Dr. James A. Charles on Migraines

Dr. James Charles is a respected neurologist and Ridgewood resident whose work in headache medicine has helped countless patients reclaim their lives from chronic pain. In this conversation, he shares insights on migraine care.

Why do you think migraine headaches are so frequently undiagnosed and under recognized?

Migraine is ranked second in years lived with a disability and is the most common cause of disability in those under the age of 50. Unfortunately, 50% of migraine patients are either not diagnosed, undertreated, or treated incorrectly. Myths such as impacted molars, wrong glasses, sinus headache, and psychic stress are rampant. Once a child or teen reaches six headache days per month, there is a high risk of progression to chronic migraine, defined as 15 or more headache days per month. Self-medication with OTC drugs like ibuprofen taken 15 or more days per month further perpetuates migraine, and some patients develop refractory migraine. If one has one to three devastating migraines per month and is not treating them properly, it can lead to further progression of migraine. Four or more headache days per month require preventive therapy.

What kinds of advances in diagnosis or treatment give you the most hope for patients today?

In 2018, CGRP inhibitors came on the market, which revolutionized the preventive and abortive treatment of migraine. CGRP (calcitonin gene-related peptide) is the brain peptide that causes headache pain. Real-world and published studies have proven their safety and effectiveness. The first CGRP inhibitor was approved for children over the age of six this past summer.

For those who might dismiss migraines as “just bad headaches,” what would you like them to understand about the reality of the condition?

Migraine is a neurological disease that can be profoundly disabling. It’s not simply a headache—it’s a complex disorder involving sensory hypersensitivity, nausea, dizziness, and often visual or auditory disturbances. When left untreated, it can severely disrupt education, work, and quality of life. This is why early diagnosis and appropriate treatment are so critical.

If someone suspects they suffer from migraines, what first steps should they take toward getting help?

Go to www.ucns.org to find a neurologist who is board-certified in the field of headache medicine. Due to my extensive research, I was elevated to the position of Fellow of the American Headache Society, one of only two in New Jersey. It goes without saying that I am a strong advocate for patient access to these life-changing treatments.

For patients struggling with chronic or treatment-resistant migraines, what does your program at Holy Name offer?

For patients with chronic refractory migraine, defined as more than 15 headache days per month and unresponsive to outpatient therapies—and patients who develop a migraine that lasts more than 72 hours and is unresponsive to treatment, also known as Status Migrainosis—the Headache Program at Holy Name is the best in New Jersey and New York. We use infusion therapies for one to five days, and they work!

For more information, visit www.holyname.org/headache to read patient stories or www.jamesacharlesmd.com.