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Headaches and migraines: new program offers latest treatment options

Neurologist Sarah Benish, MD, treats patients with the new University of Minnesota Health Headache Care program. We asked her about headache symptoms, causes, treatments and medications.
Headache and migraine sufferers know the symptoms all too well, but answers and lasting solutions can be more difficult to find. We asked Neurologist Sarah Benish, MD, a few questions about headache causes and treatments.

Headache sufferers know the feelings well: the sudden pain in that certain spot, the throbbing sensation or the need to get away from noise and light. And then the questions start: do I have to take off work? Can I still make it to my kid’s soccer game? How long will this headache last?

Neurologist Sarah Benish, MD, FAAN, is a member of the new University of Minnesota Health Headache Care program. There are many different kinds of headaches—including tension headaches, cluster headaches, migraines, sinus headaches and other types. Benish partners with patients to help them understand the source of their headaches, identify prevention techniques and develop a treatment plan.

We asked her to answer some frequently asked questions about headache and migraine basics. Scroll down to read more.

Find customized headache solutions, specialized care, and the latest treatments at the new University of Minnesota Health Headache Care program.

What causes headaches—and why do some get them when others don’t?

Whether you experience headaches or not, you can thank your parents—genes play an important role in determining who is susceptible to headaches. Past head trauma and injuries or infections that affect the brain can also increase the risk of chronic or severe headaches.

Headaches can be triggered by diet, dehydration, stress levels, sleep deprivation, caffeine withdrawal, certain medications or hormones. Any person can get a headache from any of these triggers, but people who are more susceptible to headaches may experience them more frequently or with greater severity. Weather can also be a factor. Barometric pressure changes and large temperature swings within short periods of time can lead to headaches, which is why many people experience headaches in the spring and fall.

Because triggers and symptoms may be unique for each person—and can also differ based on the type of headache you experience—Benish encourages each person to track their headaches. Knowing your headache triggers can be a helpful starting point if you choose to seek medical care for headaches, Benish said.

How can I treat headaches at home?

Benish recommends keeping hydrated (even if you feel nauseous), staying away from noise or taking a short nap. The latter two options may not be realistic with a busy schedule, which prompts many people to use over-the-counter medications to cope.

Medicines like ibuprofen (Advil), acetaminophen (Tylenol), or Excedrin can help relieve headache symptoms. But those medications should be used carefully and with moderation, Benish said. Frequent or prolonged exposure to some over-the-counter headache medications can contribute to heart or kidney problems. The brain also gets used to these quickly. Over time, their effect will wear off and potentially cause more headaches.

If you are using them, it’s important to inform your primary care doctor, Benish said. Your doctor can advise if these options are right for you. Benish recommends that people never take over-the-counter medicines more than two days a week. If you do, it’s worth seeing a doctor to discuss a different care option.

What about migraines?

Migraines are severe headaches accompanied by other symptoms such as light or sound sensitivity, nausea or vomiting. They are usually associated with a throbbing sensation and may be accompanied by warning symptoms known as aura.

Though migraines aren’t fully understood, experts believe they are caused when the pain fibers on the brain’s outer covering (called the meninges) turn on and create pain signals. The pain fibers turn on when they interact with two peptides, calcitonin gene-related peptide (CGRP) and Substance P (the ‘p’ stands for pain). These peptides are thought to be turning nerve fibers in the body on or off, resulting in symptoms of migraines. They dilate blood vessels, which causes throbbing. They also change how our stomach moves, causing nausea and vomiting. The signals even interact with on receptors in our eyes, creating sensitivity to light.

Other types of headaches involve different physiology, but it is believed CGRP may still play a role triggering pain.

What are the treatment options for chronic migraines?

As headache research continues to advance, drugs are being developed that target headaches in new ways.

In 2018 the Food and Drug Administration approved Monoclonal Antibody Injections to treat chronic migraines. The injections are self-administered on a monthly basis. The drugs bind either to CGRP or to the receptor for CGRP, blocking the peptide and preventing it from triggering the signals that would cause a migraine. Benish believes these injections could be a game changer for treating chronic migraines.

Botox is another option. After patients who received Botox for cosmetic purposes noticed reduced headache symptoms, doctors began exploring headache-related uses for it. Clinical trials have shown that Botox injections can reduce number of migraines and severity of migraines in patients with a diagnosis of chronic migraine.  Researchers and experts believe Botox may have an anti-inflammatory effect near the brain that that stops the release of CGRP and Substance P, but the exact mechanism is not clearly understood.  Botox treatments for chronic migraines involve a series of injections on the head and neck that is repeated every 12 weeks.

Both options are available through the new University of Minnesota Health Headache Care program. Our specialists can also provide referrals to treatment options that don’t involve drugs, like physical therapy or chiropractic care for tension headaches and acupuncture for migraines.

When should I seek help for my headaches?

While there is no cure for headaches, University of Minnesota Health headache experts, including neurologists and physiatrists, can help people identify solutions that lessen the severity and frequency of headaches and prevent the possible need to seek urgent or emergency care. Patients don’t need a doctor’s referral to make an appointment, though it’s best to check with your insurance to find out if you need one.

Occasionally, headaches can also be a sign of another medical issue. Consider making an appointment if any of the following apply to you.

  • Headaches accompanied by neurologic symptoms, like numbness, dizziness, or weakness
  • New or different headaches you’ve never had before, especially after age 50
  • Headaches that awaken you from sleep
  • Headaches accompanied by a fever
  • Worsening headaches over time
Ask yourself: Are my headaches disabling me and interrupting the life I want to live? Do I have to miss work or cancel social plans because of my headaches? If you answered yes, the services of the Headache Care program might be right for you.