Air Force Col. Kirsten Aguilar, Joint Base Elmendorf-Richardson and 673d Air Base Wing commander, participates in a Cephaly treatment during a 673d Medical Operations Squadron immersion tour at JBER, Alaska. A Cephaly device uses electrical impulses that treat and prevent migraine headaches without the use of medication or its side effects (Photo by: Senior Airman Crystal Jenkins, Joint Base Elmendorf-Richardson Public Affairs).

Treatment & Triggers

Communication is key to helping to control migraines, said Michael Oshinsky, who holds a doctorate of neuroscience and serves as the program director for pain and migraine at the National Institute of Neurological Disorders and Stroke. "Make sure you communicate with your physician that you have migraines. Migraine is very manageable if you build a plan that works for the individual."

That plan may indicate the use of over-the-counter medications, prescription oral drugs, monthly infusions, or neuromodulation through devices aimed at nerves that trigger migraine symptoms. Field kits for active-duty service members should be tailored to the regimen of treatment and prevention of migraines that works for every individual. "It's got to be the right plan for the individual and should be figured out before they are deployed," Oshinsky said.

The number one trigger for migraine is stress, Oshinsky said, adding, another trigger is strong emotional experiences - be they happy or sad - because of the significant changes in neurotransmitters within the brain.

Oshinsky also said that certain behaviors trigger migraines but noted that some of these factors cannot be controlled during a deployment. All migraine patients should:

• Keep well hydrated
• Go to bed and rise at the same hours each day
• Don't skip meals
• Watch out for hormonal changes

Bright lights (sunlight, computer screens, or fluorescent lamps) also can be a trigger, Cruzcrespo said.

There are many oral drugs to prevent migraines that need to be taken daily. They include three different drug classes: anti-seizure medications, beta-blockers (blood pressure medications), and antidepressants (depression and/or anxiety medications), Cruzcrespo said.

"Abortive medications are prescribed to be taken at the onset of headaches or aura," she said. These agents include an ergotamine derivative, nonsteroidal anti-inflammatories such as ibuprofen, acetaminophen, "triptans," calcitonin gene-related peptide inhibitors called "gepants," and the immunologics, which are administered subcutaneously once a month or quarterly via an infusion in the provider's office.

Said Cruzcrespo: "Some procedures can be performed at the physician's office to prevent headaches or as adjunctive treatment." Botox injections for headache are performed quarterly for prevention. "Other procedures are performed more frequently, including peripheral nerve blocks, trigger point injections, and sphenopalatine ganglion block (SPG block)," she said.

There are also rescue medications (tranquilizers and sedatives) for a breakthrough migraine while on medication. Breakthrough migraines should be factored into your treatment plan, Oshinsky said.

Additionally, there are new treatments that use neuromodulation of various nerves to treat migraine, he said. These devices include single-pulse transcranial magnetic stimulation, external non-invasive vagus nerve stimulator, external trigeminal nerve stimulation, and an electrical stimulation arm patch that stimulates another nerve that can create migraine.

Other, nonmedical treatments may include yoga, mindfulness, and meditation, Scher said.

"It's important for anybody who's having headaches that interfere with their lives to see a doctor, preferably a neurologist or headache disorder specialist, because there are treatments for migraine that might be effective for that individual," she advised.