When her migraine headaches got bad, Ashley Absmeier-Koppenhafer could barely function.
“I'm a physical therapist, and I do dry needling, and whenever I would get a migraine, I couldn't do the dry needle. I didn't feel comfortable poking somebody,” Absmeier-Koppenhafer says. “There were times I'd have to leave the clinic and go home. My symptoms included nausea, vomiting, and being very sensitive to light. I would often have to go home and just sleep it off.”
Finding the headache clinic
Absmeier-Koppenhafer, 44, had been dealing with migraines since college, and they got even worse after she gave birth to her son at age 32. She assumed it was a problem she would just have to live with, but her primary care doctor told her there were medications that could help. Absmeier-Koppenhafer started taking medicine for her migraines, but it wasn’t until she went to the headache medicine clinic at the University of Colorado Anschutz School of Medicine that things started to change for the better.
Overseen by Danielle Wilhour, MD, assistant professor in the Department of Neurology, the clinic counsels patients in non-pharmacologic interventions and pharmacologic therapies and offers procedures including Botox injections, pain-relieving nerve blocks, sphenopalatine ganglion blocks, and trigger point injections. The clinic also refers patients to the outpatient infusion center, pain clinic, integrative medicine, psychology, physical therapy, and other specialties.
Absmeier-Koppenhafer was treated at the clinic by Nicole Caunt, DO, assistant professor of neurology.
“By the time I got in with Dr. Caunt, I had probably tried five different avenues of medications,” Absmeier-Koppenhafersays. “Some were good, some weren't good, but Dr. Caunt really fine-tuned them and helped me avoid some of the side effects, like weight gain. I’m very pleased with my medication regimen now.”
Migraine specialty
Caunt says the clinic treats other types of headaches as well, including cluster headaches and tension headaches, but migraines are the most common type of headache she sees.
“Migraine is one of the most common and most disabling neurologic disorders in the world,” says Caunt, who has specialized training in headache medicine. “There are fewer than 900 board-certified headache specialists nationwide compared to the 40 million Americans affected by headache disorders, so there's a big shortage in headache specialists.”
Though researchers aren’t certain what causes migraines, Caunt says, they know that genetics and hormonal changes can play into the headaches, along with pain signals that trigger inflammation. For some people, over-the-counter drugs such as ibuprofen or acetaminophen can be effective in treating migraines; others might be prescribed triptan medications such as sumatriptan (Imitrex), which stimulates serotonin receptors to constrict dilated blood vessels in the brain and block pain signals.
| The University of Colorado Headache Team will take part in the Miles for Migraine walk-run on August 15 at Denver's Great Lawn Park. Visit the race website for more information. |
“If migraines are happening more frequently, more than one to two times a week, then we start thinking about preventive therapies,” Caunt says. “The goal there is to reduce the frequency, severity, and duration by at least 50%. There are a lot of different options for preventive therapies — some are medications used for other reasons that we saw worked well for migraine, and some are newer medication options that were designed for migraine prevention specifically.”
Putting meds to the test
Among those newer medications are ones that block a pain peptide called CGRP. Injectable CGRP inhibitors like Aimovig, Ajovy, and Emgality help to prevent migraines, while oral pills like Nurtec and Qulipta can be used both for prevention and acute treatment during a migraine.
“The headache clinic is part of a multisite trial across the nation looking at the efficacy and side effect profiles of established migraine therapies,” Caunt says. “We know these medications all work and can be effective, however, we suspect that older medications have more side effects than newer medications like Qulipta. But right now, insurance companies say you have to try the cheaper, older therapies first before you can try the new ones.
“We're hoping that if this study shows that more people have side effects with the older therapies, or if newer therapy doesn't cause as many side effects and works better, maybe we can change insurance prescribing guidelines to try these newer medications first.”
Other changes
In addition to medications, the headache clinic also works with patients on ergonomic adjustments and lifestyle modifications to prevent migraines.
“Lifestyle measures, such as exercise, can have a modest protective effect if they are done consistently,” Caunt says. “We recommend that people exercise for 30 minutes, four to five times per week. I also recommend that people drink 64 to 96 ounces of water a day, limit caffeine to one to two small cups of coffee a day, and focus on eating a diet low in processed food and high in proteins, healthy fats, and fiber. Getting enough sleep is really important, too.”
Life-changing results
The mix of medication management and lifestyle changes has worked wonders for Absmeier-Koppenhafer, who has gone from having 18 migraines a month to having an average of one.
“Usually I get them a lot when I travel, because of pressure changes and stuff,” she says. “In February, I traveled to the West Coast for a conference, and I only had one the whole week I was there. I was in Boston after that — and usually Boston gets me bad, because of all the rainstorms they have there — and I didn't have any at all. It's such an improvement to my quality of life.”
That’s music to the ears of Caunt, who says that helping patients is the most rewarding part of her job.
“Seeing people go from having daily headaches to having them once a week or less is one of the most gratifying things,” she says. “Not only are they having improvement on their pain, but they're able to start to live their life. They're not missing work as much anymore. They're able to go to the movies or go to a concert —simple things that we might take for granted but are really disabling to migraine patients because it's too loud or too bright.”
Featured image: Ashley Absmeier-Koppenhafer with her husband, Travis, and son, Grant.
