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Health // Doctor in the House
Rasa Fournier

There’s Relief For Migraine Pain

Dr. Sharin Sakurai
Neurologist at Kaiser Permanente

Where did you receive your schooling and training?

I received my medical degree and doctorate from the University of Michigan Medical School in Ann Arbor. I completed my residency in neurology at Partners Healthcare, the largest healthcare provider in Massachusetts, with founding partners Massachusetts General Hospital and Brigham and Women’s Hospital.

How long have you been in practice?

I have been practicing medicine for 13 years.

What causes severe headaches?

Severe headaches can be caused by several different things. Migraine headaches, or cluster headaches, can cause severe pain. But other causes of severe headaches can include infections such as meningitis, or bleeding in the brain – intracerebral hemorrhage or bleeding caused by a ruptured blood vessel (subarachnoid hemorrhage).

What distinguishes a migraine? Is any severe headache called a migraine?

Not all severe headaches are migraines. There are many different types of headaches, several of which produce severe pain. We can distinguish a migraine headache from other types of severe headaches because there are certain clinical symptoms that set them apart from the other types of headaches.

Typical symptoms of migraine headaches include: recurrent headaches that can last from several hours to two to three days. The headache is often one-sided with a pulsating or throbbing quality and moderate to severe pain. Migraines can also be associated with nausea, vomiting, sensitivity to light (photophobia), and sensitivity to sound (phonophobia). There can also be a family history of migraines. Migraine headaches can be triggered by food including MSG, nitrates, chocolate, alcohol and cheese. Other triggers include odors, and for women, menstrual cycles. Migraines can also be caused by stress or lack of sleep. And, some people have warning signs or auras, such as visual changes including flashing lights, zig-zag lines or a loss of vision.

Some people seem to have chronic migraines while others have never had one. When someone does get migraines, is it usually something they deal with chronically?

Chronic migraines are migraine headaches lasting more than 15 days per month for a period greater than three months. Some people may get an occasional migraine while others may get frequent migraines throughout the month.

What help is available for migraines?

Medications can prevent migraines and provide acute relief from the headache once it has started. Acute treatment involves treating a migraine as fast as possible. Over-the-counter treatments include analgesics and nonsteroidal anti-inflammatory medications such as ibuprofen, acetaminophen, naproxen and aspirin. Prescription medications include “trip-tans” – sumatriptan, rizatriptan, naratriptan, zomatriptan and frovatriptan. This type of medication alleviates migraine headache pain by causing the blood vessels in the brain to constrict, and it also can decrease the release of chemicals in the brain that cause pain.

Other types of prescription medications that are effective in treating migraine headaches include ergota-mine-derived drugs, which also cause blood vessels to constrict, or opioid-derived drugs that are analgesic pain relievers. If migraine headaches are accompanied by nausea, treatment may include prescription drugs such as prochlorperazine or metoclopramide, both of which reduce nausea.

Prevention is the best strategy to avoid chronic migraines. Drugs that have been used to treat other disorders, such as high blood pressure, seizures, or depression, are effective in treating migraine headaches. These include beta blockers (propranolol, metoprolol), which are medications that treat high blood pressure. Medications that are used to treat seizures that are effective in migraine headache prevention include topiramate, sodium valproate and divalproex sodium. Depression medications such as amitryptline and nortriptyline are effective in preventing migraine headaches, as well. When a person continues to experience migraine headaches frequently despite standard preventative medication therapy, injections with Botulinum toxin A have also been shown to be effective.

In addition to traditional prescription medication, complementary prevention treatment includes over the counter supplements such as Riboflavin (Vitamin B2), coenzyme Q10, magnesium and butterbur.

If someone has them chronically, is there a way to completely get rid of them?

Chronic migraines can be managed effectively. With medications and supplements aimed at migraine prevention and avoiding things that can trigger headaches, migraines attacks can be reduced significantly.

Anything else you’d like to mention?

It is important for people who experience migraine headaches to know that they can find relief.

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