Treatment

Treatment

Many effective headache remedies are available for treating a migraine attack. Still, a 2002 study that analyzed over 800,000 case of migraine, reported that most migraines are not treated according to any expert recommendations or accepted evidence. In the study, 30% of patients were treated with potentially addictive opioids -- most often Demerol. Furthermore, 70% of these patients were not offered effective and available anti-migraine drugs. Anti-nausea drugs that have no effect on headaches were used six times more often than drugs that reduce headaches.

As many as 30% of patients with migraine also have accompanying headaches resulting from tension, drugs, infections, or other causes. It is important to distinguish between headache types in order to determine appropriate treatment.

General Guidelines. The general goals of treatment are:

• On the advice of the doctor, choose drugs with as few side effects as possible. Patients should discuss various methods for administering the medication (pills, injections, nasal spray, or rectal suppositories) and begin with the one they believe will be the least distressing.
• Treat the attack rapidly, within an hour of symptom onset if possible. Start with low doses first and build up dosage slowly.
• Try to minimize the use of back-up or "rescue medications." (A rescue medication is typically an opiate, which the patient uses at home for pain relief when other medications fail.)
• Try to guard against rebound effect. Nearly all drugs used for migraine can cause rebound headache and none of the drugs should be taken for longer than 2 days per week.
• It may take 2 - 4 months for any drug to be effective.

Stepped-Up Treatment Approach. Some experts recommend a stepped-up treatment course for an acute migraine attack. This involves starting with the least potent treatments and taking increasingly more potent drugs until the pain stops. In this approach, patients may need up to five different medications to achieve pain relief. A typical stepped-up approach is the following: