Treatment

Withdrawing from Medications

If rebound migraines develop because of medication overuse, the patients cannot recover without stopping the drugs. (If caffeine is the culprit, a person may need only to reduce coffee or tea drinking to a reasonable level, not necessarily stop drinking it altogether.) The patient usually has the option of stopping abruptly or gradually and should expect the following course:

• Most headache drugs can be stopped abruptly, but the patient should be sure to check with the doctor before doing so. Certain non-headache medications, such as anti-anxiety drugs or beta-blockers, require gradual withdrawal.
• If the patient chooses to taper off standard headache medications, withdrawal should be completed within three days or shorter. Otherwise the patient may become discouraged.
• Alternative medications may be administered during the first days. Examples of drugs that may be used include dihydroergotamine (with or without metoclopramide), NSAIDs (in mild cases), corticosteroids, or valproate.
• Whatever approach is used for stopping medication, the patient must expect a period of worsening headache afterward. Most people feel better within 2 weeks, although headache symptoms can persist up to 16 weeks (and in rare cases even longer).
• If the symptoms do not respond to treatment and cause severe nausea and vomiting, the patient may need to be hospitalized.

On the encouraging side, some patients experience dramatic long-term relief from all headaches afterward, and one study reported that 82% of patients significantly improved 4 months after medication withdrawal.

Investigational Treatments

New treatments in clinical trials include:

Neurostimulation Devices. Researchers are investigating a transcranial magnetic stimulation (TMS) device to help stop migraines before they occur. The hair dryer-size device is held to the back of the head and delivers quick magnetic pulses. The device is used when a patient experiences the first signs of a migraine. Preliminary research presented at the 2006 American Headache Society meeting suggested that the device helped stop or lessen migraine pain within 2 hours after treatment. Other types of nerve stimulation devices are also under investigation.