End the Suffering: Science-Backed Strategies for Managing Migraine

This article is based on one of the most recent and comprehensive scientific reviews on migraine treatment: Migraine Treatment, published in 2020 in the journal Clinics in Plastic Surgery (Elsevier). The review was authored by Dr. Daniel Olla, Dr. Justin Sawyer, Dr. Nicole Sommer, and Dr. John B. Moore IV—physicians with expertise in plastic surgery, neurology, and surgical approaches to chronic headache.

The following information addresses some of the most common questions patients and their loved ones ask about migraines, their diagnosis, and current treatment options.

What the Experts Say

1. How serious is the social and economic impact of migraine?

Expert insight:

“Migraine affects 35 million Americans and is ranked as the third leading cause of disability worldwide. The condition has significant economic consequences, including lost workdays and reduced productivity.”

Explanation: Migraine is not just a “bad headache.” It’s a serious neurological condition that can drastically affect a person’s quality of life and work capacity—and it has far-reaching economic consequences. According to the World Health Organization, migraine is one of the top causes of disability among people under age 50.

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2. What is the current scientific understanding of what causes migraines?

Expert insight:

“Recent years have seen a shift from the vascular theory to the neural theory, which focuses on the central and peripheral nervous systems as the main contributors to migraine. This includes the idea of ‘peripheral trigger points,’ where branches of the trigeminal and occipital nerves, along with nearby muscles and tissues, can be irritated and trigger an attack.”

Explanation: Modern science views migraine as a neurological disorder caused by irritation and inflammation of certain nerve endings—not just changes in blood vessel diameter, as previously thought. This updated view opens the door to new treatment strategies that specifically target these peripheral “trigger points.”

3. What are the most important non-surgical migraine treatments available today?

Expert insight:

“Non-surgical migraine management includes two primary approaches—non-pharmacological and pharmacological. Pharmacological therapy includes both preventive and acute medications. One of the latest developments is the class of ‘anti-CGRP’ drugs (gepants and monoclonal antibodies), which show promising results even in advanced clinical trials.”

Explanation: Standard medications like beta-blockers, antidepressants, triptans, and NSAIDs are still widely used. However, new biological therapies targeting the molecule CGRP (calcitonin gene-related peptide) are showing potential in reducing or even preventing attacks, often with fewer side effects.

4. When and how can Botox help with migraine?

Expert insight:

“Research shows that botulinum toxin type A (Botox) can affect the release of certain neurotransmitters and alter the activity of pain-related receptors and cytokines. In major clinical trials (like PREEMPT, 2010), 55% of patients experienced complete resolution of migraine attacks, while 38% reported partial improvement—leading to FDA approval of this treatment.”

Explanation: Botox is injected into specific muscle groups—commonly identified as trigger points—based on a detailed patient headache diary and physical exam. If Botox is effective, it can also serve as a “test” to determine whether a patient may benefit from more long-term surgical treatment.

5. How effective is migraine surgery, and who is it for?

Expert insight:

“Studies report an average success rate of about 90% for migraine surgery, defined as either complete elimination or significant reduction (over 50%) in headache frequency or intensity. For patients who respond well to Botox, surgery can lead to complete migraine resolution in 35% of cases, and major improvement in 90%. Over time, surgical treatment may also be cost-effective, as ongoing medication costs can surpass the price of surgery within about two years.”

Explanation: Surgery is generally considered for patients who don’t respond adequately to medications or Botox. The procedure involves decompressing or removing the peripheral nerves and tissues that trigger migraine pain. Long-term results are promising, with many patients experiencing lasting relief.

Questions & Answers

1. How can I tell if my headaches are actually migraines?

Answer: Doctors diagnose migraine using specific criteria. You may have migraine if you’ve experienced at least 5 attacks that last between 4 and 72 hours (untreated), and the headache includes at least two of the following:

• Pain on one side of the head

• Pulsating or throbbing sensation

• Moderate to severe intensity

• Worsens with routine activity (like walking or climbing stairs)

Additionally, at least one of these symptoms must be present during the attack:

• Nausea and/or vomiting

• Sensitivity to light (photophobia)

• Sensitivity to sound (phonophobia)

Other causes of headache must also be ruled out.

2. Are there different types of migraine, and does it matter for treatment?

Answer: Yes, migraines can be categorized into four main types based on pain location and likely triggers:

• Frontal migraine – Forehead pain, often in the afternoon, linked to stress; may be accompanied by drooping of the eyelid

• Temporal migraine – Pain in the temples, often in the morning, associated with teeth grinding or jaw joint problems

• Occipital migraine – Pain at the back of the head and neck, possibly triggered by neck muscle tension or injury (like whiplash)

• Rhinogenic migraine – Pain behind the eyes, often in the early morning; associated with allergies, weather changes, or hormonal shifts; may involve a deviated nasal septum

Identifying your migraine type helps doctors tailor the most effective treatment—whether that’s medication, Botox, or surgery.

3. What happens if standard medications don’t work for me?

Answer: If conventional medications (like pain relievers, triptans, antidepressants, etc.) aren’t effective—or cause too many side effects—there are two key alternatives:

• Botox injections into trigger points, which have shown proven benefits for many people with chronic migraine

• Surgery, which may be considered if Botox provides temporary relief and you want a more permanent solution

Keeping a migraine diary and consulting with a neurologist is essential to confirm the diagnosis and determine the next best step.

4. Can I identify and avoid my own migraine triggers?

Answer: Yes. Avoiding personal triggers is a core part of non-pharmacological migraine management. Triggers can include:

• Certain foods

• Stress

• Weather changes

• Bright lights

• Lack of sleep

• Physical exertion

Maintaining a detailed migraine diary helps track when and how attacks occur—and what might be causing them—so you can take steps to avoid those triggers.

Some people also benefit from techniques like cold compresses, pressure on specific points, acupuncture, or other complementary therapies.

5. What are the risks or side effects of newer treatments like Botox or surgery?

Answer: Botox risks:

• Temporary muscle weakness (e.g., drooping eyelid)

• Localized muscle atrophy

• Development of antibodies that reduce effectiveness over time

Surgical risks:

• Infection

• Bleeding

• Temporary or permanent numbness in part of the scalp

• In some cases, additional procedures may be needed if new trigger points develop

It's critical to discuss these options thoroughly with your doctor and weigh the risks and benefits to find the best solution for your situation.

Conclusion

Migraine is a complex medical condition with a significant impact on personal and social well-being. Fortunately, medical science has made great strides in recent years—both in understanding what causes migraines and in developing treatments that work. From traditional medications and lifestyle changes to cutting-edge options like Botox injections and specialized surgery, today’s patients have more choices than ever.

The information in this article, drawn directly from the scientific work of Dr. Olla and colleagues, is designed to give you the knowledge and confidence to explore your treatment options with your healthcare provider—and take control of your health and quality of life.

Source: Olla, D., Sawyer, J., Sommer, N., & Moore, J. B. (2020). Migraine Treatment. Clinics in Plastic Surgery, Elsevier Inc. https://doi.org/10.1016/j.cps.2020.01.003