Migraine Diagnosis & Treatment in Texas

Early warning signs including mood changes, food cravings, neck stiffness, increased urination, and yawning.

• Mood changes
• Food cravings
• Neck stiffness
• Frequent yawning

Reversible neurological symptoms affecting vision, sensation, or speech. Occurs in about 25–30% of migraineurs.

• Visual disturbances
• Numbness/tingling
• Speech difficulty
• Zigzag lines

The main headache phase — typically unilateral, throbbing pain with nausea, vomiting, and sensitivity to light and sound.

• Severe throbbing pain
• Nausea/vomiting
• Light sensitivity
• Sound sensitivity

The "migraine hangover" — fatigue, cognitive fog, mild head pain, and mood changes as the brain recovers.

• Fatigue/exhaustion
• Brain fog
• Mild residual pain
• Mood changes

Migraine with Aura

Preceded by neurological aura symptoms such as visual phenomena, numbness, or speech changes lasting 20–60 minutes before headache onset.

Migraine without Aura

The most common type — recurring moderate-to-severe headache without preceding aura, typically unilateral and pulsating.

Chronic Migraine

15 or more headache days per month for over 3 months, with at least 8 fulfilling migraine criteria. Requires aggressive preventive therapy.

Hemiplegic Migraine

A rare, severe form with temporary motor weakness or paralysis on one side of the body during aura phase, mimicking stroke symptoms.

• Triptans
  Sumatriptan, rizatriptan — serotonin agonists, gold standard for decades
• Ubrelvy (ubrogepant)
  Oral CGRP receptor antagonist, works even with established attacks
• Nurtec ODT (rimegepant)
  CGRP antagonist — both acute AND preventive in one medication
• NSAIDs & antiemetics
  Naproxen, ketorolac, promethazine for nausea control
• Dihydroergotamine
  For refractory or prolonged attacks

• Topiramate / Valproate
  Anticonvulsants that reduce cortical excitability
• Beta-blockers
  Propranolol, metoprolol — first-line oral preventives
• Tricyclic antidepressants
  Amitriptyline for comorbid sleep and mood disorders
• OnabotulinumtoxinA (Botox)
  FDA-approved for chronic migraine — 31 injections every 12 weeks
• CGRP Monoclonal Antibodies
  Aimovig, Ajovy, Emgality — monthly or quarterly injections

• Headache diary
  Identify personal triggers and attack patterns over time
• Sleep hygiene
  Consistent sleep schedule — both deprivation and oversleeping trigger attacks
• Hydration & diet
  Regular meals, adequate water intake, limit processed foods
• Stress management
  Biofeedback, CBT, mindfulness — proven efficacy in clinical trials
• Exercise program
  Regular aerobic exercise reduces frequency without triggering attacks