Wellness Tips from Josef Schenker, MD
Welcome to our Wellness Tips blog series, brought to you by Dr. Josef Schenker, the Medical Director at Centers Urgent Care. In this series, Dr. Schenker shares his extensive knowledge and experience in internal medicine and emergency medical services, including migraine treatment and prevention, to help you lead a healthier life.
Dr. Schenker will cover a range of crucial health topics, offering expert advice on how to avoid common ailments. With a focus on prevention and practical tips, each blog post is designed to empower you with the information you need to make informed decisions about your health and well-being.
Migraine Treatment and Prevention for Recurring Attacks
Migraine treatment and prevention start with seeing migraine as a brain disorder, not just a strong headache. Migraine affects about 12% of people worldwide and remain one of the leading causes of disability in adults under 50. In this guide, Dr. Josef Schenker explains what migraine is, which symptoms to watch, and which treatments can ease or shorten attacks. The next sections also walk through simple prevention steps and when to visit urgent care, so migraine episodes disrupt your day as little as possible.
Dr. Josef Schenker Explains the Symptoms of Migraine
Migraine symptoms usually follow a pattern, even though every person describes pain in a slightly different way. Josef Schenker, MD, notes that learning your pattern helps you recognize an attack early and start treatment when it works best. Migraine symptoms often involve several phases:
Early Warning Signs (Prodrome)
Prodrome symptoms can appear hours to a day before the headache. People may feel more tired, yawn more, crave certain foods, feel irritable, or have trouble focusing.
Aura In Some Patients
Aura is a temporary change in vision, sensation, or speech that appears before or during the headache. Many describe seeing zigzag lines, flashing lights, or a blank spot in part of their vision. Others feel tingling in the face or arm or notice trouble finding words.
Headache Phase
Migraine headache often:
- Causes throbbing or pulsing pain, usually on one side of the head
- Gets worse with routine activities like walking up stairs
- Comes with nausea or vomiting
- Brings strong sensitivity to light, sound, and sometimes smells
Recovery phase (postdrome)
After the pain fades, many feel drained, sore in the head or neck, and foggy for several hours to a couple of days. Some compare it to a “migraine hangover.”
Symptoms do not always include every phase. Some people never have an aura. Others have an aura without any head pain. New, sudden, or very different headache symptoms should always be reviewed by a clinician, since they can mimic more serious problems like stroke or bleeding in the brain.
What Is Migraine?
Migraine is a primary headache disorder that starts in the brain and its nerves, not in the scalp muscles. Nerve pathways and brain chemicals misfire during an attack. Those changes affect pain pathways, blood vessels, and the brain’s processing of light, sound, and other sensations.
According to Dr. Josef Schenker, migraine is classified as a neurological condition and often runs in families. Several main types include:
- Migraine without aura: Repeated headaches that last 4 to 72 hours with one-sided, pulsating pain, nausea, and sensitivity to light or sound.
- Migraine with aura: Headache attacks that include visual or sensory aura symptoms.
- Chronic migraine: Headache on 15 or more days per month, with at least 8 days showing migraine features.
- Other specialized types: Forms such as vestibular migraine, hemiplegic migraine, or retinal migraine involve dizziness, weakness, or vision loss in specific patterns.
Same-day urgent care for pain relief and longer-term prevention are both part of how migraine attacks are managed.
Can You Stop a Migraine Attack Once It Starts?
Migraine attacks respond best when treatment starts early. Many people can shorten or soften an attack if they act at the first sign of pain or aura. Several options are used to treat migraine attacks:
- Simple pain relievers. When taken at the onset of symptoms and at the appropriate dosage, over-the-counter pain relievers such as NSAIDs like ibuprofen or naproxen, as well as acetaminophen, can be effective in managing mild to moderate migraines, particularly when used as part of a treatment plan developed with a healthcare provider.
- Triptans and similar prescription medicines. Triptans target serotonin receptors in the brain, blood vessels, and nerves. They are standard prescription options for moderate to severe migraine. Newer medicines called “gepants” and “ditans” also target migraine pain pathways and help many patients who cannot take triptans.
- Anti-nausea support. Nausea symptoms that need attention are common during migraine attacks and may require medicine taken by mouth, a dissolving tablet, or sometimes by injection. Treating nausea keeps fluids down and improves comfort while other medicines work.
- Non-medical steps during an attack. Simple steps still help. A dark, quiet room, cold or warm packs on the head or neck, and steady hydration all reduce extra strain on the brain during an attack.
Migraine treatment and prevention also rely on limits. Overusing quick-relief pain medicine can rebound and increase headache days, so most guidelines suggest limiting acute treatments to fewer than 10 days per month, depending on the drug.
How Long Does a Migraine Attack Last?
Most migraine headaches last from 4 to 72 hours if they are not treated. Josef Schenker, MD, explains that the entire attack can feel longer when you include the prodrome and recovery phases before and after the headache. Here is a simple guide to how long parts of an attack can last:
- Prodrome: Early warning signs may appear up to 24 hours before the headache.
- Aura: Visual or sensory aura usually lasts 5 to 60 minutes.
- Headache phase: Pain typically lasts 4 to 72 hours without treatment and may shorten when treated early.
- Postdrome: Recovery symptoms can persist for several hours to 48 hours.
Some people develop status migrainosus, a severe migraine that lasts longer than 72 hours. This prolonged form may require emergency-level care for hydration and pain control, and to rule out other causes.
Migraine treatment and prevention become more important when attacks are frequent, last a long time, or keep you from daily tasks. That is the point when preventive strategies usually enter the plan.
Josef Schenker, MD, Explains How to Prevent Migraine Attacks
Migraine prevention aims to reduce the number of attacks, lower their intensity, and make each easier to treat. As Josef Schenker, MD, points out, prevention often mixes daily habits and medicines that adjust how the brain responds to triggers over time. Several approaches are commonly used for migraine treatment and prevention:
- Lifestyle routines that support the brain. Regular sleep, consistent meal times, hydration, and moderate exercise all support more stable brain chemistry and blood flow.
- Preventive prescription medicines. Daily medicines such as certain beta blockers, antidepressants, antiseizure medicines, and newer calcitonin gene-related peptide (CGRP) monoclonal antibodies can reduce attack frequency and severity.
- Newer oral CGRP blockers and gepants. Some oral CGRP antagonists (gepants) are now approved for both acute and preventive migraine use. Clinical trials show they can cut the number of monthly migraine days and offer another option for people who do not tolerate other preventives.
- Behavioral and non-drug tools. Relaxation training, cognitive behavioral therapy, biofeedback, and certain neuromodulation devices can support prevention, depending on access and insurance coverage.
Providers often discuss preventive medicines when a person has at least 4 migraine days per month, attacks that are very disabling, or frequent use of quick-relief medicines. Migraine treatment and prevention plans should always be tailored with a clinician who knows your other health conditions and medications.
Migraine Triggers You Should Know
Migraine triggers are things that increase the chance of an attack in someone who already has migraine. They are not the root cause of the condition, but they often “tip over” a sensitive brain.
- Stress and sudden stress drops. Stress during busy periods and the “letdown” after a stressful week both trigger attacks for many people.
- Sleep changes. Too little sleep, too much sleep, or inconsistent bedtimes can trigger migraine attacks, especially in people with sleep disorders that disrupt rest, like sleep apnea.
- Hormonal shifts. Changes around menstruation, pregnancy, or menopause can increase attacks, which is why “women’s health care near you” may be part of a broader migraine management plan.
- Caffeine and alcohol. Too much, too little, or sudden changes in caffeine intake may trigger symptoms. Alcohol, especially wine or certain spirits, is a well-known trigger in some patients.
- Food and hydration patterns. Skipping meals, dehydration, and certain foods such as processed meats, aged cheeses, or foods with specific additives can contribute to attacks in sensitive people.
- Weather and environmental factors. Sudden changes in barometric pressure, high heat, bright lights, loud noise, or strong smells can set off or worsen a migraine.
Migraine treatment and prevention benefit from a simple trigger diary. Writing down sleep, meals, stress, menstrual cycles, and weather on days you have attacks can reveal patterns that guide your plan.
What to Do if Someone Has a Migraine Attack
Migraine care during an attack focuses on comfort, safety, and watching for signs that it may be more than a typical migraine. Josef Schenker reminds patients and families that severe head pain can sometimes mimic emergencies, so paying attention to red flags is important. Practical steps during a migraine attack include:
- Check for serious warning signs to watch. Call emergency services right away if the headache is “the worst ever,” starts suddenly like a thunderclap, comes with new weakness, confusion, slurred speech, seizure, trouble seeing, or a stiff neck.
- Use the person’s migraine action plan. Help them take their prescribed migraine medicine at the first sign of symptoms, following the dose and timing given by their clinician.
- Support a calm, low-stimulation space. Turn off bright lights, reduce noise, and offer a cool cloth for the forehead or neck. This reduces extra triggers while the medicine takes effect.
- Encourage hydration and light snacks if tolerated. Small sips of water or an oral rehydration drink help, especially when nausea or vomiting is present.
- Monitor how the attack changes over time. Take note of how quickly medicine works, how long the attack lasts, and whether symptoms look different from usual. This information helps the clinician adjust future migraine treatment and prevention.
Urgent care is a good option when a migraine feels worse than usual, does not respond to home medicines, or causes repeated vomiting, but there are no stroke-like signs. Urgent care teams can give IV fluids, anti-nausea medicines, and stronger migraine drugs in a quieter setting than a busy emergency department. Centers Urgent Care can evaluate severe migraine symptoms, rule out many common urgent causes, and provide same-day treatment to help you recover faster and safely.
Josef Schenker, MD, Answers Frequently Asked Questions:
Are migraines dangerous or life-threatening?
No, most migraines are not dangerous or life-threatening, but certain patterns require caution. Migraine with aura increases stroke risk, especially in women who smoke or use estrogen-containing birth control. Sudden, severe, first-time, or clearly different headaches require urgent evaluation to rule out bleeding, infection, or stroke.
Do I need a brain scan (CT or MRI) if I get migraine headaches?
No, most people with typical migraine headaches do not need a brain scan such as a CT or an MRI. Imaging is recommended when headaches are new, sudden, change in pattern, or include weakness, confusion, seizures, or personality changes. Later-age onset or neurological deficits also require imaging.
Are migraines hereditary, and can my child develop them?
Yes, migraines can be hereditary, and your child can develop them if a parent has migraines. Family history significantly increases risk, and certain types, such as hemiplegic migraine, clearly run in families. Recurrent headaches with nausea, light sensitivity, or abdominal pain require pediatric evaluation.
Do I need daily preventive medication if my migraine attacks are not frequent?
No, you do not need daily preventive medication if migraine attacks are infrequent and cause minimal disruption. Preventive therapy is usually recommended when migraines occur 4 or more days per month, last many hours, or significantly impair work or school.
When should I go to urgent care for migraine?
You should go to urgent care for migraine when severe pain does not improve with your usual medication, when vomiting prevents fluid intake for 8–12 hours, or when dehydration symptoms appear.
Take Migraine Attacks Seriously and Seek Timely Care
Migraine treatment and prevention work best when you understand your symptoms, know your triggers, and act early with a clear plan. This guide outlined how migraine develops, what symptoms to watch for, how long attacks can last, which preventive options exist, and when urgent care makes sense.
You can visit an urgent care facility in New York if migraine symptoms are hard to manage at home or feel more intense than usual. Our team at Centers Urgent Care, led by Dr. Josef Schenker, provides prompt evaluation, acute migraine treatment, and guidance on follow-up care to support long-term control.
We operate multiple clinics across New York City to make same-day help easier to reach when you need it most. Locate a Centers Urgent Care near you.
About Josef Schenker, MD:
Dr. Josef Schenker, a board-certified expert in internal medicine and emergency medical services, brings extensive experience and compassion to his role as Medical Director and Partner at Centers Urgent Care. With leadership in SeniorCare Emergency Medical Services and as an Attending Physician at New York-Presbyterian Brooklyn Methodist Hospital, Dr. Schenker oversees critical care and treatment protocols across varied medical needs. His dedication extends to chairing NYC REMAC, ensuring adherence to state standards in emergency medical procedures. At Centers Urgent Care, Dr. Schenker's expertise ensures prompt, high-quality emergency care for patients of all ages, supported by state-of-the-art facilities including a dedicated pediatric suite.