Jessica Ailani M.D. FAHS
Director, Medstar Georgetown Headache Center
Associate Professor Neurology
Department of Neurology
Medstar Georgetown University Hospital
Washington, DC 20007

Jessica Ailani, MD, is board certified in neurology, with added certifications in neurology and headache. Dr. Ailani is associate professor of neurology at MedStar’s Georgetown University Hospital and director of the MedStar Georgetown Headache Center. The conditions she treats include migraines, cluster headaches, tension headaches, post-traumatic headaches, occipital neuralgia, headache related to neck strain and concussion-related headaches. She uses a wide variety of treatment options in headache management including Botox for migraines. Dr. Ailani’s research involves a national project focused on interventions, including nerve blocks, for headaches. She is dedicated to patient education, and recently gave a presentation on “Migraine Management: Practical Tips for an Impractical Disease” for a local family clinic.


For a disease that affects over 36 million people in the US, migraine is still a poorly recognized and under diagnosed disease. By 2018, the number of migraine specific treatments available in the US will be almost double what was available 2 decades ago. Studies shows that most people are rarely offered these treatments. We will discuss what you need to know about migraine to make sure you are getting the best treatment to reduce disability related to this disease.

What is Migraine?

Migraine is brain disorders that causes time periods of changes in the brain that give you moderate to severe head pain, stomach upset, vomiting, and make lights and sounds more difficult for you to handle. The pain can be one sided, can get worse with movement, and can cause you to be stuck in bed instead of getting to work. These episodes can last anywhere from 4 to 72 hours and can occur numerous times a month.   Sometimes you can get symptoms, such as seeing flashing lights, or losing part of your vision, or having difficulty with your speech, that can occur prior to the head pain. This is called an aura.   While less common, aura can be a symptom of a type of migraine called migraine with aura. For up to 3.2 million people in the US, headaches can occur more than half the month, with about half of these headaches being migraine like. When this happens at least 3 months in a year, it is called chronic migraine.

You are not alone

Migraine is a common brain disorder. It affects over 36 million people in the US. Migraine is more likely to occur in women compared to men. Migraine can occur in any age group, from children to people in the later part in life. It is most common in your 20’s and 40’s and tends to improve for many women after menopause.

What triggers migraine?

Migraine is a genetic disease. Most people with migraine have a family member who had migraines. You inherit a brain that is more likely to go into cycles of attacks that cause pain, upset stomach, and light and sound sensitivity. These attacks can be triggered by things in your environment. There are many things that can trigger migraine, but often, triggers will layer on each other before they cause an attack. Stress, weather changes, sleep irregularities, skipped meals, dehydration, hormone changes (prior to your period, or prior to menopause) are the most common triggers. For some people, certain foods can trigger migraine as well, such as MSG, processed foods containing high amounts of nitrates, alcohol, and excessive caffeine are a few common food triggers.

Keeping a calendar of your headaches and any changes in your life around the time they occurred may help you track your triggers. Certain applications you can download to your phone can help you track your headaches and triggers as well (curealator if we can name one).

If you can identify a few consistent triggers, avoiding them can help reduce your risk of getting a migraine. Triggers can layer on each other, so avoiding multiple triggers together may give you better results (no alcohol when you have your period, or no fast food if you are stressed).

How do I treat migraine?

Migraines are treatable, though there currently is no cure. When treating migraine, consider treating the current attack, but also ways to reduce future attacks.

When treating a current attack, you can use some lifestyle modifications along with medications called “abortive” treatments to improve the symptoms of a migraine. Combining both will be more helpful that just doing one alone (Table 1)

When looking at ways to reduce future attacks, you can also use some lifestyle modifications along with medications called “preventive” treatment to help reduce the frequency of attacks (Table 2). Preventive medications should be discussed and prescribed by your health care provider. If you have made lifestyle modifications and are still having frequent headaches, consider seeing a health care provider to discuss options to help improve your migraines.

When should I see a health care professional?

If you are having frequent headaches (more than 1 day a week), or you have tried over the counter and lifestyle modifications and find them ineffective to treat your symptoms, consider speaking to your health care provider about migraine. There are many options available to treat migraines, and many new options on the way. Start the conversation with your primary care provider. This can put you on your way to better days with fewer migraines.

If you feel you have discussed symptoms with your provider and are still not improving, consider seeing a headache specialist. A headache specialist is a health care provider who has dedicated their career to taking care of people with headaches. They often have extra training in headache management and are usually up to date with the latest treatment options. Headache specialist can be nurse practioners, physician assistants, primary care providers, dentist, pain specialist, or neurologists, who have received extra training in headache.


Migraine is a common lifelong disease for which there is currently no cure, but there are a number of treatment options to manage and reduce attacks and symptoms. If you are having more days in bed due to migraine than out living life, consider seeing a headache specialist to discuss your treatment options.


Table 1: Abortive Treatment for Migraine

Lifestyle Environment: Go to a dark, quiet, cool room

Oils/rubs: Lavender or Peppermint oil to your temples and neck

Use a balm, such as tiger balm over areas that hurt- cooling balms with essential oils can ease pain as it starts to build

Try an ice pack over the back of your neck or across the forehead or temples. There are a number of cooling head gear you can buy on-line

Hydration: Drink some water with lemon, during a migraine, hydration can be helpful

Relaxation: Deep breathing, biofeedback techniques can help lower the heart rate and the body’s response to stress. These work best when practiced routinely outside of a migraine so you can quickly bring your body into a relaxed state when you are feeling unwell


Over the counter medications

These need to be used in limited quantities, or can trigger more headaches.

It is best to limit the use of medications to 8-10 days a month.

If you need to use over the counter pain medication more often, speak to your health care provider


Acetamenophen, Ibuprofen, and Naproxen can all be helpful during a migraine

Combination medication, such as Excedrin, can help


Prescription medication NSAIDS: Anti-inflammatory medications that can help with migraine attacks. Examples include diclofenac, cambia, nabumetone, ketorolac, and indomethacin

Anti-emetics: Some medications used for nausea can help both nausea and migraines. Examples include metochlopramide, prochloperazine, and promethazine

Triptans: Migraine specific medications that reduce certain chemicals in and around the brain during migraines. Examples include almotriptan, eletriptan, frovatriptan, naritriptan, rizatriptan, sumatriptan, and zolmitriptan


Ergots: Migraine specific medications that reduce certain chemicals in and round the brain during migraines. Examples include dihydroergotamine.




Table 2: Preventive Treatment for Migraine


These changes may help reduce your migraine frequency

Limit excess sugars, carbohydrates, and caffeine

Eat healthy, eat fresh

Exercise every day for 20 minutes

Sleep and wake the same time daily

Use mindfulness and meditation to reduce stress


Certain supplements have been show to help reduce the frequency of migraines. Speak to your provider before starting any.



Coenzyme Q10


Prescription medications

Certain types of medications have been found to be effective to reduce the frequency of migraines when taken as prescribed.

Anti-depressants: Certain tricyclic antidepressants and seratonin neurepinephrine reuptake inhibitors can help reduce migraine frequency

Anti-hypertensive medication: Certain beta blockers, calcium channel blockers, ACE inhibitors, and ARB medications can reduce migraine frequency.   Propranolol, and Timolol have been FDA approved to treat migraine.

Anti-seizure medication: Certain anti-seizure medications, such as topiramate and divalproex sodium, have been FDA approved to treat migraine

Onabotulinum toxin A: Botox has been FDA approved to treat chronic migraine



Neuromodulation, a way to change the way the brain is reacting to certain information, has been show to be effective in reducing migraine frequency. These are a few devices currently available.

Cefaly: FDA approved to treat migraine

Transmagnetic Stimulation: Spring TMS device has been FDA approved to treat migraine with aura