Migraine Headaches – Diagnosis and Treatment

Orthopaedic & Spine Center
Image of Dr. Mark McFarland

Mark W. McFarland, DO

In the last article, I discussed the causes, triggers, symptoms and the four phases of migraine headaches.  In this article, my focus will be the diagnosis and treatment of migraines.  As an orthopaedic spine physician, I already perform many interventional procedures for chronic pain, such as epidural steroid injections.  I will be providing BOTOX injections not only for migraines, but also for cervical dystonia, which is a disorder that causes patient’s necks to twist and contort unnaturally.  These additional services will expand the number of patients that we can treat at OSC who are currently waiting months to get treatment elsewhere.

Having laid the groundwork for what a migraine headache is and isn’t, it should be pretty obvious to any headache sufferer if their headache falls into the migraine category or not.  When I talk to patients, they typically can describe the symptoms and phases of an average migraine to me quite well.  However, migraine sufferers also have less severe, more normal types of headaches frequently.

That’s why it is very important for my patients to carefully track their headaches for a month on a chart.  I ask them to log which days they have a headache, if it is a migraine or not, and for how long it lasts, or if they were totally headache free.  At the end of a month, we have some very telling results. It is very important that the results be well chronicled so that we know how to best proceed with treatment.

Severe chronic migraine sufferers typically have at least eight or more days that are associated with a migraine per month.  Remember, there are four phases to a migraine headache (predome, aura, headache and postdome), so potentially the entire headache could last for days.  In addition, they will usually have seven or more days of headaches a month that aren’t migraines.  Their headaches, no matter what variety, will last four or more hours, every time they have them.  These patients are severely affected by their disease and will qualify for the use of BOTOX injection to treat their disease as the treatments are very expensive.

Moderate to mild migraine sufferers have less days of headache activity, with fewer migraines, less intensity and shorter duration.  These patients are treated with acetaminophen or NSAIDS as well as prescription oral or injectable drugs that work to either stop the migraine once it has started or the prevent the migraine from occurring in the first place.  This type of treatment is typically handled by the patient’s PCP or a Neurologist.

After a patient qualifies for BOTOX injections, they will schedule appointments with me, my nurse practitioner or physician assistant every three months to get the injections on a regular basis.  That’s because the medication wears off after this period and the chances of having more migraines increases when this happens.  After a while, the medication will help to prevent migraine attacks from occurring.  The research indicates that patients can see as many as 8-9 days fewer headache days in a month, which is a quite substantial reduction.

The injections take about 10-15 minutes.  The patient will be injected with BOTOX in the shallow muscles in their forehead and scalp area.  There is a specific pattern that research has proven to be effective for treating migraines, and that is the pattern we use all the time, for everyone.  The needles we use are tiny and short and have the circumference of about 5 human hairs.  The 32 injections are very tolerable and feel like little pinches.  There is a small risk of bruising, but as most of the injections will be done in the scalp that is covered by hair, this is typically not an issue.

Before leaving the office, the next injection appointment will be made for approximately three months, to keep the patient on schedule.  After the injections, the patient is free to leave, drive, return to work or their other activities.

As with all medications and injections, there are risks for complications and side-effects.  All risks and side-effects will be explained and outlined in written material provided to the patient before treatment is approved.