Easing stigma and pain of migraines with information and expert care

Sarah Kratzer had her first migraine when she was 12 years old. “I'm 39 now, so it's been part of my story for a long time.”

A story that involves learning to live with a chronic condition that others can’t see and sometimes don’t sympathize with. But Howell Jarrard, M.D., a headache specialist at MUSC Health Neurosciences, said not only are migraines debilitating – they also affect a lot of people. 

“Probably 18% to 20% of women have migraines. It's a lot at any given point in time. We're talking one in five women, and then it's like 6% of men. So you're looking at 12, 13, 14% of people at any point in time have had a migraine at some point in the last year, which is a huge number.”

The good news? In many cases, migraines are preventable and treatable, and the options are growing quickly. “There's a bunch of new medicines that have been coming out in the past six or seven years that have been game changers for migraine that work very well,” Jarrard said.

Those new treatments include: 

• Calcitonin gene-related peptide antagonists, or CGRPs, which block a protein linked to headache pain. They can be injected or taken by mouth.
• Lasmiditan pills that block pain pathways in the brain.
• Neuromodulating devices that users wear to disrupt nervous system activity, which can lead to fewer migraines. 

Kratzer gets a monthly shot of the CGRP medication Emgality to try to prevent migraines, along with a Botox injection. Botox blocks pain signals from the brain. That double dose of preventive care has cut down on the number of headaches she gets from more than 15 a month to one or two. 

 

“Those migraines are now things that I can recognize quickly and treat quickly. And so it doesn't really impact my day,” Kratzer said. Her treatment involves taking a medication called sumatriptan that narrows blood vessels in the brain, easing migraine pain.

“I'm able to take my rescue medication and go pick up my kids from daycare or take the dog on a walk outside or finish my workday, whatever I generally need to do. And that's part of why good control is just so important.”

And control is key, Jarrard said. When migraines are uncontrolled, they can take people out of commission. “Generally, migraines are one-sided, severe headaches that you need to lie down with. Sometimes people get nausea and vomiting and extreme sensitivity to lights and sounds.”

The effects can last for hours or even days if left untreated. So what causes migraines?

One factor: genetics, as Kratzer knows. “I have a family history of migraine, in an older sibling and then in multiple family members. So I was lucky in the fact that my parents were able to recognize what was going on - that they were more than just an average headache,” she said.

“They were able to get me in with a neurologist early on who made the diagnosis and then was able to thankfully get me on a better path for treatment.”

Genes play a key role in brain development, including brain chemistry. Jarrard pointed to that chemistry as a likely basis for migraines. “There's probably multiple different flavors of chemical imbalances linked to migraines,” he said.

But chemical imbalances aren’t the only culprits. Jarrard said migraines are also caused by environmental factors called triggers, which include:

• Stress.
• An inconsistent sleep schedule.
• Hormones.
• Caffeine.
• Alcohol.
• Dehydration.
• Weather changes.
• Certain types of food.
• Light.
• Strong scents.
• Overuse of migraine medication.

For Kratzer, a day in the bright sun at the beach without polarized sunglasses can trigger a migraine. So can a sip of red wine or a bad night’s sleep. 

But she’s happy for Jarrard’s help. Living with migraines isn’t as simple as getting a diagnosis and starting treatment. It needs to be adjusted over time, Kratzer said. “I've tried multiple things throughout my life. And they've changed over time from adolescence into adulthood. I've gone through two pregnancies, two postpartum periods that have all affected how well my controllers have been working,” she said, referring to preventive treatments. 

That’s why she said it’s important to maintain relationships with experts such as Jarrard who can adjust treatments as needed. Jarrard, an assistant professor of Neurology at the Medical University of South Carolina, said headaches are the No. 1 reason people go to see neurologists. “People can get remarkably better. We have a huge toolkit of medicines, natural things, injections, lots of different treatments that we can do for these people.”

Kratzer, who happens to be a primary care nurse practitioner with patients of her own, said migraine treatments can also include counseling, acupuncture and practicing mindfulness. “Most people with migraines want to get better. And that path to getting better is generally lifelong and changes over time. And so what works for people can be different and often involves multiple approaches.”

Jarrard said there’s no test to determine if a person has migraines but there are criteria. “If you have bad, relatively frequent headaches, then odds are it's probably migraine. The earlier you get assessed and given something to take as needed, the odds of it getting worse over time decrease.” 

Kratzer is a perfect example. “I feel really lucky to be very well controlled. Not everybody is as well controlled as I am at this moment in time. And I may not be this well controlled in two years. Migraines tend to fluctuate. And so just be open to changes in your treatment regimen and always be mindful of what's recommended by your professional team. It’s generally what's worked best for me to date.”