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Migraine: Not just a headache

Neurological disorder of migraines eased by new, specific medications

Dr. Tracy Vargas, left, a neurologist at UCHealth Neurology Clinic in Steamboat Springs, discusses an injectable medication option to prevent migraines with Susan Woodring, of Steamboat Springs. More than 30% of Vargas’ practice focuses on treating patients with headaches, with 95% of those patients experiencing migraines. (UCHealth/courtesy)

The first thing that neurologist and certified headache specialist Dr. Marius Birlea wants people to understand about a migraine is that the condition is a neurological disease.

When family members or colleagues hear a person has a migraine “headache,” that does not accurately explain the often-debilitating neurological condition that can include intense headaches, nausea, sensitivity to noise and light, as well as possible vomiting, visual disturbances and other symptoms. Dr. Birlea estimated that 200,000 people living in Colorado suffer from migraine disorder, which equates to 40 million people in the U.S., or 12 to 15% of the general population. Experts say more than 90% of sufferers are unable to function during migraine episodes.

Fortunately for serious or chronic migraine patients, who can suffer from the pain multiple times per week, the past three years have seen significant breakthroughs in prescription medicines specifically for migraine disease. Researchers have developed migraine medications that block the neuro pathway for calcitonin gene-related peptide, or CGRP, a protein that is released around the brain that causes activation of pain signals in the brain, Birlea said.



Advances in medicines now helping migraine patients come in three new categories that target the CGRP pathway: patient-administered monthly injections for migraine prevention, daily pills for prevention, and new effective pills for acute therapy when a migraine starts. In the past, medications developed for other conditions — such as blood pressure drugs, antidepressants or epilepsy medications — were used by patients but were not specific to migraines. Some of those treatments caused intolerable side effects for patients.

“After three decades of research, now we have something that specifically targets the migraine pathways CGRP, and we can do that preventatively … so that migraines are less frequent and severe,” explained Birlea, with the UCHealth Neurosciences Center on the Anschutz Medical Campus in Aurora. “It’s excellent for patients to have other options. Now we have these therapies that work and are well tolerated with less side effects.”

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Dr. Marius Birlea is a neurologist and headache specialist at the UCHealth Neurosciences Center on the Anschutz Medical Campus in Aurora.

Dr. Tracy Vargas, a neurologist at UCHealth Neurology Clinic in Steamboat Springs, said the majority of her patients trying the new medications “have noticed significant reduction in headaches.”

For Routt County residents who suffer from migraines, the neurologists say lifestyle changes that may help prevent attacks include exercise, relaxation work and understanding triggers. Patients should stay well hydrated, not skip meals and get sufficient sleep. Other migraine triggers in adults can include alcohol, weather changes, schedule changes, teeth grinding at night, hormonal changes and psychosocial stressors.

Researchers believe that 90% of the time, migraine disease is inherited or has a genetic component and is three times more common in women than men, especially during a woman’s reproductive years. Researchers have found that migraine patients may experience a prodromal phase, or precursor signals, one or two days in advance, such as mood changes, light sensitivity, yawning, food cravings and cognitive dysfunction.

Migraine support starts with a primary care doctor who should rule out other possible red flag issues. A migraine patient who does not receive relief through primary care can be referred to a neurologist or a headache center.

Patients can seek out a headache specialist who is certified through the United Council for Neurologic Subspecialties. Colorado currently only has seven of these certified specialists, which are all located on the Front Range.

Birlea said the headache clinic at Anschutz opened in 2013 and has grown to include five physicians and five nurse practitioners who see some 1,000 patients per year and have a five- to six-month waiting list for new patients. The clinic serves about half of patients through the remote tele-medicine visits.

Both neurologists say patients should not use over-the-counter or acute migraine medications or caffeine frequently each week because that can cause rebound migraines.

“If you are needing that more than two or three times a week, then you need to be on a preventive therapy,” Vargas said. “When you get to that stage, it’s best to see a neurologist to help with a tailored approach to your preventive migraine treatment.”

The doctors warned that women age 35 or older who have migraines with the precursor visual symptom of auras are at higher risk of stroke, especially if they also smoke and take estrogen-containing hormones or birth control pills. Sufferers of migraines with auras who are older than 45 and also have high blood pressure, obesity and diabetes also are at more risk of stroke.

The Front Range headache specialist said migraine sufferers — whether they be employees on the job, women or moms — should not have to “suck it up” and endure through the pain. He encourages patients to advocate for themselves and review the migraine bill of rights found at HeadacheMigraine.org under the “Community” tab. One of the tenants in the bill of rights notes, “Educate and work to correct the culture that penalizes people with severe headache, migraine and cluster disease.”

He also recommends the nonprofit Miles for Migraine that raises awareness that migraine and similar disorders are more than just a headache.


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