How do I manage severe monthly migraines with aura?

Question

Hello doctor,

I get terrible headaches for 15 to 20 days every month that completely knock me out for hours. The pain is awful, usually on my left side, and I throw up a lot. I can not stand any light or noise and have to lie in a dark room. Before a headache starts, I see weird zigzag lines. I have tried so many medications, but nothing really works, or they make me gain weight and feel foggy. The headaches are ruining my job and my life. I have a few concerns:

What actually causes migraines?
Are they genetic?
What is the difference between regular headaches and migraine?
What are these new monthly shots I have heard about?
How does Botox help headaches?
What is CGRP?
Do the shots really work?
Are they safe?
Will insurance pay for them?
I take regular painkillers too. Why do I throw up?
What about my triggers like chocolate and wine, can stress cause them?
Do hormones make it worse?
Will menopause help?
Are there surgery options?
Can migraines cause strokes?
Will they ever go away?
What if nothing works?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand your concern.

Your symptoms sound like chronic migraine, which means headaches on 15 or more days per month, with at least eight having migraine features like throbbing pain, light sensitivity, nausea, and visual auras (zigzag lines).

Migraines happen because of abnormal brain activity involving pain pathways and blood vessels. A key chemical called CGRP (calcitonin gene-related peptide) becomes overactive and causes inflammation and pain signals. Genetics plays a big role in migraines, which often run in families.
Common headaches are dull and mild, while migraines are severe, often one-sided, pulsating, and associated with nausea, vomiting, and light or sound sensitivity.
Stress, hormonal changes, skipped meals, dehydration, certain foods (chocolate, wine, cheese), weather changes, and poor sleep are common triggers. Keeping a headache diary helps identify yours.
During a migraine, brainstem changes affect the nausea center and slow stomach movement, causing vomiting. Anti-nausea medicines like Domperidone or Ondansetron can help.

CGRP-blocking injections (Erenumab, Fremanezumab, Galcanezumab): taken monthly or quarterly, reduce both frequency and intensity of attacks. They are generally safe, cause few side effects, and are approved for long-term prevention. Insurance coverage depends on local guidelines and previous medication trials.

Tiny doses into the scalp and neck muscles every 12 weeks; reduce muscle tension and block pain signals. Works well for chronic migraine.
Oral preventives like Propranolol, Topiramate, and Amitriptyline still help many people, but may have side effects such as fatigue or weight changes.
It can be used occasionally for breakthrough attacks, but overuse (more than 10 days per month) can worsen headaches.
Many women notice migraines worsen around menstruation and improve after menopause. Stress control, regular meals, sleep, and hydration are vital.
Surgery is rarely needed. Only used in very resistant cases involving specific nerve decompression.
Slightly higher in migraine with aura, especially if smoking or on estrogen-containing birth control.

With proper preventive therapy, most patients get 50 to 70 percent fewer attacks. You would not be stuck like this forever with the right plan; your migraines can become manageable, and life can feel normal again.

I hope this helps.

Thank you.