The experts at NorthShore Neurological Institute are on the leading edge of migraine management and prevention under the leadership of Susan Rubin, MD, the Ruth Cain Ruggles Chair of Neurology. New options for patients include FDA-approved medications known as Calcitonin Gene-Related Peptide (CGRP) inhibitors, and a study on the noninvasive, hand-held vagal nerve stimulator. Dr. Rubin answers questions about promising new treatments for these severe, debilitating headaches.

Q. What causes migraine headaches?
A. Migraines are likely genetic, but there hasn’t been a single gene found that explains all migraines. Whatever that common genetic risk factor is, it makes you more sensitive to common triggers including weather, processed meats, aged cheese, alcohol, stress, and lack of sleep or too much sleep. These triggers differ among patients.

Q. What have treatments consisted of to-date?
A. There are four main treatment categories, which are typically combined, for migraine control:

1. Trigger management
2. Abortive medications to halt a migraine
3. Preventive medications to thwart migraines from occurring
4. Alternative treatments used with preventive medications to help naturally control the headaches

Q. What new treatments are available at the Neurological Institute?
A. NorthShore provides all FDA-approved treatments and research study opportunities. CGRP inhibitors are new—they’re the first preventive medication designed specifically for migraines, proving highly effective for many patients. Botox therapy also can help patients with chronic migraines (over 15 headache days per month) who haven’t received good control with oral preventives.

NorthShore is currently involved in a study assessing a new device that provides noninvasive vagal nerve stimulation to prevent migraines. Participants place the device on their neck activating pulses to the vagus nerve, which is felt to decrease headaches. We’re investigating if using this device on a scheduled basis will reduce the frequency or eliminate migraines.

NorthShore also has been collecting data and blood samples to determine if there are specific genetic markers differentiating types of migraines, and responsiveness to medications or associated symptoms. Data is still being analyzed, but we hope this will lead to better diagnosis and treatment.

Q. How can I find the best treatment?
A. We recommend you partner with a neurologist/headache specialist. They consider migraine types, other medical conditions and the patient’s own objectives to tailor a specific treatment plan.