Migraine Headaches


Migraine Causes

There is no definitive cause for migraines, but some studies indicate a genetic link may be a factor. Some researchers believe that the trigeminal nerve, which controls feeling for much of the face and head, can be overstimulated by certain nerve cells. This causes a chemical cascade within the brain which causes blood vessels to enlarge, which then causes a release of neurotransmitters, resulting in inflammation and pain. 


Migraine Risk Factors

  • Being female – women get migraines three times as often as men
  • If one or both parents had migraines
  • Age between 10-50
  • Medical conditions, such as:
    • Epilepsy
    • Depression
    • Sleep Disorders
    • Anxiety
    • Bipolar disorder

Common Migraine Triggers

The most often seen triggers are listed as follows, but this is not all-inclusive:

  • Hormonal Changes in Women
  • Stress/Anxiety
  • Loud noises
  • Bright or flashing lights
  • Strong or unpleasant odors
  • Too much or too little sleep
  • Sudden changes in the weather
  • A variety of foods and beverages
  • Tobacco
  • Skipping meals
  • Too much/too little caffeine

The Four-Phases of a Migraine Headache

Migraine headaches are different than regular headaches in that they have four distinct phases.  A person does not have to have every phase each time they suffer a migraine, but these phases are part of the migraine headache cycle and differentiate them from a run-of-the-mill headache.

Phase I is called the Prodrome Phase and it occurs up to 24 hours before the headache begins.  The signs and symptoms are weird and include increased urination, food cravings, mood changes, uncontrollable yawning, and fluid retention.  Researchers have not been able to explain these symptoms.

Phase II is called Aura Phase and those who experience it see flashing or bright lights and/or zig-zag lines and may feel like they are being grabbed or touched.  This can happen before or during the actual headache phase.

Phase III is called Headache because this is when the throbbing or pulsing head pain starts, typically on one side of the head.  Occasionally, a migraine will not involve head pain, but will include nausea and vomiting, sensitivity to light, sound and smells, worsened pain with movement of any kind.

Phase IV is called Postdrome, or after the headache has passed. The person will feel physically weak, extremely tired and even confused for up to a day after the migraine has ended.

Types of Migraine

Patients who have migraines reported so many variations that researchers had to come up with types to classify them all to make them easier for physicians to diagnose and treat. They are as follows:

  1. Migraine without aura (common)
  2. Migraine with aura (classic)
  3. Abdominal migraine – usually seen in children, with nausea, vomiting and stomach pain
  4. Vestibular Migraine – with or without headache, balance problems, vertigo, nausea and vomiting. Typically occurs to those who suffer from motion sickness
  5. Silent (Acephalgic) Migraine – Aura symptoms with no headache.
  6. Ophthalmic (retinal or ocular) Migraine – Causes temporary, partial or total loss of vision in one eye, with accompanying ache behind the affected eye. The headache may spread to the rest of the head.
  7. Hemiplegic Migraine – Temporary weakness or paralysis (hemiplegia) on one side of the body, which may be accompanied by numbness, vision issues or weakness. May be confused with a stroke, so medical attention should be sought.
  8. Brainstem Aura Migraine – This type is linked to hormonal changes in young adult women. Confusion, loss of balance and dizziness may occur before the headache, which starts in the back of the head. Vomiting, ringing of the ears, and trouble speaking are often observed. Symptoms will come on rapidly and medical attention is advised.
  9. Ophthalmoplegic Migraine – This type is characterized by vision changes, such as blurred or double vision or droopy eyelids. It is a medical emergency, as it involves pain around and possible pressure on the nerves behind the eye. It can also signal an aneurysm.
  10. Status migrainosus – This migraine often lasts 72 hours or more and often requires hospitalization for the intense pain and nausea involved. Medications may cause them.


Download the Migraine Tracker Tool.


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. Patients typically can describe the symptoms and phases of an average migraine.  However, migraine sufferers also have less severe, more normal types of headaches frequently.

Patients will need to make an appointment with Dr. McFarland to talk about their migraines and to see if they qualify for BOTOX injections.  That’s why it is very important for patients to carefully track their headaches for a month on a chart.  They’ll be asked 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’ll 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 (prodrome, aura, headache and postdrome), 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. 

Treatment for Migraines

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 prevented 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 Dr. Mark McFarland 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

If patients qualify for BOTOX injections, their insurance will cover the majority of the cost.  98% of insurers cover BOTOX for migraines. The BOTOX Savings Program also helps patients save on their treatments. Go to BOTOXSavingsProgram.com or call 1-800-44-BOTOX.

When a patient is treated with BOTOX injections, Dr. McFarland will inject them with approximately 32 injections into the shallow muscles of their scalp and forehead.  The needles used are very short and tiny in gauge (about the thickness of five hairs). The injections feel like little pinches and are tolerable.  Every patient is injected in the same proven muscle pattern that scientific research shows impacts migraines the most.

The injections take about 10-15 minutes to administer.  There is no downtime afterward and the patient is free to drive and return to work or activities immediately thereafter.  As with any injection of medication, there is a risk for complications, and Dr. McFarland will provide patients an information sheet explaining all of the possible side effects that could occur.  There will be a waiver form for patients to sign before the procedure.

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.

Click here to learn about the Botox Savings Program.

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Call (757) 596-1900, option 5, to schedule an appointment with Dr. McFarland. Visit our Contact Us page for information on office hours. Our office is located in Newport News, VA. We are 40 minutes from Virginia Beach and an hour from Richmond, VA.