress,” said Mikhael.

He noted that there are situations where people may need to take medication for their migraine headaches.

Patel added that a person should seek urgent medical attention if they experience:

  • “The worst headache in their life” such as a “thunderclap” headache.
  • A headache different from their usual headache – such as lasting longer than usual.
  • A headache that wakes them up from sleep.

“In the case of frequent headaches, a person should be evaluated by a neurologist for treatment as currently there are multiple treatment modalities that can prevent migraine and improve quality of life,” she added.

Posas noted that having a proper “buy in” and trust between patients and physicians is key.

Also thinking about recovery time and understanding there is no magic in treating migraine is important. Even the best medications and therapies need time to work. A realistic outlook on migraines is key, knowing that if someone has suffered from headaches for years, that it may take a few visits/a few months before any real progress is made,” he concluded.

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