About Integrative Headache Medicine - Lauren Natbony, MD
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About Integrative Headache Medicine

CLINICAL FOCUS

  • Pediatric, adolescent and adult headache medicine
  • Integrative model of headache care utilizing both pharmacologic and non-pharmacologic therapies
  • Medical acupuncture for the treatment and prevention of headache and facial pain
  • Interventional approaches to headache: botulinum toxin injections, peripheral nerve blocks, trigger point injections, sphenopalatine ganglion blocks

MOST COMMON CONDITIONS TREATED

  • Migraine headache
  • Menstrual migraine
  • Vestibular migraine
  • Tension type headache
  • Cluster headache and other Trigeminal Autonomic Cephalalgias
  • New daily persistent headache
  • Typical and atypical facial pain syndromes
  • Trigeminal neuralgia
  • Occipital neuralgia
  • Post-concussive syndrome/headache
  • Idiopathic intracranial hypertension
  • Headache in pregnancy and postpartum
  • Cervicogenic headache
  • Medication overuse headache

My Approach To Migraine

LIFESTYLE

EXERCISE

Studies for migraine have shown that regular cardiovascular exercise for 30-40 minutes 3-4 days per week is just as effective as a daily medication for prevention of migraine. Exercise triggers the body to produce endorphins, which are natural pain relievers. These endorphins will decrease migraine frequency and severity.

SLEEP

The average amount of sleep an adult needs is 8-9 hours per night. However, in migraine, it is the sleep schedule, not the duration of sleep that is of utmost importance. Migraineurs should maintain a regular sleep schedule, going to bed at the same time every night and waking up the same time every morning, on weekdays and weekends.

EATING

Migraine suffers should eat regular meals throughout the day, every 3-4 hours as drops in blood sugar can be a trigger. Studies have shown that breakfast is especially important, and that eating a protein filled breakfast get reduce migraine incidence. Diets containing vitamin B2 (found in green leafy vegetables) and CoQ10 (found in meats, fish and poultry) can be beneficial as they are both involved in energy production.

DRINKING

Dehydration is a known migraine trigger. A minimum of 64oz of water should be consumed everyday. An extra ~16oz of water should be consumed for every half hour of exercise. Caffeinated beverages should be kept to a minimum as caffeine can be both a trigger for migraine and a cause of dehydration.  Caffeine intake should be less than 200mg (~2 cups of coffee) per day.

PREVENTATIVE TREATMENT

When headaches occur more than 4-5 days per month or are debilitating, preventative treatment is indicated. The goal of preventative treatment is to reduce the frequency and severity of migraine attacks. Preventative therapies include medication, medical devices, acupuncture, biofeedback.

ACUTE THERAPIES

These are medications taken to abort a migraine attack. The most common agents are triptans (migraine specific medications) which work to stop a migraine attack acutely. Other agents include non-steroidal anti-inflammatory medications such as ibuprofen and naproxen.

WORKING ON CO-MORBID CONDITIONS

There are other factors that can contribute to migraine that need to be worked on to achieve a positive result. 

These include:

MEDICATION OVERUSE

Medication overuse headache occurs when acute headache treatments (such as simple analgesics, triptans etc) are used too frequently. The end result is a worsening of headaches which become harder to treat, more resistant to preventative medications and more chronic. In fact, medication overuse is one of the main risk factors for episodic headaches (less than 15 days per month) to become chronic (more than 15 headache days per month). Medication overuse headache can even occur if you are taking medications to treat pain conditions other than headache. 

STRESS, ANXIETY, DEPRESSION

Many migraine patients suffer from symptoms of depression and/or anxiety. Migraine patients are 2-5 times more likely to have symptoms of depression than those without migraine. This phenomenon is likely due to the common brain regions and chemical brain messengers that control headache and mood. It is therefore not surprising that poor mood increases the odds of developing a headache. Treatment of depression and anxiety can significantly improve headache frequency.