Mercy's Dr. Howie Zheng Discusses Debilitating Migranes and Their Treatment

In a recent interview with PAIN-FREE LIVING national health magazine, Mercy’s Howie Zheng, M.D., answered questions regarding migraines and their treatment. Dr. Zheng is a Board Certified general neurologist with The Neurology Center at Mercy Medical Center in Baltimore, MD.

What is the diagnostic criteria for migraine? How does migraine differ from other types of headache?

Migraines are usually severe, debilitating headache attacks. They are different than the classic tension type headaches based on severity, typical unilateral nature and stimuli sensitivity (lights, noise, smells) in addition to possible nausea/vomiting. About 10% of the world population suffers from migraines and it is universally more prevalent in women. 

Diagnostic Criteria for Migraine:

Description: Recurrent headache disorder manifesting in attacks lasting 4-72 hours. Typical characteristics of the headache are unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity and association with nausea and/or photophobia and phonophobia.

Diagnostic criteria:

A. At least five attacks 1 fulfilling criteria B-D

B. Headache attacks lasting 4-72 hrs (untreated or unsuccessfully treated) 

C. Headache has at least two of the following four characteristics:
1. unilateral location
2. pulsating quality
3. moderate or severe pain intensity
4. aggravation by or causing avoidance of routine physical activity (e.g., walking or climbing stairs)

D. During headache at least one of the following:
1. Nausea and/or vomiting
2. Photophobia and phonophobia

E. Not better accounted for by another ICHD-3 diagnosis.

What are some key migraine triggers?

Huge number of triggers: foods, hormonal changes in women, wine, alcohol, food additives, stress is a huge trigger, sensory stimuli, sleep pattern changes, weather, menstrual cycle, other medications like OCPs also are considerations.

Is there anything sufferers can do to be proactive in their own treatment--foods or situations to avoid?

I advise most to keep a journal of modifiable triggers and eliminate them. This is usually the first step in controlling migraines is getting rid of reversible causes.

How soon until relief is found and how does Botox work in the treatment of migraines?

We will do a full comprehensive consultation, exam with counseling and recommendations in regards to migraine therapy. New appointments usually are one hour in duration. Most patients with severe chronic migraines need preventative therapy which entails trial of medications which lasts around three months as we gradually optimize dose. Botox is another thing we offer. It is an FDA approved measure for refractory chronic migraine patients. The botox is a neurotoxin which can be used on an every three monthly basis for injections. We inject into 31 sites around the head and neck, shoulders. The proposed theory of why it works is that it researchers think Botox blocks sensory nerves that relay pain messages to the brain and relaxes muscles, making them less sensitive to pain. It is according to most large randomized studies 80% effective. Responders usually will notice decrease in headache/migraine frequency severity within the first three months, some up to six months from initial injection.

--Howie Zheng, M.D., The Neurology Center at Mercy