Migraine | Symptoms & Treatment | Medstar Health

If you’ve experienced a migraine attack, you know it’s more than just a bad headache. It’s a debilitating neurological condition that, without specialized care, can take over your life. 

MedStar Health migraine specialists are here to help you manage and even prevent migraine attacks with the latest therapies and medications. Our experts are board-certified in neurology and headache—we will hear you, and we will bring deep expertise to your care with a customized treatment plan designed to give you more headache-free days.

Specialized headache care 

Headache specialists across MedStar Health and at MedStar Georgetown University Hospital Headache Center can give you a precise diagnosis and a personalized treatment plan to manage your headache condition. In our care, you’ll be surrounded by experts who rally behind you to reclaim a healthier, happier life.

Symptoms and diagnosis

Migraine is a chronic disorder that causes excruciating headaches and debilitating symptoms that may include:

  • Aura, a warning of an oncoming migraine and may include visual flashes of light, facial tingling, or blind spots
  • Throbbing or pulsating pain on one side or both sides of your head
  • Pain worsens with physical activity
  • Nausea or vomiting
  • Sensitivity to light and noise

If attacks occur frequently and last for more than 36 hours untreated, talk with your doctor about whether you might have migraine or another underlying health condition. If you have a history of headaches and notice a change in the pattern or frequency—or if headaches are accompanied by fever, weight loss, or confusion—see a doctor to rule out other diagnoses. New and severe onset of headaches could be a sign of a more serious condition, especially after age 50.

When to seek emergency care

Go to the emergency room if you have: 

  • The worst headache of your life 
  • “Thunderclap” headache—a sudden, severe headache that escalates to peak pain within a minute
  • Uncontrollable vomiting 
  • New neurological symptoms, such as numbness or loss of strength on one side of the body, vision loss, or vertigo. 

Migraine risk factors

Women are 3 times more likely than men to develop migraine. Attacks can be associated with ovulation, pregnancy, contraceptive use, and other hormonal changes. Other risk factors include:

  • Genetics: 70% percent of migraine patients have a close relative with the disorder.
  • Age: Unlike many neurological disorders, migraine symptoms typically develop in the teen years or early adulthood.
  • Head or neck trauma: Migraine attacks might start after a vehicle accident, fall, or traumatic brain injury.

Types of migraine

Episodic migraine is classified as 14 or fewer migraine days a month, while chronic migraine is classified as 15 or more headache days a month. From there, migraine is diagnosed as either with or without aura.

Migraine with aura

This type of attack will typically start with a change in vision, such as a bright spot that flashes and then turns dark, floats, and becomes difficult to ignore. Some patients experience aura as ringing in the ear, unusual smells, difficulty speaking, numbness, tingling, or dizziness. These signals can be frightening because they’re similar to the onset of stroke. Auras go away quickly but are followed closely by classic migraine symptoms.

Migraine without aura

Most migraine patients do not experience an aura prior to an episode. Pain occurs on just one side of the head, aggravated by routine physical activity. Nausea, vomiting, and avoidance of light and noise also occur.

Migraine and headache - Q&A

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Jessica Ailani, MD, director of the MedStar Georgetown University Hospital Headache Center, answers common questions about symptoms, risk factors, and treatment for migraine and other headache disorders.

Treatment

When over-the-counter pain relievers and self-care remedies no longer work, a neurologist or headache specialist will help you find treatments that target your specific symptoms. Talk with your health care provider before starting a new therapy, especially if you take medication for another chronic condition such as diabetes, heart disease, or cancer.

Prescription medications

Your headache specialist may recommend one or more medications depending on your symptoms. These medications can be combined to target pain, inflammation, and nausea.

Preventive medications

Preventive drugs stop migraine attacks from occurring and can lessen symptoms during a migraine event. Most preventive medications take 6-8 weeks to reach maximum benefit. While this waiting period can be frustrating, it’s important to continue taking your medication as prescribed to assess whether it makes an impact on your symptoms.

Management medications

These therapies work to stop a full-on migraine attack as soon as the first signs appear. The longer you wait to treat, the less likely the medication will work.

Advanced therapies

New, noninvasive treatment innovations are giving patients more headache-free days with chronic migraine. Some of the latest advancements include:

  • Neuromodulation devices: A non-invasive device designed to improve headache by changing brain function from outside the body. There are several different types; though not covered by insurance, they can be helpful as part of a treatment plan to improve headache.
  • Nerve blocks: A medication is injected near the occipital nerve in the back of the head to reduce migraine pain.
  • Botulinum toxins: Botox has been FDA-approved to treat chronic migraines since 2010.
  • Complementary treatments: Physical therapy, nutrition counseling, acupuncture, and biofeedback training—teaching you to take more control over body functions such as heart rate or muscle tension—can improve symptom management. 

Patient's story

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Andrea’s story

Andrea struggled with migraine events as a child, and by age 26 the episodes became chronic. Seeking more effective treatment, she came to Jessica Ailani, MD, director of the MedStar Georgetown University Hospital Headache Center.

Dr. Ailani took the time to understand Andrea's past treatment and symptoms, as well as her goals and aspirations. Together Andrea and Dr. Ailani curated a treatment plan that worked best for her through her adult life, pregnancy, and beyond.

Research and clinical trials

MedStar Health patients may have access to clinical trials, which offer the latest Migraine therapies before they are widely available elsewhere.