My Doctor Online The Permanente Medical Group

Symptoms

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If you suffer from migraines, you may experience the following symptoms:

• Pain on one side of the head that pulsates or throbs
• Moderate or severe pain that inhibits daily activities
• Pain that is aggravated by walking up stairs or similar routine activities
• Nausea and/or vomiting with light and sound sensitivity
• Fatigue and poor concentration after a severe attack
• Weak, sore muscles after the headache is over

Migraine with aura describes a subgroup of migraines that are associated with visual neurological symptoms that begin 20 to 60 minutes before the headache itself. The most common aura symptoms include:

• Seeing zigzag lines, or flashes of light, or having blind spots or blurred vision
• General weakness
• A numb or tingling sensation in the lips and hands
• Difficulty concentrating or speaking

You may experience an aura without a headache. Also, there are some less common forms of migraines that have different symptoms.

Causes and Risk Factors

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Gender increases your risk of developing migraines.

• Women are 3 times as likely as men to experience migraines, although in children, equal numbers of girls and boys experience them.
• For many women, migraines follow their reproductive life cycle, starting in their teens and continuing throughout their reproductive years.
• Since hormones are thought to play a significant role in triggering migraines, women are most apt to get an attack just prior to menstruation, when estrogen levels have fallen.
• Migraines often get worse in the years leading up to menopause, and then diminish as hormonal changes cease. For most women, migraines diminish after menopause.

Lifestyle causes and triggers:

• People with migraines are thought to have inherited a sensitive nervous system.
• By balancing your lifestyle and avoiding too many triggers at one time, particularly if you feel a headache coming on, you can minimize your headaches.
• You can feel better and minimize attacks when you are able to follow a routine that keeps your nervous system calm.
• Your routine should incorporate regular sleep, regular meals, regular exercise, and stress management.

Diagnosis

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Accurately diagnosing the cause of your headaches is important so that we can choose the most effective treatment. 

We diagnose your condition by asking you questions about your symptoms and past medical history, and performing a physical examination. This enables us to verify that your symptoms are not caused by a more serious underlying illness or condition.  

When we suspect another condition we may order a brain scan, such as a CT scan or MRI. We may recommend additional tests if:

• Headaches are a new problem.
• You have a change in your symptoms.
• Your exam indicates you may have another condition.

Some kinds of headaches, particularly chronic daily headaches, can be caused by depression. We will also evaluate you for depression during your examination.

In addition, women can experience headache-type symptoms early on in pregnancy. In the majority of cases, there is no apparent cause for this condition. Treatment is based upon symptoms and specified by what is safest for you and the pregnancy. By midpregnancy, most of these symptoms will decrease in severity or disappear entirely. Later in pregnancy, a new-onset headache may be a sign of a different condition or pregnancy complications. Any persistent or severe headache should be evaluated.

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Treatments

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Home treatment

In many cases, you can prevent a migraine from developing by treating it appropriately during the prodrome phase. There are some things that you can do to help control the severity of your migraines:

• Over-the-counter pain relievers such as ibuprofen and naproxen (known as nonsteroidal anti-inflammatory drugs, or NSAIDs) are effective. However, using them too often or not following directions about how much to take can lead to more headaches.
• Resting before the headache develops can sometimes help stop a migraine.
• Caffeine can be helpful if your migraines are infrequent. If you have regular migraines, however, using caffeine can lead to a vicious cycle of more headaches.
• We can also recommend additional classes of drugs, depending on your symptoms. It's important to talk to us if your headaches are very frequent.

Prescription medications to stop a migraine

• We may prescribe a class of medications called triptans that are designed to stop migraines when taken early enough in an attack.
• Before prescribing these drugs we will talk with you about the appropriate dosage and guidelines for taking them.
• We may recommend that you take a triptan at the same time as an over-the-counter pain reliever in order to boost the effect and stop the migraine.
• These drugs should not be taken too often, or they can cause a vicious cycle of rebound headaches.
• If you are getting more than 3 to 4 migraines per month, or 1 to 2 very disabling migraines, talk to us. We can prescribe daily medications that decrease the frequency and severity of migraines.
• Some headache medications are not recommended during pregnancy. If you are considering getting pregnant, or are currently pregnant and taking medications to control your migraines, please notify me so we can review these medications together.   

Prevention

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There may be factors, such as weather changes and changes in barometric temperature, that can trigger migraines. These are largely outside of your control. However, you may find that you function better and have fewer attacks when you follow a routine that incorporates regular sleep, regular meals, regular exercise, and minimal stress. Common triggers you can avoid include:

• Skipping meals. Missing a meal or fasting is one of the surest ways to bring on a migraine. It's important to eat breakfast even if you don't feel like it.
• Diet. Certain substances seem to trigger migraines, especially caffeine, alcohol, chocolate, monosodium glutamate, processed foods, sweets, and aged cheeses and meats.
• Dehydration. Be sure to drink plenty of water.
• Lack of regular sleep. It is best to go to bed and get up at the same time every day.
• Sedentary lifestyle. As little as 20 to 30 minutes of exercise or activity such as walking, 4 to 5 times per week, can make your headaches less frequent and less severe.

Keep a headache diary

Keep a Headache Diary and bring it to your appointments. The diary can help us understand your headache pattern, identify any obvious triggers, and manage your treatment effectively. Include the following details in your diary:

• The days you have headaches
• The time of day
• How long the headache lasted
• If you are a woman, the dates of your period
• What you were doing at the time the headache began

Lifestyle Changes and Management

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Commit to a healthy lifestyle

Many headaches can be prevented by committing to a healthy lifestyle that includes:

• A healthy diet 
• Plenty of exercise
• Getting 8 hours of regular sleep
• Minimizing stress

Use an online program  

Our online health coach has programs that can help you lose weight, eat more healthy foods, quit smoking, and manage stress. Please refer to our Managing Your Headaches program for detailed information about everyday changes you can make to help reduce and control your headaches.

Manage anxiety and depression

Anxiety and depression can be underlying causes of headaches. Our online video, Understanding Depression, can help you evaluate your own symptoms to see if depression may be a factor. Contact us if you think you need to be evaluated or treated for depression.

Find a support group

Find, or create, your own headache support group. We have headache management classes at many of our medical centers in Northern California. A number of community headache organizations also have online or in-person support groups for headache sufferers. 

Your Care with Me

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Most headaches can be treated at home with over-the-counter pain relievers. If you have regular headaches that do not respond to these medications, or if you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

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If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

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Coordinating Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

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Convenient Resources for You

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As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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