Headaches, Facial Pains and Migraines | UnityPoint Health - Des Moines
A neurologist's first job is to listen to your story and try to diagnose the discomfort in your head, face or neck. Some people have one diagnosis while others may have more than one. The first goal is to determine whether any worrisome red flags are present, which would require further testing.
Most headache and facial pain is primary, meaning without an identifiable cause, and neurologists are trained to identify those rare instances when headache features point to a lesion or disorder affecting the central nervous system.
Our neurologists will look at the following symptoms of your migraines: where the pain is occurring, how long it has been present, duration and/or patterns of attacks, severity, impact on functioning, the quality of pain (sharp, stabbing, throbbing, band-like, etc.), triggers, warning symptoms before the attacks, aggravating or alleviating factors, and associated symptoms such as eye tearing, nausea, or sensitivity to light, noise or smells.
An exam will be conducted to make sure there are no abnormalities in the visual or nervous system.
Common primary headache types we treat include:
- Migraine, with or without aura
- Chronic migraine (when there are 15 or more total headache days a month, at least 8 of which are migraine days)
- Medication overuse headache (AKA rebound headache)
- Tension type headache
- Cluster headache
- Hemicrania continua
- Trigeminal neuralgia
- Occipital neuralgia
- Post-traumatic headache
Migraines: Frequently Asked Questions
Who gets migraines?
Migraines can begin in childhood, adolescence or adulthood. Boys and girls are equally affected but starting in early adolescence, girls are more likely to develop migraines and this can continue into adulthood. 18% of women and 6% of men experience migraines. Often in a person's 50's or 60's, migraines start to recede.
What is a migraine?
Recurrent headaches lasting 4-72 hours, which typically are throbbing, worsen with activity, and impair functioning, are a symptom of migraines. But a headache is not the only symptom. There can be visual changes before or during the migraine, as well as nausea, and sensitivity to light and/or noise. Dizziness is also common. During a migraine attack, sensory nerve endings around the head and neck are activated, releasing inflammatory proteins which cause pain and dilation of neighboring blood vessels.
When do migraines happen?
Some people with migraines notice triggers or patterns. For example, females often report starting to feel a migraine 1-2 days before the start of their period. Attacks can often hit during or just after stressful life events. Lack of sleep, being late for a meal, consuming foods with MSG or other preservatives, dehydration, or even weather changes can trigger attacks. However, it is not uncommon for attacks to happen without a reason.
Where does migraine pain occur?
It can be located anywhere in the head, face or neck (but is usually in a consistent place for the individual person experiencing migraines). It is most often located on one side or the other, but can be on both sides, affect the entire head, and can also involve the face or neck.
Why do I get migraines?
That is a million dollar question! Usually migraines are inherited but can start after a major hormonal change or a head injury. Certain conditions are more likely to be present in people with migraines such as depression and anxiety, fibromyalgia, irritable bowel syndrome, insomnia, and hypermobility disorders.
How we can help
No two people will have the same exact headache or facial pain history, and because of that and individual responses to treatment, our neurologists will partner with you to come up with a treatment plan that aligns with your goals.
It will likely consist of a combination of maintenance medication, medication for breakthrough attacks, and advice on diet and lifestyle.
Often times, what is good for the body is good for the brain, so we emphasize keeping a healthy routine including:
- Regular sleep and enough sleep
- Healthy meals three times a day
- Minimal use of caffeine or alcohol
- Good hydration, and
- Regular exercise
Treatments offered include:
- Prescription preventive medication (pills, anti-CGRP autoinjections monthly or IV quarterly)
- Prescription medication to stop attacks (pills, nasal sprays, home injections)
- Quarterly Botox treatments to prevent chronic migraines
- Scalp nerve blocks
- Neuromodulation devices
- Oxygen for cluster
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