Chronic Migraine Solutions

Defining Chronic Migraines

Chronic migraines are a neurological condition characterised by recurrent moderate to severe headaches. Unlike occasional migraines, which may happen once in a while, chronic migraines are defined by experiencing headaches on fifteen or more days per month for at least three months, with at least eight of those headaches having features of migraine.

Here are some key points about chronic migraines:

• Frequency. Chronic migraines occur on 15 or more days per month.
• Symptoms. The symptoms can vary but often include intense throbbing or pulsing pain, usually on one side of the head. Other symptoms can include nausea, vomiting, and sensitivity to light and sound.
• Duration. A migraine attack can last anywhere from a few hours to several days.
• Triggers. Various factors can trigger chronic migraines in susceptible individuals. Common triggers include stress, hormonal changes (such as menstruation), certain foods or drinks, lack of sleep, and environmental factors.
• Difference From Other Types of Headaches. It is essential to differentiate chronic migraines from other types of headaches like tension-type headaches or cluster headaches. This differentiation helps in providing the right treatment approach.
• Impact on Daily Life. Chronic migraines can significantly impact a person’s quality of life, affecting their ability to work, socialise, and engage in daily activities.

If you suspect that you have a chronic migraine issue, consult with doctor for an accurate diagnosis and appropriate treatment plan.

Where Does Migraine Pain Occur?

Migraine pain can occur in different areas of the head, and the location can vary from person to person. Here are the common locations where migraine pain may occur:

• Unilateral. Many people with migraines experience pain on one side of the head, which is often described as unilateral pain. This means the pain affects only one side of the head, either the left or the right.
• Frontal. Some people may feel migraine pain primarily in the forehead or front of the head.
• Temporal. Pain can also be felt in the temples, which are the sides of the head near the eyes.
• Occipital. Pain may occur at the back of the head or at the base of the skull, known as the occipital region.
• Bilateral. Although less common than unilateral pain, some people may experience migraine pain on both sides of the head.
• Generalised. In some cases, the pain can be diffuse or generalised, affecting various areas of the head.

In addition to the head, migraines can also cause other symptoms that are not necessarily related to head pain. These can include:

• Sensitivity to light (photophobia).
• Sensitivity to sound (phonophobia).
• Nausea and vomiting.
• Aura (visual disturbances, sensory changes, or speech difficulties that can precede or accompany the headache).
• Dizziness or vertigo.

It is worth noting that the exact location and nature of migraine pain can vary from one migraine attack to another and can also change over time.

What Causes Chronic Migraines?

Chronic migraines are believed to be caused by a combination of genetic predisposition, neurological abnormalities, and environmental triggers. Factors like hormonal changes, stress, certain foods, and medication overuse can also contribute to the development of chronic migraines.

Identifying and managing these triggers, along with appropriate medical treatment, can help in reducing the frequency and severity of chronic migraine attacks.

What is a Chronic Migraine Specialist?

A chronic migraine specialist is a healthcare professional, often a neurologist or headache specialist, with specialised training and expertise in diagnosing and treating chronic migraines. 

Dr. Mittal and her collaborative team at the Persistent Pain Solutions clinic treat chronic migraines and accordingly, they have in-depth knowledge of the various triggers, treatments, and management strategies specific to chronic migraines. 

Their focus is on providing comprehensive care to help patients manage and reduce the frequency and severity of chronic migraine attacks.

Multidisciplinary Teams For Migraine Management

Multidisciplinary teams for migraine management typically include a range of healthcare professionals with different areas of expertise to provide comprehensive care. 

Some common roles of a multidisciplinary migraine management team include:

• Pain Management Specialists. Focuses on managing pain through medications, injections, or other interventions.
• Neurologists or Headache Specialists. Specialises in diagnosing and treating neurological conditions, including migraines.
• Neurosurgeons. Specialise in providing advanced forms of migraine treatment such as neuromodulation or occipital nerve stimulation.
• Psychologists or Psychiatrists. Addresses the psychological aspects of migraine, such as stress, anxiety, and depression, and provides behavioural therapies.
• Nutritionists or Dietitians. Provides guidance on dietary changes that may help reduce migraine frequency and severity.
• Physical Therapists. Offers exercises, manual therapies, and techniques to improve posture and relieve muscle tension that can contribute to migraines.
• Pharmacists. Ensures proper medication management, including reviewing medications for potential interactions or side effects.
• Sleep Specialists. Addresses sleep disorders or disturbances that can trigger or exacerbate migraines.
• Women’s Health Specialists. Focuses on managing hormonal factors related to migraines. This is especially for women who undergo menstruation or may be undergoing menopause.
• Social Workers or Counsellors. Provides support, counselling, and resources for coping with the impact of migraines on daily life, work, and relationships.

By working together, a multidisciplinary pain management team can develop a personalised treatment plan tailored to your needs, addressing the various aspects of chronic migraine management, including prevention, acute treatment, lifestyle modifications, and psychological support.

How Does a Pain Specialist Treat Chronic Migraines?

Managing chronic migraines usually involves a combination of lifestyle changes, preventive medications, and acute treatments for when a migraine attack occurs. Lifestyle changes may include identifying and avoiding triggers, maintaining regular sleep patterns, managing stress, and staying hydrated.

What Does a Treatment Plan for Chronic Migraines Involve?

A treatment plan for chronic migraines is typically tailored to your specific needs and may involve a combination of approaches to manage and reduce the frequency, severity, and duration of migraine attacks. 

Here is what a comprehensive treatment plan for chronic migraines may involve:

• Exclusion of pathology. The first step is to undergo a thorough evaluation which may include further investigations such as CT, MRI and blood tests, to ensure there are no other reversible causes for the headaches.
• Collaboration. This is very important to ensure that all aspects of migraine treatment are being addressed. Dr Mittal may refer you to one or more specialists/ allied health professionals depending on your requirements and previous treatment trialled.
• Medication Management.
  • Preventive Medications. These are taken regularly to reduce the frequency and severity of migraine attacks. Examples include beta-blockers, anticonvulsants, antidepressants, and CGRP inhibitors.
  • Acute or Abortive Medications. These are taken at the onset of a migraine attack to stop or reduce its severity. Examples include triptans, NSAIDs, and combination medications.
  • Medication Overuse Management. Addressing and reducing reliance on medications that can lead to rebound headaches or medication-overuse headaches.
• Lifestyle Modifications.
  • Identifying Triggers. Keeping a migraine diary to identify and avoid triggers such as certain foods, drinks, stressors, or environmental factors.
  • Healthy Sleep Habits. Maintaining regular sleep patterns and improving sleep quality. It is important to diagnose and manage conditions such as obstructive sleep apnoea that can contribute to migraines.
  • Regular Exercise. Engaging in regular physical activity, as tolerated and advised by a healthcare professional.
  • Dietary Changes. Following a balanced diet and avoiding potential migraine triggers.
• Behavioural Therapies.
  • Cognitive Behavioral Therapy (CBT). Helps in managing stress, anxiety, and coping with chronic pain.
  • Biofeedback. Teaches patients to control physiological functions to reduce migraine frequency and severity.
  • Relaxation Techniques. Includes meditation, deep breathing exercises, and progressive muscle relaxation.
  • Hypnotherapy. Involves identifying the triggers and managing the triggers and sensation of pain.
• Complementary and Alternative Therapies.
  • Acupuncture. Some find relief from migraine symptoms through acupuncture.
  • Herbal Supplements. Although evidence is limited, some people use supplements like magnesium, riboflavin (vitamin B2), or coenzyme Q10 for migraine prevention.
• Physical Therapy.
  • Manual Therapies. Techniques like massage and myofascial release to relieve muscle tension and improve posture.
  • Exercise Programs. Tailored exercises to improve strength, flexibility, and posture, which can help reduce migraine frequency.
• Botox Therapy. For patients who do not have an adequate benefit from oral preventative migraine medications, or are limited by side effects from oral medications, targeted botox therapy can be used to obtain positive benefit. Certain criteria would need to be fulfilled for Botox therapy to be administered under the Pharmaceutical Benefits Scheme (PBS). 
• Intravenous Infusions. Lignocaine infusions performed as an inpatient over 5 days are used for refractory migraines in some cases. Accessibility can be an issue with such infusions.
• Neuromodulation. This included advanced invasive therapies such as occipital or peripheral nerve stimulation or peripheral field stimulation and/ or cervical spinal cord stimulation to manage refractory migraines.
• Management of Co-existent conditions. Often patients who suffer from chronic neck pain due to whiplash injury or cervical spondylosis can have recurrent migraine attacks or exacerbation of chronic migraine. Chronic neck pain would require specific treatment on its own merit depending on the underlying cause of the chronic neck pain. Other conditions that can impact chronic migraines include temporomandibular joint dysfunction, bruxism and occipital neuralgia.
• Psychological Support.
  • Counselling or Therapy. To address emotional and psychological aspects of living with chronic migraines, including stress, anxiety, and depression.
  • Support Groups. Connecting with others who have migraines can provide emotional support and practical coping strategies.
• Education and Self-Management.
  • Patient Education. Understanding migraine triggers, medications, and self-management strategies.
  • Self-Care Techniques. Learning relaxation techniques, stress management, and self-care practices to manage migraine symptoms.
• Regular Follow-up and Monitoring.
  • Monitoring and Adjusting Treatment. Regular follow-up visits with healthcare professionals to monitor progress, adjust medications, and make necessary changes to the treatment plan.
  • Migraine Diary. Continuously tracking migraine frequency, triggers, and response to treatment to refine the management plan.

It is essential to work closely with your doctor to develop a personalised treatment plan that addresses your unique needs and preferences. Treatment may require trial and error to find the most effective combination of therapies for managing your chronic migraines effectively.

The Challenges of Living with Chronic Migraines

Living with chronic migraines presents numerous challenges that can significantly impact a person’s quality of life. 

Constant pain and frequent attacks can lead to difficulty in performing daily activities, work, and social engagements, while the unpredictability of migraine attacks can create anxiety and fear of when the next episode will occur. 

Managing medications, treatments, and lifestyle modifications to control migraines can also be complex and time-consuming, requiring ongoing effort and adjustment.

How Do I Find a Migraine Specialist Near Me?

Finding a pain specialist who treats chronic migraines in your area starts with discussing your health concerns with your general practitioner. They can evaluate your symptoms, provide initial treatment or pain relief, and refer you to a doctor who focuses on pain management.

Your friends and family may also be helpful. Look for recommendations from friends, family members, or colleagues who have experience with migraines or other headache pain issues. They may be able to recommend a migraine specialist in your area.

Hospitals or medical centres in your city or region may also offer migraine treatment or neurology services. They may have dedicated pain centres or clinics staffed by pain specialists who understand how to treat chronic migraines and similar issues.. These facilities often have multidisciplinary teams of experts who are familiar with the latest and greatest treatment options. 

A migraine specialist should assess your symptoms, study your medical history, and listen to your treatment preferences. From there, your doctor will create a plan designed for your unique challenges and health concerns.

If you are in Melbourne or the surrounding region, contact the Persistent Pain Solutions clinic to connect with Dr Mittal who can help diagnose your exact migraine issues and more importantly, help you find relief.

Persistent Pain Solutions for Chronic Migraines

The Persistent Pain Solutions clinic in Melbourne is deeply committed to providing compassionate care to every patient who arrives at the Persistent Pain Solutions clinic seeking relief from their migraines (or any other type of chronic pain).

Dealing with migraines takes a massive emotional and physical toll on patients and their loved ones, which is why we offer empathy, understanding, and support in every interaction we have with you. 

At our Melbourne clinic, you’ll discover a welcoming, healing environment where your voice is heard and your priorities are paramount. Dr Mittal focuses on understanding, engaging, and evaluating your migraine issues and any related conditions. Together, we will develop personalised treatment plans tailored to your needs and goals.

We are the first step on your journey to relief from migraines and towards a more fulfilling everyday life.