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New Therapies Reduce Chronic Migraine Pain

Jun. 3, 2021

If you’ve ever experienced a migraine headache, you understand how normal everyday life screeches to a halt until the overwhelming pain is relieved.

You may have taken over-the-counter pain medication and retreated to a dark room to lie down and recover; you might have had to cancel plans or take a day off from work. If the pain was severe enough, perhaps you wound up in the emergency room or at an urgent care clinic. Migraine attacks aren’t “just a headache” — they are the second-most disabling disease in the U.S., affecting many Americans.

The National Center for Health Statistics (NCHS) recently published a study on the prevalence of migraines and severe headaches in the U.S. The 19 years of data revealed how burdensome migraines are in the adult population. Headache is consistently the fourth most common reason of emergency department visits, accounting for about 3% of visits annually. In reproductive-aged women, headache is the third leading cause of emergency department visits.

“My No. 1 goal for patients is to eliminate, or at the very least to minimize, their disability,” says Saad Kanaan, MD, UC Health neurologist at the Dayton Clinic and assistant professor in the Department of Neurology and Rehabilitation Medicine at the University of Cincinnati College of Medicine. “Secondly, I want to reduce emergency room and urgent care visits. When you go to the ER for a migraine, you’re not seen under the supervision of a neurologist or a headache specialist, and patients are often treated with a narcotic pain medication.”

The Problem with Narcotics for Chronic Migraine

Dr. Kanaan explains that narcotics aren’t an effective treatment for migraine patients because, while they offer temporary migraine relief, medications are known to trigger what are called rebound (or medication overuse) headaches.

“At the UC Health Dayton Neurology office, we offer acute migraine treatments that provide immediate relief without triggering rebound headaches. For example, if a patient has had a migraine for 48 hours and they’ve taken all the medication they could, instead of going to the ER, they can come to us and receive an IV infusion,” says Dr. Kanaan.

The infusion contents are patient-specific, using combinations of fluids, anti-nausea medications, anti-inflammatories, steroids, DHE and valproic acid.

The medications are for rescue therapy; not preventative, but they do help by preventing ER visits. Migraine patient care is two-fold: prevention and rescue. Prevention focuses on how many headaches a patient has in a month and how severe they are. This information gives a better idea of how disabled the patient is by the migraine, and the numbers are tracked closely.

Pursuing Migraine Prevention and Relief with Dr. Kanaan

Before an appointment with Dr. Kanaan, patients receive a packet of information and questionnaires, either by mail or electronically since many patients are now seen virtually. They are asked to complete their medication and treatment history when it’s convenient for them, eliminating unnecessary pressure the day of their appointment. “We see patients who have been to multiple physicians and who have tried numerous medications and treatments, so we dig deep into that history and gauge what they have and have not tried,” says Dr. Kanaan. “As a headache specialist, I’m always finding that they haven’t tried everything and I’ll tell them, ‘I know it feels like you’ve tried it all, but we still have options — there are effective treatments that may benefit you.’”

For most migraine patients, there isn’t a hesitancy to try new options; they are desperate for relief, for a new treatment that could improve their quality of life. Prevention medications take time to work, unlike the immediate relief of painkillers. Dr. Kanaan stresses the importance of keeping a positive mindset and not giving up during the treatment process using preventive medications. Structural changes have to happen within the brain, chemicals in the body need to restore balance, and those changes take time and consistency.

The Importance of Seeing a Headache Specialist

Making an appointment with a headache specialist is the first step to truly feeling better instead of putting a band-aid on the pain. “Neurologists really understand the pain and frustration migraine patients live with. I’ve had patients break down in tears in my office because they finally feel validated,” says Dr. Kanaan. “We know their pain is real, and our job is to find the right treatment options to alleviate their suffering.”

UC Health’s robust research foundation allows neurologists access to the latest developments in headache treatment. Neurologists offer more than 10 treatment options for migraine prevention, while a primary care provider, for example, may only have one or two options for a patient to try.

In the past 30 years, the research community has become quite active in regard to migraines. Since 2018, the U.S. Food and Drug Administration has approved eight new migraine therapies. “New information is coming in quickly, and expanding the field, so when patients choose to see a headache specialist, they’re assured we are up to date with the latest information,” says Dr. Kanaan.

“At UC, we are deeply involved in all aspects from research, to trials and we feel confident in all the therapies we offer.” Many older medications come with a long list of side effects, and Dr. Kanaan says he’s hopeful to see more effective medications being approved.

“Side effects with older medications almost always include some type of sedation, sleepiness or memory problems. We run into problems where the patient can’t tolerate a medication because of side effects. If we’re trying to help patients reduce disability and become more functional, medication benefits need to outweigh side effects,” says Dr. Kanaan.

Preventative Migraine Treatments Available at UC Health

UC Health’s Dayton office is a convenient location for patients who to receive care closer to home, without having to travel to receive treatment. In addition to IV infusions, some of the following acute treatments are available:

  • Nerve block injections.
  • Trigger point injections.
  • Botox injections.

Dr. Kannan came to UC Health from Harvard Medical School in Boston, Massachusetts, where he completed his headache medicine fellowship and was exposed to a large variety of complex and intractable headache disorders.

“I chose to be a headache specialist because it’s horrible to see people suffer with an invisible disease and feel like they’re not taken seriously,” says Dr. Kanaan. “I’ve dedicated my career to helping this specific group of people because I deeply understand and will do my best to help improve their lives.”