What Is Your Migraine Profile?

Factors your doctor will consider when devising your unique treatment plan

Everyone experiences migraines differently. Therefore, caring for a person with migraines requires an individualized—rather than an algorithmic—approach. This means that when you see a neurologist or headache specialist for your migraines, they will likely delve into a discussion of various factors in order to best sort out your unique migraine profile.

Here are some factors your doctor will likely address.

Age

Age is a big factor when it comes to diagnosing and treating migraines, especially when it comes to migraines in children versus adults.

While migraines in children share some features with migraines in adults, they also have their own unique features. For instance, children often experience migraine headache pain on both sides of their head, as opposed to one side of the head in adults. Moreover, along with their migraine headache, children experience unique symptoms not typical of an adult migraine.

Associated Migraine Symptoms in Children

  • Abdominal pain
  • Osmophobia (sensitivity to smell)
  • Vertigo
  • Autonomic symptoms—runny nose, tearing eyes, facial sweating, etc.

The treatment of migraines is also different between adults and children. Some children and adolescents will not respond to typical adult migraine medications, like ibuprofen or certain triptans.

Instead, pediatric headache specialists tend to focus on more unique migraine therapies like minimizing stress through relaxation techniques and meditation, formulating a migraine action plan at school, and ensuring proper sleep and eating schedules.

Family History of Migraines

Migraines are hereditary, meaning this disorder tends to run in families. In fact, according to the American Migraine Foundation, if one or both of your parents has migraines, you have a 50 percent to 75 percent chance of having migraines too.

With that, talking to family members with migraines about their attacks can be helpful, considering that migraineurs within the same family often share symptoms and triggers. In addition, it's interesting to note that migraine medications that work for one family member often tend to work for other family members.

Of course, after speaking with family members, be sure to share this information with your doctor.

Migraine Pattern

Prior to going to your doctor's appointment, it's a good idea to jot down notes about the pattern of your migraines.

Pattern Factors to Consider

  • Time of day: Do your migraines begin in the morning after waking up, afternoon, evening, or middle of the night?
  • Number of migraines: Are you experiencing migraines more than fifteen days per month (this is indicative of chronic migraine)?
  • Associated symptoms: Do you experience nausea and/or vomiting with your migraines, and are these symptoms more or less debilitating than the actual migraine headache?
  • Aura: Do you experience an aura with your migraines?
  • Triggers: For example, certain foods, weather changes, sleep deprivation, skipping meals, strenuous exercise.
  • Hormone connection: For women, do your migraines occur just prior to menstruation and/or did they worsen or improve during pregnancy, perimenopause, etc. (if applicable)?

The latter point—hormone connection—can be extremely important for women. For instance, if a young woman notes her migraines are worse before menstruating (called menstrual migraine), a doctor may prescribe continuous birth control pills or a medication like Frova (frovatriptan) taken five or six days prior to menstruation.

Alternatively, if an older woman reports a worsening of her migraines with menopause, hormone replacement therapy may be an option (if the doctor suspects estrogen depletion as the culprit). Or your doctor may delve into the woman's lifestyle—for instance, her mood and sleep changes—which may be more likely explanations for her worsening migraines.

Medication History

Migraine medications consist of two classes of drugs: treatment and preventive. Determining exactly what medications you have tried and what has worked or not worked for you is a key part of your migraine profile.

Treatment Drugs

Some questions your doctor may ask you about your migraine treatment medications include:

  • What do you take when you develop a migraine—nonsteroidal anti-inflammatory (NSAID), triptan, a combination NSAID/triptan, an herbal supplement, or nothing (you wait for your migraine to pass on its own)?
  • How often do you take one or more of these above medications a week?
  • Do you take the medication right at the onset of your migraine?
  • Is the medication tolerable and effective?

By better understanding the nuances of your migraine medication use, your doctor can tease out your unique migraine profile. For instance, perhaps she will be able to decipher whether you may be suffering from medication overuse headache in addition to your migraines or whether the side effects of the medications are limiting their use.

Prevention Drugs

Traditional episodic migraine preventive medications—such as a blood pressure medication called Inderal (propranolol), an antidepressant called Elavil (amitriptyline), and an anti-seizure medication called Topamax (topirimate), amongst others—are wrought with side effects and require months before a benefit is seen.

Likewise, Botox is a reasonable option for chronic migraine, but can be pricey and require some hoops to jump through before obtaining insurance approval.

The good news is that there are three new migraine therapies approved by the FDA for treating both episodic and chronic migraine:

These drugs are injectables and target a protein that plays a major role in migraine pathogenesis, called calcitonin gene-related peptide (CGRP). These drugs have many advantages, but they are generally only approved for use if a person has not tolerated prior preventive medications.

Underlying Medical Conditions

Your medical history is a major factor when considering your migraine care. Imagine a healthy person suffering from migraines versus a person with multiple medical problems like uncontrolled high blood pressure and kidney disease. Even if they share similar migraine symptoms and disabilities, the treatment plan will differ based on these underlying medical problems.

Sorting out a person's migraines from an alternative or additional diagnosis can be complex and therefore requires a thoughtful discussion with your doctor.

For instance, while a doctor may consider treating a healthy person with no medical problems with a nonsteroidal anti-inflammatory (NSAID) or a triptan for her migraines, these drugs would not be an option for that person with uncontrolled high blood pressure and kidney disease.

Preventive migraine care is also affected by a person's medical history. For instance, the novel anti-CGRP drugs have not been studied in pregnancy, so these drugs would not be an option for a woman who is pregnant or considering pregnancy in the following few months.

Finally, sometimes what people consider to be their usual migraines are actually headaches occurring as a result of another condition, like sleep apnea, high blood pressure, or thyroid disease. Moreover, certain health conditions, like obesity, may even be worsening your migraines.

Lifestyle

Your daily habits and general lifestyle can affect your migraine experience, whether they are triggers, contributors, or interacting with therapies.

Questions Your Doctor May Ask

  • Do you consume caffeine, including coffee, tea, chocolate, and energy drinks, and if so, how much?
  • How much alcohol do you consume on a weekly basis?
  • Do you exercise every day?
  • What is a usual daily meal plan for you?
  • Do you engage in any mind-body therapies, like yoga or meditation?
  • What medications do you take every day, including supplements, herbals, and vitamins?
  • Do you see a primary care physician regularly?

In the end, while migraines do not define you, they are a part of your life. Perhaps getting to know the ins and outs of your daily routine may reveal a new migraine culprit or something about your lifestyle that is negatively impacting your migraine health.

A Word From Verywell

Migraine is a complicated, neurological condition, so do not let the burden of this condition rest on your shoulders.

See a headache specialist and beforehand, write down the factors that comprise your personal migraine profile. By understanding the depths of your migraines, your doctor can best treat your migraines, with the ultimate goal of giving you back the life you deserve.

Keep in mind too, when you are reviewing your unique migraine profile with your doctor, there is no right or wrong feeling or answer. Be yourself and be honest—this way you can work together in creating a treatment plan that works best for you.

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Article Sources
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