Migraine
Management Fewer migraines. More life.

Comprehensive migraine care combining trigger identification, preventive therapy, acute treatment options, and lifestyle support to reduce frequency, severity, and the impact migraines have on your daily life.

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More Than a Headache Migraine Care That
Goes Deep Enough

Migraines are a neurological condition, not just bad headaches. The throbbing pain, nausea, light sensitivity, and cognitive disruption of a migraine attack can sideline you for hours or days at a time. At Superior Health Medical & Wellness, Dr. Akers takes migraines seriously as a clinical condition that deserves comprehensive, personalized management, not a prescription for ibuprofen and a suggestion to rest.

Whether you have occasional migraines that have recently increased in frequency, chronic migraines that occur more than 15 days per month, or have tried multiple treatments without lasting relief, Dr. Akers builds an individualized management plan that addresses your specific migraine pattern, triggers, and quality-of-life goals.

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Migraine management at Superior Health Medical and Wellness
Migraine Management What We Manage

Migraine management requires a layered approach covering prevention, acute treatment, trigger management, and lifestyle support. Dr. Akers builds a plan that addresses every dimension of your condition rather than treating each attack in isolation. Explore the components of comprehensive migraine care below.

Not all headaches are migraines, and not all migraines look alike. Dr. Akers takes a detailed headache history covering frequency, duration, location, character, associated symptoms, and known triggers to accurately classify your headache disorder. Distinguishing episodic migraine from chronic migraine, migraine with aura from migraine without aura, and migraine from tension-type or cluster headache is essential to selecting the right treatment approach.
Common migraine triggers include hormonal fluctuations, sleep disruption, dehydration, caffeine changes, stress, certain foods and additives, weather changes, and bright or flickering light. Dr. Akers works with you to identify your specific trigger profile through headache diary review and systematic evaluation, then builds practical strategies to reduce exposure to modifiable triggers without unnecessarily restricting your life.
Preventive therapy is indicated when migraines occur four or more days per month, significantly impair function, or do not respond well to acute treatment. Options include oral preventives such as topiramate, amitriptyline, propranolol, and valproate, as well as newer CGRP-targeting medications including erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality). Dr. Akers selects based on your migraine type, coexisting conditions, and medication history.
Acute migraine treatment aims to stop an attack quickly and completely. Options include triptans such as sumatriptan and rizatriptan, newer gepants including ubrogepant (Ubrelvy) and rimegepant (Nurtec), NSAIDs, antiemetics, and combination medications. Dr. Akers identifies which acute agent is most appropriate for your migraine severity, any cardiovascular considerations, and whether you have been overusing acute medications in ways that may be making your headaches worse.
CGRP (calcitonin gene-related peptide) plays a central role in migraine attacks. A class of injectable monoclonal antibodies targeting CGRP has transformed preventive migraine treatment, reducing migraine frequency by 50 percent or more in many patients with minimal side effects. These monthly or quarterly self-administered injections are now a first-line preventive option for patients with frequent or disabling migraines who have not responded adequately to traditional preventives.
Using acute headache medications including triptans, NSAIDs, or combination analgesics on 10 or more days per month can paradoxically increase headache frequency, a condition called medication overuse headache. Many patients with chronic daily headache are caught in this cycle without realizing it. Dr. Akers identifies medication overuse patterns and guides patients through a structured withdrawal and preventive therapy transition to break the cycle.
Migraines are three times more common in women than men, largely due to hormonal fluctuations across the menstrual cycle, pregnancy, perimenopause, and menopause. Menstrual migraines, which occur in the days around menstruation due to estrogen withdrawal, can be among the most severe and medication-resistant. Dr. Akers evaluates hormonal patterns in female migraine patients and adjusts both contraceptive management and migraine treatment accordingly.
Both too little and too much sleep are established migraine triggers. Sleep disruption also increases pain sensitivity and reduces the effectiveness of acute medications. Dr. Akers evaluates sleep quality in all migraine patients, screens for sleep apnea when appropriate, and incorporates sleep hygiene recommendations into the migraine management plan as a first-line non-pharmacological intervention.
Migraine aura consists of neurological symptoms including visual disturbances, tingling, speech difficulty, or motor changes that precede or accompany the headache phase. Aura is an important clinical distinction because migraine with aura carries a moderately elevated stroke risk, particularly in women who smoke or use estrogen-containing contraception. Dr. Akers evaluates aura carefully and adjusts treatment choices, particularly contraceptive choices, when aura is present.
Consistent daily habits are among the most effective migraine prevention tools available. Regular sleep and wake times, consistent hydration, scheduled meals to prevent blood sugar drops, regular aerobic exercise, stress management, and limiting caffeine and alcohol all reduce migraine frequency in clinical studies. Dr. Akers integrates these evidence-based lifestyle recommendations into your personalized management plan alongside any pharmacological treatment.
Medical Botox (onabotulinumtoxinA) is an FDA-approved treatment for chronic migraines — defined as 15 or more headache days per month. Dr. Akers administers Botox injections to key trigger points in the head, neck, and shoulders every 12 weeks to significantly reduce migraine frequency and severity. Medical Botox for migraines may be covered by insurance. Dr. Akers will review your coverage and eligibility during your visit.
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Why It Matters Why Proper Management
Changes Everything
Dr. Akers providing preventive care
01 Migraines Are
Undertreated

The majority of people with migraines never receive adequate diagnosis or treatment. Many rely on over-the-counter medications that are not designed for migraines, take them too frequently, and develop medication overuse headache that makes everything worse. Effective migraine management requires a physician who understands the condition and takes it seriously, not just a prescription for whatever is available.

02 Prevention and Treatment
Are Different Strategies

Many patients use only acute medications and accept that migraines will continue at their current frequency. Preventive therapy, when indicated, is a fundamentally different strategy that reduces how often attacks occur rather than treating each one after it starts. Dr. Akers helps you understand when prevention is appropriate and which preventive option is most likely to work for your specific migraine pattern.

03 Quality of Life
Is the Metric That Matters

The goal of migraine management is not just fewer headaches. It is fewer lost workdays, fewer cancelled plans, fewer nights suffering in a dark room, and less anxiety about when the next attack will come. Dr. Akers measures success by the impact on your actual life, not just by a reduction in the number you report at follow-up.

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Understanding Migraine The Four Phases of A Migraine Attack

A full migraine attack can involve four phases. The prodrome phase begins hours or days before the headache with subtle changes in mood, appetite, and energy. The aura phase, present in about 30 percent of migraine patients, produces transient neurological symptoms. The headache phase brings the characteristic unilateral, throbbing pain with nausea and light sensitivity. The postdrome phase follows the headache with fatigue and cognitive fog that can persist for a day or more.

Understanding which phases you experience helps Dr. Akers identify the right time to intervene with acute medication, recognize patterns that suggest preventive therapy is needed, and evaluate whether what you are experiencing is typical migraine or a headache disorder that requires different evaluation.

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Preventive Therapy When Prevention Is the Right Strategy

Preventive migraine therapy is considered when attacks occur four or more times per month, last longer than 12 hours, are severely disabling, or do not respond reliably to acute treatment. It is also considered for patients with migraine with aura given the elevated stroke risk with frequent aura. Starting preventive therapy does not mean you will take it forever, it means you are actively reducing the burden of migraines while you and Dr. Akers work on the full picture.

Dr. Akers re-evaluates your need for preventive therapy at every visit. If migraines have been well-controlled for 6 to 12 months, a gradual taper is often appropriate. The goal is always the lowest effective intervention that gives you the quality of life you deserve.

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Frequently Asked Questions Migraine
Questions Answered
A migraine is a neurological condition characterized by moderate to severe unilateral throbbing head pain, nausea or vomiting, and significant sensitivity to light and sound. Attacks last between 4 and 72 hours without treatment. A tension headache is typically bilateral, pressing rather than throbbing, and does not cause nausea or light sensitivity. Cluster headaches are short, extremely severe attacks centered around one eye. Correct classification determines which treatments are appropriate.
Migraines involve a complex cascade of neurological and vascular changes, including cortical spreading depression, activation of trigeminal nerve pathways, and release of inflammatory neuropeptides including CGRP. Genetic predisposition plays a significant role, migraines run in families. External triggers lower the threshold for an attack in susceptible individuals, which is why identifying and managing your personal triggers is an important part of reducing frequency.
Chronic migraine is defined as 15 or more headache days per month for at least three months, with at least 8 of those days meeting criteria for migraine. Episodic migraine is fewer than 15 headache days per month. The distinction matters because chronic migraine is more disabling, more likely to involve medication overuse, and may respond better to different preventive strategies including CGRP-targeting therapy.
Triptans remain the most widely used acute migraine medications and are effective when taken early in the attack. Newer gepants including ubrogepant and rimegepant can be used more frequently without the same risk of medication overuse headache and are an option for patients who cannot use triptans due to cardiovascular conditions. For severe attacks, combination therapy with a triptan and an NSAID is often more effective than either alone. Dr. Akers identifies the right approach for your severity and medical history.
If you are using acute headache medications more than 10 to 15 days per month, depending on the medication type, and your headaches have become more frequent over time rather than less, medication overuse headache is likely contributing. Paradoxically, the medication that is supposed to stop your headaches ends up causing them. The solution is to gradually reduce acute medication use while starting an appropriate preventive therapy, which Dr. Akers manages carefully to minimize the rebound period.
Yes. Clinical trials show that CGRP monoclonal antibodies reduce monthly migraine days by 50 percent or more in approximately half of patients, with some patients achieving near-complete freedom from migraines. They are well-tolerated with few side effects, do not carry the medication overuse risk of acute agents, and are self-administered monthly or quarterly by subcutaneous injection. They represent the most significant advance in migraine prevention in decades.
Yes. Migraines have a strong genetic component. If one parent has migraines, their child has approximately a 50 percent chance of developing them. If both parents have migraines, the risk increases to around 75 percent. Having a family history does not mean you are destined to have frequent disabling migraines, it means you have a lower threshold for attack in response to triggers, which is something that can be effectively managed.
Menstrual migraines are triggered by the drop in estrogen that occurs just before menstruation. They tend to be longer, more severe, and more resistant to acute treatment than non-menstrual migraines. Dr. Akers evaluates hormonal patterns in female migraine patients and can discuss options including short-term preventive therapy timed to the menstrual cycle, hormonal supplementation, or adjustment of any hormonal contraception that may be making menstrual migraines worse.
Migraines are not associated with structural brain damage or cognitive decline in most patients. MRI changes including small white matter lesions are sometimes seen in frequent migraine sufferers but are not associated with clinical impairment. The primary concern is that migraine with aura carries a modestly elevated stroke risk, particularly in women who smoke or use estrogen-containing contraception. Dr. Akers evaluates this risk and adjusts treatment accordingly.
The lifestyle factors with the strongest clinical evidence for reducing migraine frequency include consistent sleep and wake times seven days a week, adequate daily hydration, regular aerobic exercise three to five times per week, consistent meal timing to avoid blood sugar drops, limiting caffeine to one consistent source per day, and stress management through regular relaxation practice. These are not minor adjustments. Implemented consistently, they can meaningfully reduce migraine frequency even without medication changes.
Seek emergency care immediately for a headache described as the worst of your life, a headache that comes on suddenly like a thunderclap, a headache with fever and stiff neck, a headache accompanied by confusion, vision loss, weakness, numbness, speech difficulty, or loss of coordination, or a headache following head trauma. These are warning signs of serious conditions including subarachnoid hemorrhage, meningitis, or stroke that require immediate evaluation.
CGRP monoclonal antibodies are covered by most commercial insurance plans and Medicare for patients who meet clinical criteria, typically four or more migraine days per month with documented inadequate response to at least two standard preventive medications. Prior authorization is required. Dr. Akers's office handles the prior authorization process and works with manufacturer patient assistance programs when insurance coverage is insufficient.