Meridith Balas, who experiences 24 to 28 headache days a month, meticulously plans how and where she sits, what she eats, and even the air she breathes to keep her migraine attacks at bay. She manages her chronic migraine “like a 24/7 job,” and while she has better control of her disease now, she didn’t always feel that way.

For years, she suffered from debilitating migraine attacks, finding no relief from the treatments she received. When she moved to Morgantown from Georgia, she finally found the life-changing care she needed at the WVU Rockefeller Neuroscience Institute (RNI) Headache Center.

Migraine is a common neurological disease involving moderate to severe head pain, accompanied by associated symptoms like nausea and vomiting; extreme sensitivity to lights, sounds, and smells; trouble concentrating; problems with balance; and mood changes.

“Some of these symptoms may begin several hours to as much as two-to-three days before the onset of head pain,” Umer Najib, M.D., director of the RNI Headache Center and vice chair of the Department of Neurology, said.

The disease is complex, and for some, the accompanying symptoms can be worse than the head pain.

After the head pain resolves, Dr. Najib explained, patients often suffer from additional symptoms like fatigue, neck pain, and cognitive slowness that can last up to an additional 48 hours. Patients experiencing multiple attacks in a week can have the lingering effects of a migraine for a prolonged period. This is why migraine is the second leading cause of disability worldwide, according to the National Institutes of Health.

Migraine is not caused by an underlying structural abnormality or lesion, but certain medical problems, environmental factors, and lifestyle choices – often called triggers – can make migraine worse.

Cervical spine or neck problems, temporomandibular joint disorder, sleep problems, dehydration, changes in weather or barometric pressure, allergies, and hormonal changes are some common migraine triggers for patients.

Balas, 34, injured her neck in an auto accident when she was 16 years old. She didn’t realize the extent of the damage until a few years later when her migraine attacks became more frequent and more debilitating.

“On average, I was having two overnight hospital stays per year as a result of a migraine that had lasted for more than 24 hours,” she said. “With that came extreme nausea and often severe dehydration. Many of my friends and family have had to transport me unconscious to the hospital because of some of those migraine attacks taking their toll on my body.”

When Balas visited the RNI Headache Center, she was seen by Najib, who worked with her to find the right combination of medications that would be most effective in managing her disease.

“Meridith is a great example of a complex migraine patient who did not respond to several therapies individually but responded well to a combination of therapies,” Najib said.

Migraine treatment is based on two strategies: abortive therapy to stop the migraine attack when it starts, and preventive therapy to keep migraine attacks from occurring.

Abortive therapies are fast-acting and work by blocking a specific chemical in the brain involved in the migraine process. The earlier these medications are taken, the more effective they are.

Preventive therapies are ongoing treatments taken as daily pills, monthly injections, or infusions that keep certain brain chemicals low to prevent migraine attacks. Lifestyle improvements, especially sleep hygiene, can also act as preventive therapy for migraine.

“It’s very rare to have a neurologist like Dr. Najib who is able to not just look at the symptoms and the challenges you’re facing, but to really take into account your whole life and the whole picture,” Balas said with a bit of emotion in her voice. “With chronic illness, that is the type of care you want to receive.”

Balas takes three preventive medications, an abortive medication, and continues to track data to help manage her migraine attacks. Although she still experiences more than two dozen headache days a month, her disease severity has significantly improved, and she feels confident enough with her care that she can go on with her life.

And Balas has certainly been living life to the fullest. Since she’s been under Najib’s care, she completed her Ph.D. in Higher Education, got married, visited all 50 U.S. states, and became a full-time faculty member at West Virginia University. She also continues to be active in the community and with family.

Perhaps most excitingly, she is pregnant with her first child. Her treatment protocol has changed during her pregnancy, but she said Najib worked with her two years in advance to develop a safe and healthy plan for family expansion.

“Having this level of care gives me the ability to still be flexible and still be spontaneous sometimes, and I know that I have resources if things get hard,” Balas said.

While she said her journey with migraine has been deeply personal and sometimes upsetting, Balas was encouraged by friends to share one of her data reports on social media. She received hundreds of responses from people who thought perhaps they were the only ones dealing with something similar.

“I would encourage people to talk about it more,” Balas said. “I have never been in a conversation about migraine where I haven’t walked away with at least one new insight or idea about maybe how to make things even one percent more comfortable, which, with a chronic illness matters quite a bit.”

Despite having had opportunities to leave the area, Balas said her care at WVU Medicine has kept her here.

“It has been a place that has given me the level of comfort, care, and confidence to be able to manage my chronic illness while also still having a fairly normal life,” she said. “They do a really great job of showing there’s more to the full picture of your life than just that diagnosis or just the symptoms you’re experiencing that day. And I’m really grateful for that.”

Balas explains her chronic migraine in a video available here.

For more information on the WVU Headache Center, visit RNI.WVUMedicine.org/Headache-Center.