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Migraines are responsible for about 1.2 million emergency room visits each year, and more than 90% of sufferers experience head pain and neurological symptoms so severe they can’t work or function.

Migraine is a genetically influenced complex disorder characterized by episodes of moderate-to-severe headache, most often unilateral and generally associated with nausea and increased sensitivity to light and sound.

Classifying headaches as primary (migraine, tension-type or cluster) or secondary can facilitate evaluation and management. A detailed headache history is very important to distinguish among the primary headache disorders.

“Red flags” for secondary disorders include sudden onset of headache, onset of headache after 50 years of age, increased frequency or severity of headache, new onset of headache with an underlying medical condition, headache with other systemic illness, focal neurologic signs or symptoms, swelling of the optic nerve, and headache after head trauma.

When you hear “migraine,” you may think of a severe headache. But migraine is more than just a headache—it is a debilitating neurological disease that comes in many forms, both with and without a headache.

What are some types of migraines?

Migraine With Aura, Migraine Without Aura, Migraine Without Head Pain, Hemiplegic Migraine, Retinal Migraine, Chronic Migraine, Abdominal Migraine, Migraine “Let Down” Headache, Ice Pick Headache (Primary Stabbing Headache), Cluster Headache, Cervicogenic Headache and status migranosus (a rare and severe type of migraine that can last longer than 72 hours).

How are headaches diagnosed?

A thorough neurologic examination will be performed, with abnormal findings warranting neuroimaging to rule out intracranial pathology. Magnetic Resonance Imaging (MRI) is more extensive than CT scanning, reveals more detail, and is necessary for imaging the posterior fossa.

A referral to a neurologist is appropriate for patients with headaches that are difficult to diagnose, or that worsen or fail to respond to management.

What treatments are available for chronic headaches?

Treatment options for migraines are mainly divided into acute and preventive medications and treatment options such as BOTOX injections, nerve blocks and trigger point injections or neuromodulating devices.  Acute medicines, taken when a migraine attack occurs to treat the symptoms. Acute medicines for migraine are taken to stop or shorten the symptoms of a migraine attack. They are taken once an attack starts, not beforehand, and should have a quick effect on the migraine attack. Preventive medicines (also known as prophylactics) for migraine are taken to prevent migraine attacks. They are taken every day and are aimed at preventing migraine attacks altogether or at least reducing their frequency and severity. If you are having at least four migraine attacks per month you may wish to discuss preventive medications.

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