Online Health Chat with Tarannum Khan, MD

February 24, 2015


A migraine headache is known as a primary headache disorder that often recurs in individuals causing moderate to severe pain when left untreated. Chronic, recurring headaches affect the lives of nearly 45 million people in the United States, according to the National Headache Foundation, with an estimated 28 million of these suffering from migraines. Repeated migraines and headaches can have significant impact on an individual’s quality of life, causing them to frequently miss work and other social activities. Recognizing external factors that may trigger a migraine can significantly reduce the frequency of attacks and restore an individual’s quality of life. Persons suffering from chronic headache pain should seek medical attention for an accurate diagnosis of their symptoms in order to explore the most effective options for treatment.

The symptoms of migraine headaches can present themselves in various combinations resulting from exposure to possible triggers including, but not limited to:

  • Emotional stress
  • Sensitivity to chemicals and preservatives in foods
  • Caffeine
  • Changing weather conditions
  • Menstrual periods
  • Excessive fatigue

Join us to speak with a Cleveland Clinic Florida neurologist about migraine triggers and to explore available treatment options.

About the Speaker

Tarannum Khan, MD, is a staff Neurologist in the Department of Neurology at Cleveland Clinic Florida. Her specialty interests include Alzheimer’s disease, dementia, Huntington’s disease, memory loss, migraine headaches, Parkinson’s disease, tension headaches, cervical dystonia, other dystonias, parkinsonism, hemifacial spasms, blepharospasm, writer’s cramp and essential tremors. Dr. Khan received her medical degree from Jawaharlal Nehru University Medical College in New Delhi, India. She completed a neurology residency and movement disorders fellowship at Cleveland Clinic Florida.

Let’s Chat About Migraine Triggers and Treatment

Welcome to our "Migraine Triggers and Treatment" online health chat. Please submit your questions early. All questions will be addressed during the live chat at 12pm ET (12 pm CST) on Tuesday, February 24.

What is a migraine?

Soccermom1979: What is the difference between a regular headache and a migraine headache?

Tarannum_S._Khan,_MD: Great question. Migraine headaches usually are more severe. They affect one side of the head more than the other side, (although it can sometimes occur on both sides of the head), many times associated with nausea sometimes even vomiting, disabling, sometimes interfering with activities and work, and are recurrent. Some migraines are associated with aura- which is loss or blurring of vision in one or both eyes, bright lights in the visual fields. The aura usually happens before the migraine hits. Not all cases of migraines have aura. Sometimes the migraine headaches do not respond to the usual over the counter medications. It tends to have a throbbing or pulsatile quality. There can be photophobia (light worsening the pain) or phonophobia (sound worsening the pain). So there are distinct features that separate migraines from other headaches. Same individual can have regular headaches and migraine headaches at different times.

Medication Therapy

ParklandMom33067: My mother has suffered from migraines for years now with very little to no improvement. A friend of mine recommended Botox as a possible treatment option for her. Is this an effective treatment for headaches? How does it improve symptoms?

Tarannum_S._Khan,_MD: Yes, Botox can be an effective treatment for chronic migraines. It will have to be determined by her treating neurologist. The exact mechanism is not very clear how Botox works in migraine sufferers. Botulinum toxin has been shown to reduce pain (incidentally) in a number of disease states, including cervical dystonia, neuropathic pain, spasticity, myofascial pain, etc. Botulinum toxin is believed to inhibit the release of peripheral nociceptive neurotransmitters, which may then have a effect on the central pain processing systems which are responsible for migraine headaches. In my personal experience, it has worked for many of my patients.

MeganMBrown: I'm 49 and have suffered migraines with aura since I was 17. They used to occur monthly but now they are more random, about five in a two-three week period and then no headaches for a couple of months. I did not respond well to Topamax, can they be regulated by estrogen therapy instead?

Tarannum_S._Khan,_MD: Specially around this time of age with some menstrual irregularities, some people do get more headaches. HRT (hormone replacement therapy) has been used for some perimenopausal symptoms like hot flashes etc. but its usefulness for migraines is not all proven beyond doubt. It is worth exploring with a GYN doc. If low doses are to be tried, it should be given ample time (a few months) to see the effect. But there are some potential side effects to such HRT which should always be discussed first.

DanWeinstein0425: My wife has experienced migraine headaches for years and taken many different medications without much relief. Are there any newer, more advanced treatment options out there for her? Is medication the only option?

Tarannum_S._Khan,_MD: Preventive daily medications with the medications to be taken when the headache comes. In addition lifestyle changes, certain over the counter supplements as I discussed before, biofeedback, etc. are helpful. Botox has also been helpful for a number of chronic migraineurs and can be considered. There is also the first transcutaneous electrical nerve stimulation (TENS) device recently approved by FDA called Cefaly which can be tried.

Alternative Therapies

omermary: I have chronic migraine headaches and have seen multiple doctors and used multiple treatments, all of which are unsuccessful. I have almost given up on medical help BUT now am about to try the herb butterbur 50mg twice daily, which a neurologist prescribed. Do you have any comments on that herb?

Tarannum_S._Khan,_MD: Yes, I am glad you asked about this herb. It was in a study which was published in a neurology journal some years ago. It has been helpful in my personal experience also. In most studies Petasites (butterbur) has been found effective with 150mg daily dose- divided into 2 ie. 75mg twice daily.

pa2four: How, if any, benefit comes from cold pack therapy during a Migraine?

Tarannum_S._Khan,_MD: Cold pack therapy sometimes works for acute migraines. It may cause the vasoconstriction (narrowing of blood vessels) temporarily, may cause some numbing type of sensation leading to some pain relief, or may even reduce some inflammation/ swelling locally.

M_Lynn02: I have had migraines for ten years, seen various doctors and taken various meds. I currently take 350mg of Topamax a day but I still get at least four headaches a month. I am forty now and wonder if there is something I might do to try to reduce headaches on my own? For example, vitamins, lifestyle changes, things of that nature?

Tarannum_S._Khan,_MD: Definitely lifestyle changes matter for migraine headaches-including good sleep hygiene, routine meal schedules, regular exercise, and avoidance of your migraine triggers if you have any. There are some over the counter supplements like Magnesium, Petasites or butterbur, vitamin B2 which have been found to be helpful in migraineurs.

Terri_Rogers: What is biofeedback and how is it used with migraines?

Tarannum_S._Khan,_MD: Biofeedback is a relaxation technique used for headache sufferers and is found to be helpful. There are machines which help us learn to relax in stressful situations. There are instrument that monitors a bodily response, such as muscle tension or skin temperature, as the person tries to modify that response. For example, the monitor might give feedback with a tone that goes higher if the muscles in the forehead tighten and lower if the muscles relax. Similarly it can help gauge the temperature of the skin to help learn relaxation.

Triggers and Side Effects

Floridian954: What is the correlation between migraine headaches and changes in weather? I've seen articles that indicate weather changes can trigger a headache in some people. If so, why is that?

Tarannum_S._Khan,_MD: Yes, weather is an important trigger in some migraine sufferers. It’s due to increased sensitivity of the pain fibers to the changes in barometric pressure, humidity, temperature etc. There is no clear answer to this question; possibly increased susceptibility of the migraineurs to these triggers.

Blue_7501: Is vertigo a side effect of having a migraine headache? I recently experienced a severe headache with this symptom and am concerned it might be a more serious neurological problem?

Tarannum_S._Khan,_MD: There is a migraine variant called vestibular migraine for this entity. The migraine is associated with vertigo type symptoms in these patients. It is important to rule out other conditions which might mimic this. One should be evaluated by their regular primary physician and if needed by a neurologist also.

TTaylor45: What foods typically trigger migraines? Also, are there foods/drinks that help with the pain, like drinking a beverage with caffeine?

Tarannum_S._Khan,_MD: Please check this website for the list. It’s a comprehensive list of food triggers. However I must say the food triggers vary a lot from patient to patient and it takes some diligent observations to know your triggers. Caffeine can help migraines but on the other hand too much of it can lead up to rebound headaches.

george1958: Can exertion be a trigger to a migraine headache? Can a migraine headache start during sleep? I consistently develop a headache several hours after only half an hour of intense exercise. It develops after I go to sleep and wakes me up around 3 am. By leaving my bed and staying up for the following one hour, reduces the pain by 40%. One doctor thinks it might be cluster headache. What are the differentiating features of these two types of headaches?

Tarannum_S._Khan,_MD: Exertion can be a trigger to migraine headache. It’s not the usual case but migraine can start during sleep. Cluster headache can start at night, it’s usually one sided (as compared to migraine which can be unilateral or bilateral), relieves by pacing/ moving (as compared to migraineurs who want to rest/ sleep), affects mostly men (as compared to migraines which affect more females). It also occurs in clusters-several times within a week/ day and migraine is usually several times a month.

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To make an appointment with Tarannum Khan, Neurologist or any of the other specialists in the Department of Neurology at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at

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