I'm Dr. Jessica Ailani, director of the MedStar Georgetown Headache Center. I see patients in
McLean, Virginia, and Chevy Chase, Maryland. So, I take care of headache patients. The bulk of
my practice is focused on migraine patients, but we do see other types of headache disorders as
well. Patients who have post traumatic headaches, occipital neuralgia, tension headaches, and a
variety of other very rare disorders in the world of headache itself. What makes the Headache Center
at MedStar Georgetown unique from other headache centers, which is seeing a primary care doctor or
general neurologist, is that we focus a lot on you as a person, that what makes all of us unique can
also make our treatment options very unique. And, our plans are catered towards the person that
we're seeing. So this might include a variety of prescription options. But, this might also include
physical therapy, acupuncture. This might include some lifestyle changes that we have to discuss.
This might include procedures like nerve blocks or Botox to help try to improve the frequency
and severity of your headaches. And this plan is not the same for everybody. It's very much
catered to the person in front of us, the story that you're telling us, and what's acceptable to
you as a person. The last 10 years of headache medicine has been really exciting, and the next
two to three years is extremely promising. There's been a number of new treatment options that have
come out in the last few years, and there's a number of treatment options that are going to
come out in the next one to two years. So if you haven't seen somebody in the last several years
because at some point you didn't do well on the treatments that are available, this is a good time
to check in again and to talk about what are some of the newer options that have come out since you have
last seen someone. I enjoy what I do because I really get to be a part of so many people's lives
and get to hear their stories, to get to, you know, spend part of their life journey with them. And I
really get to make an impact in taking care of them and making their life better, to take some of
their burden away from their suffering. I think that's probably the best part of my everyday.
Migraine is a brain disease that is partly related to what your genes are.
So what happens in your mom or dad or your grandparents can be inherited on
to you, where your brain is a little bit more sensitive to changes that occur in
the environment that start a cycle of changes in the brain that cause not only headache, the
kind of headache that you might get because you missed a meal or you were really stressed
out, but other symptoms. And these other symptoms are really what defines migraine.
So the symptoms of migraine are having headache but also having upset stomach, vomiting, light
and sound sensitivity. The headache is often one-sided, but it can be both sided. And, it can
come with a throbbing type or stabbing type pain. Physical activity will make it worse, so
going up and down stairs, walking around the hallway, you'll feel a lot worse. Basically if
you're getting a headache, and you want to be in a dark quiet room away from everybody else,
laying down, and maybe taking a nap, it's probably more of a migraine than another type of headache.
There's a type of migraine aura where you can get symptoms that are neurological in nature. So
the brain gets overactive and starts a change that can cause vision changes or cause sensory
changes. You can feel tingling on one side of the body or like a crawling sensation. You can
get weakness on one side of the body. You can get speech changes. You're stuttering, or it's
difficult to get the right words out. Or, you think you're saying something, but the person
next to you has no idea what you're saying. These kinds of brain changes can actually
occur in migraine. Sometimes, they can come before a headache actually starts, up to an hour before.
Sometimes, you don't really get a severe headache after, or you might not even get a headache after.
This is something that we can see when people get these vision changes first. They see little
flashes or dots, and they don't actually have a headache after. It's very frightening to have these
kinds of symptoms. You can be very concerned about what's happening. Am I having a stroke? And I will
say the first time something like this happens, it's important to get emergency treatment just
to be evaluated and make sure that there's nothing else that's going on that's causing
it. But when we look at these symptoms as a whole and we put the picture together with the
patient and we know that there's a normal exam, it's likely that you might be having a migraine.
Sometimes, migraine and stroke can look very similar, especially when you're getting a
migraine where you're getting weak on one side, and you're having difficulty speaking. You're
having trouble moving an arm or a leg. In these cases, if this has never happened to you before,
it's important to go to the emergency room for an evaluation. But if this is something that you've
had evaluated before and it keeps happening, it's very possible that you're having migraine
with aura. The aura being a neurological symptom that comes with migraine itself.
So there's a variety of treatment options available for migraine. The way we treat migraine,
again, is looking at a person as a whole. There's lifestyle things that can happen that can make
migraines more often, what we call triggers. Changes in the environment like stress, not eating, skipping
meals, being dehydrated. These things are known to trigger migraines. So the first thing we talk
about is managing your life a little bit better, Regular sleep. Regular eating habits. Trying to keep
yourself hydrated. Try to actively manage stress. We all have stress. You can't take that away, but you
can make how you respond to it better. Exercise is a great way to get rid of stress. Deep breathing
relaxation techniques when you first get home or when you're stressed at work is another way to bring
that stress level down. And this can help stop that cycle that's going to happen with migraine.
Of course, this isn't enough. Studies have actually shown that lifestyle changes can improve migraines.
But sometimes, you need more help. So, we can start you on what we call a preventive medicine to try
to reduce the frequency and severity of headaches. And, this is often a prescription drug, or in some
cases, can be a procedure that helps reduce how often you're
actually getting headaches. When you do get a migraine or a different kind of headache, it is
important to treat at the beginning. Because if you start to have symptoms and they get out of
control, the longer you have symptoms, the longer it can go on for. And migraine is known to be able
to last up to 36 hours, so that's almost three days of feeling really terrible, being ill,
and not really being able to function. And so in those cases, we can write you for medications to
try to stop the headache within the first two hours, so it doesn't continue to go on.
So migraine is a brain disease, as I mentioned earlier, that can be caused by genetic changes.
So, you have inherited from your mom or your dad or your grandparents, a brain that's a
little bit more sensitive to being sent into a cycle that happens. That cycle can
be what we call triggered or set off by changes in your environment. So, changes
in the environment like stress, having your period if you're a woman, not eating
or drinking on time, having too much caffeine, big weather changes like a big storm. These are
common triggers or environmental changes that can start that cycle of migraine.
So the difference between migraine and other headaches are the symptoms that
come with migraine, that upset stomach, the light and sound sensitivity, worsening with
activity. These things are very unique to migraine.
So migraine is treated with a variety of different methods. There's lifestyle changes,
making your life a little bit more regular to try to reduce your ability to start a migraine
because of triggers. There's medicines that you take to prevent migraines if they're happening
frequently. These are medications that are taken on a daily basis to try to reduce
the frequency and severity of headaches. And then there's medicine you take as needed when
you're getting a migraine itself, so things like abortive medicine. You take it within
the first two hours, and it should help reduce or completely stop the migraine from getting worse.
So our current treatment options are about 65% effective. And what I mean by that is about six
to seven people out of ten, will reduce how often they're having migraines because of the treatment.
Also six to seven people out of ten will have improved symptoms when they take the medicine
immediately when they're having a migraine. So, it doesn't work for everybody, and that's
what makes it important to really work with your healthcare provider to find a good fit.
So studies suggest that once you're having headaches four days a month or more, your
disability from migraine really increases. That's usually the point we start to have
a conversation about what can we do to make these less often. Do we need to put you on a
prescription medication? Do you need to try to do more things to change your lifestyle
to improve some of the trigger targets? if you find that your migraines are very
disabling, even if they're only happening once a month, it might be another time that we have
a conversation about how can we make this less frequent because they're so disabling to you.
So most women who have migraines, about 60% so six out of ten, will notice that they get
migraines more often around their periods. For some women, a smaller group of this, they're
only getting migraines around their periods. And if you're only getting migraines around
your periods, you can consider hormonal options, so being on a type of birth control continuously
so you skip your periods to try to skip that time period in your cycle where you're having
changes in hormones that are triggering migraine. There are other treatment options as well if the
idea of being on hormones are frightening or not something you can do because of your
medical history or not something you want to do, where we really tailor treatment to taking
medicine only around the time of your period to try to prevent the migraine from happening.
So, some of the benefits of being treated at an academic headache center is that, one, we have
more time to spend with you, with your records, to really talk out what is important to you, what are
your goals, how can we work together towards that. Two, is that we're often very active in
our world of headache. We go to a lot of our meetings. We speak at our meetings. We educate
residents. We're educating medical students. We're educating other providers. So, that really pushes
us to always be the very best we can be in the field. We're pretty much aware of all
the new treatment options and well connected about when they might be coming out and when
there'll be an option for you, what the latest data is. And, we're very open to having these
conversations with you, and I think that makes it unique compared to a different kind of center.
So, we get concerned that something is more serious when, if you've had headaches before, and they've changed.
And this is different now. They don't feel the same. They're acting differently, or you start
to get new symptoms that you haven't had before. Like, you never had aura and now you're starting
to see visual flashes or having weakness. We get concerned when you start getting headaches and
you never have them before, and you're above age 50. That gets us concerned for other problems like
cancer or certain types of infection that can be causing headaches that look like migraine or
other types of headache disorders, but they're really related to something else. There's other
symptoms and signs we get worried about. You're getting a headache for the first time, and it's
the worst headache you've ever had. Or really, any time in your life it's the worst headache
ever. It can be a sign of another emergency situation. If you're getting a headache for
the first time in the setting of a high fever, and your neck is stiff. Again, we're not really
thinking of migraine in this case. We're thinking more that there's an infection that might be
causing a headache. With these lists of signs and symptoms that, you know, most doctors and
nurse practitioners and providers are well aware of that usually sends a message to us saying oh
you said this right word. We really need to send you for some emergency testing and make
sure it's not something else. Also when we're doing a neurological exam, certain things come
out that tell us that this might not just be a migraine. That your arm isn't moving
the way it should be moving, or I see something when I'm looking in your eye and I'm concerned
there might be something else going on. So, you need some further testing at that time.
So, a cluster headache is a unique type of headache disorder that occurs in less than 1% of the
population. It is one of the most intense types of headaches. It's often one side, around the eye, and
it comes with tearing. So the eye tears. It can get red. Usually, the headache is short. It lasts 10
to 15 minutes, up to 90 minutes, but a much shorter time period than a migraine which
can go on for four hours or up to a couple of days. The pain is so intense, people feel a need
to pace or move or even hit their head against the wall just to try to distract from the pain.
And they can't stop themselves from this movement. It's part of the actual diagnosis itself. The
headaches themselves can occur multiple times in a day. And it can last for two weeks, or it
can go on for a couple of months. It's more often that it's going to be only a few weeks long, and
they can go away for several years and then come back again. Or, go away for about a year and come
back again the same time the next year which makes it very unique to this headache disorder.
A cluster headache is not a migraine. It's a completely different type of headache. But
patients with migraine, a small portion, can actually get cluster headaches as
well, and a small portion of patients with cluster headache can develop migraine later
as well. So it's important to understand the differences between these diseases
and to understand the symptoms that make them different from each other.
There are a variety of treatment options out there for cluster headache. There's
actually been some new FDA treatment options that were just released this year, so that's
really promising in the world of cluster. For a long time, there wasn't much different or much
new things going on. And not only are there some new options that have come out, there's
new things that are coming out in the next few years as well. So, it's an exciting time.
So low-dose aspirin isn't really a recommended treatment for the prevention of migraine, but
aspirin is very well known to help when you're having a migraine. So your most
common over-the-counter medication which is acetaminophen, aspirin, and caffeine, the
combination exists because of the reason that it is so effective. So it can help when you're having
a migraine, but it's not known as a routine to really prevent migraines from happening.
So current research does not recommends being on a low-dose aspirin to prevent stroke just if
you only have migraine with aura. The data actually suggests, one, the risk of stroke
with migraine with aura is low. It is there, but it's very low. So low, that the risk of having a
stomach upset or stomach bleed because of being on a low dose of aspirin every
day is greater than that risk of stroke. So for this reason, we don't recommend being on a low
dose aspirin to prevent stroke if migraine with aura is your only stroke risk factor.
When you have migraine, you feel very alone. It's an extremely isolating disease where you don't want
to talk about it to your friends, to your family. You might feel embarrassed by the situation. You
don't want to talk to your friends and your colleagues at work to talk about the symptoms
that you have. So it's very easy to feel like you're the only one who's suffering. But you're
not alone. In the U.S. itself, there's over 36 million people who have migraine. So it's
really important that you understand that even at your moments when you feel like you're all by
yourself, you are not the only one who has this disease. And it's important when you're feeling
alone to remind yourself that you've got friends and family that you can talk to who are going
to want to support you through your journey with migraine. And if you have further questions about
this or you want to do more to advocate for the world of migraine, visit AmericanMigraineFoundation.org.
There's a lot of information out there about migraine, and there's a lot of ways
that you can help talk more about this disease so you don't feel like you're by yourself anymore.