Ask the Expert: Commonly Asked Questions & Answers about Migraines
Volume
29
Number 3
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Q.
I've been having very frequent headaches. How do I know if they are migraines?
A.
Contrary to what many people
think, you don't have to
have an "aura" or throw up to
have a migraine. In fact, only
about 15 to 30 percent of those
with migraine have an aura. The
official criterion for migraine is
repeated headaches that last
from four hours to several days
and have at least two of the following:
occur on one side of the
head; are throbbing; are of moderate
to severe intensity; or get
worse with activity. Also, you
need to have light and sound
sensitivity and/or nausea with
or without vomiting.
—Lee Peterlin, DO
Assistant Professor
Department of Neurology
Drexel University College of Medicine
Director of the DUCOM Headache Clinic
Philadelphia, PA
A. I understand your frustration. The class of drugs often most effective for migraines is the triptans. They decrease the inflammation associated with migraine as well as the neurotransmitter serotonin, which is abnormally high during migraine attacks. The key, however, is to take a triptan at the first sign of a migraine. If you wait, the migraine gets such a strong toehold that you might not be able to arrest it.12
Triptans are expensive—up to
$50 or more a pill in some cases.
The good news is that a generic
formulation should be available
within the next couple of years.
In the meantime, ask your doctor
for medication samples. And
if your insurance company limits
the number of pills it will cover
each month, ask your doctor to
write to the company requesting
an exception.
—Lee Peterlin, DO
Assistant Professor
Department of Neurology
Drexel University College of Medicine
Director of the DUCOM Headache Clinic
Philadelphia, PA
A. Absolutely. I would suggest
you talk to your doctor. It is
very important that you keep a
headache calendar. And track
your menstrual cycle on this
calendar, too. This will help
your doctor identify potential
treatments. You can also make
lifestyle modifications, such as
limiting caffeine to no more than
eight ounces a day and going to
bed and waking up at the same
time of day. You might also keep
a food journal to see if certain
foods trigger your headaches,
such as processed meats with
nitrites, cheeses and red wine.
Your doctor may decide to try
a preventive medication. These
include supplements such as
riboflavin (B2), magnesium
oxide (400-600 mg/day) and
coenzyme Q10 (300 mg/day),
as well as antiepileptic drugs,
antidepressants or certain cardiac
medications such as calcium
channel blockers and beta blockers.
They generally take a few
weeks to begin working, so it is
important to set realistic goals.
—Lee Peterlin, DO
Assistant Professor
Department of Neurology
Drexel University College of Medicine
Director of the DUCOM Headache Clinic
Philadelphia, PA
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