Ahead of the Pain: AHN's Approach to Treating Migraine

Dolores D. Santamaria, MD

(Credit: AHN)

Living with the unpredictable migraine cycle can feel like a constant battle that disrupts every aspect of patients’ lives.

Allegheny Health Network (AHN) has a team of migraine experts who offer breakthrough treatments to manage and even prevent attacks from ever starting. Physicians work with patients to develop a personalized treatment strategy, leaving their first consultation with a plan of action.

“Because we specialize exclusively in headache medicine, we are able to properly diagnose patients and offer nearly any available treatment on an outpatient basis,” said Dolores D. Santamaria, MD, director of the AHN Headache Center. “A lot has changed in the last decade. New therapies are emerging every year for migraines, as well as other primary headaches.

“Even if nothing worked for a patient when they were initially diagnosed, it’s worth revisiting the issue now with a headache specialist. Patients may find that one of the new therapies works very well for them, or they may find they were misdiagnosed in the first place.”

Beyond Head Pain

Migraine is an inherited disorder characterized by attacks that include a variety of neurological and gastrointestinal symptoms. These include throbbing or pulsing pain on one side of the head, often accompanied by nausea, vomiting, and sensitivity to light, sound, and smells. Some people also have visual problems (auras) that can include seeing flashing lights, blind spots, or zigzag patterns.

Migraine sufferers are more susceptible to triggers like stress, certain foods, hormonal changes, and environmental factors, and the attacks can last from several hours to a few days.

“Knowing and understanding a patient’s triggers is a significant component of treatment. Every year we are discovering new evidence to better understand the complexity behind a person’s hyperexcitable nervous system, which leads to what we call ‘migraine brain,’” Santamaria said. “Patients with this hypervigilant state are prone to having their triggers cause migraines.”

Four Phases of an Attack

Migraine symptoms are different during each of the four phases: prodrome, or before the attack; headache phase; postdrome, or after the attack; and interictal phase, or the weeks after the attack.

Prodrome phase is the onset of early migraine symptoms and happens before the actual attack. One or two days before a migraine, patients may notice slight changes that indicate an oncoming migraine, including:

1. Constipation.
2. Depression.
3. Food cravings.
4. Hyperactivity.
5. Irritability.
6. Neck stiffness.
7. Uncontrollable yawning.

Headache/migraine phase has two stages.About 30% of people with migraines will experience aura symptoms. These come before the headache phase or during. They can last anywhere from five minutes to an hour. These symptoms include:

• Pins and needles sensations in an arm or leg.
• Speech or language problems (aphasia).
• Vision loss.
• Visual phenomena, such as seeing various shapes, bright spots, or flashes of light.

Migraine attacks last anywhere from four hours to three days. If not treated or if a patient has more than eight severe attacks a month, they are at risk of having chronic migraines that can occur daily. If a patient has less than four attacks a month, this is episodic migraine. Patients may experience any or all these symptoms:

1. Blurred vision.
2. Lightheadedness, sometimes followed by fainting.
3. Nausea and vomiting.
4. Pain on one side or both sides of the head.
5. A pulsating, throbbing pain.
6. Sensitivity to light, sounds, and sometimes smells.
7. Physical and mental exhaustion.
8. Memory and thinking difficulties.
9. Neck pain or muscle stiffness.

Postdrome phase occurs after the migraine attack. It can last up to two days. During this time, patients may feel drained and washed out, depressed, and have some memory and thinking difficulties. Others may feel mildly euphoric or overjoyed.

Interictal phase is when patientsexperience mild headaches on and off during the month after the attack.

Patient experience

The AHN Headache Center’s design considers patients’ sensitivities, so they can feel safe and comfortable during their appointments. It has dimmed lights in the waiting and exam rooms, cool air, and a quiet environment.

Physicians provide patients with a thorough physical exam and don’t rush patients through their visit. It’s important the team learns all the details of a patient’s migraine history — from location and severity of pain, to frequency and symptoms of attacks, to triggers and treatments used.

Restoring lives with new options

Santamaria explained how over-the-counter medicines can make migraines more frequent if patients overuse them. But new wearable devices, injectable therapies, oral medications, and even nasal sprays have given patients more treatment options than ever.

“Migraine treatments have changed dramatically through the years. We now have new classes of drugs and new non-pharmacological therapies that have shown significant efficacy in migraine prevention,” Santamaria said. “These therapies are true game changers for patients experiencing chronic primary headache pain.”

For example, new medicines target calcitonin gene-related peptide (CGRP), a substance that elevates a patient’s blood pressure during migraine attacks. Doctors prescribe this for acute and preventive migraine treatment.

Wearables and nasal sprays can be more effective for patients who don’t tolerate oral medications, or whose nausea during a migraine makes it difficult to take oral medicines.

The center also offers monthly injections of a monoclonal antibody therapy that blocks CGRP proteins from reaching the receptors that trigger a migraine. Another option is remote electrical neuromodulation, a smartphone-controlled armband that delivers electrical impulses to the brain and turns off the body’s response to migraine pain.

Alternative therapies, including biofeedback, cognitive behavioral therapy, diet changes, and relaxation training, are also essential components of a comprehensive migraine treatment plan.

“These patients can go from being on the edge to regaining their lives,” Santamaria said. “The options we provide can make a drastic difference in a person’s health and well-being.”

To refer a patient to the AHN Headache Center, call (412) 578-3925 in Pittsburgh or (814) 452-7575 in Erie.