Migraine

  • Alternative Names

    Headache - migraine


    Treatment

    There is no specific cure for migraine headaches. The goal is to prevent symptoms by avoiding or changing your triggers.

    A good way to identify triggers is to keep a headache diary. Write down:

    • When your headaches occur
    • How severe they are
    • What you've eaten
    • How much sleep you had
    • Other symptoms
    • Other possible factors (women should note where they are in their menstrual cycle)

    For example, the diary may reveal that your headaches tend to occur more often on days when you wake up earlier than usual. Changing your sleep schedule may result in fewer migraine attacks.

    When you do get migraine symptoms, try to treat them right away. The headache may be less severe. When migraine symptoms begin:

    • Drink water to avoid dehydration, especially if you have vomited
    • Rest in a quiet, darkened room
    • Place a cool cloth on your head

    Many different medications are available for people with migraines. Medicines are used to:

    • Reduce the number of attacks
    • Stop the migraine once early symptoms occur
    • Treat the pain and other symptoms

    REDUCING ATTACKS

    If you have frequent migraines, your doctor may prescribe medicine to reduce the number of attacks. Such medicine needs to be taken every day in order to be effective. Such medications may include:

    • Antidepressants such as amitriptyline
    • Blood pressure medicines such as beta blockers (propanolol) or calcium channel blockers (verapamil)
    • Seizure medication such as valproic acid, gabapentin, and topiramate
    • Serotonin reuptake inhibitors (SSRIs) such as venlafaxine
    • Selective norepinephrine uptake inhibitor (SNRIs) such as duloxetine

    Botulinum toxin (Botox) injections may also help reduce migraine attacks.

    STOPPING AN ATTACK

    Other medicines are taken at the first sign of a migraine attack. Over-the-counter pain medications such as acetaminophen, ibuprofen, or aspirin are often helpful, especially when your migraine is mild. If these don't help, ask your doctor about prescription medications. (Be aware, however, that overuse or misuse of such pain medications may result in rebound headaches.Chronic rebound headaches typically occur in people who take pain medications more than 3 days a week on an ongoing basis.)

    Your doctor can select from several different types of medications, including:

    • Triptans -- the most frequently prescribed medicines for stopping migraine attacks -- such as almotriptan (Axert), frovatriptan (Frova), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig)
    • Ergots such as dihydroergotamine or ergotamine with caffeine (Cafergot)
    • Isometheptene (Midrin)

    These medications come in different forms. Patients who have nausea and vomiting with their migraines may be prescribed a nasal spray, suppository, or injection instead of pills.

    Some migraine medicines narrow your blood vessels and should not be used if you are at risk for heart attacks or have heart disease, unless otherwise instructed by your health care provider. Ergots should not be taken if you are pregnant or planning to become pregnant, because they can cause serious side effects to an unborn baby.

    TREATING SYMPTOMS

    Other medications are primarily given to treat the symptoms of migraine. Used alone or in combinations, these drugs can reduce your pain, nausea, or emotional distress. Medications in this group include:

    • Nausea medicines such as prochlorperazine
    • Over-the-counter pain relievers such as acetaminophen (Tylenol)
    • Sedatives such as butalbital
    • Narcotic pain relievers such as meperidine
    • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen

    If you wish to consider an alternative, feverfew is a popular herb for migraines. Several studies, but not all, support using feverfew for treating migraines. If you are interested in trying feverfew, make sure your doctor approves. Also, know that herbal remedies sold in drugstores and health food stores are not regulated. Work with a trained herbalist when selecting herbs.


    Support Groups

    American Council for Headache Education - www.achenet.org

    The National Migraine Association - www.migraines.org

    National Headache Foundation - www.headaches.org


    Expectations (prognosis)

    Every person responds differently to treatment. Some people have rare headaches that require little to no treatment. Others require the use of several medications or even occasional hospitalization.


    Complications

    Migraine headache is a risk factor for stroke in both men and women.

    Migraine headaches generally represent no significant threat to your overall health. However, they can be a long-term (chronic) problem and may interfere with your day-to-day life.


    Calling your health care provider

    Call 911 if:

    • You are experiencing "the worst headache of your life"
    • You have speech, vision, or movement problems or loss of balance, especially if you have not had these symptoms with a migraine before
    • Your headaches are more severe when lying down
    • The headache starts very suddenly

    Also, call your doctor if:

    • Your headache patterns or pain change
    • Treatments that once worked are no longer helpful
    • You have side effects from medication, including irregular heartbeat, pale or blue skin, extreme sleepiness, persistent cough, depression, fatigue, nausea, vomiting, diarrhea, constipation, stomach pain, cramps, dry mouth, or extreme thirst
    • You are pregnant or could become pregnant -- some medications should not be taken when pregnant

    See the general article on headaches for more information on emergency symptoms