Migraine is an episodic disabling headache and affects 12 percent of the American adult population. It is thought to be an inherited disorder; most migraine patients have a family history of migraine. Women are three times more likely to have migraines than men; hormonal issues are thought to be the reason.
Characteristics include: throbbing/pulsating pain; moderate to severe degree of pain if not treated early; nausea/vomiting; sensitivity to light and noise; and worsening with activity. The location can be on one or both sides of head; can include neck, jaw, facial and scalp pain.
A migraine is an intense, throbbing headache that may be accompanied by nausea or dizziness. A migraine can last from hours to days.
Many patients have been misdiagnosed as having sinus or tension headache. Sinus symptoms, including facial pain and pressure; nasal congestion; and eye watering are often associated with migraine. Also, neck pain often accompanies migraines and has often caused the misdiagnosis of migraine as tension headache.
Many factors can trigger migraine attacks, such as alteration of sleep-wake cycle; missing or delaying a meal; medications that cause a swelling of the blood vessels; daily or near daily use of medications designed for relieving headache attacks; bright lights, sunlight, fluorescent lights, TV and movie viewing; certain foods; and excessive noise. Stress and/or underlying depression are important trigger factors that can be diagnosed and treated adequately.
Medications used to treat migraines fall into two broad categories:
Pain-relieving medications. Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms that have already begun.
Preventive medications. These types of drugs are taken regularly, often on a daily basis, to reduce the frequency or severity of migraines.
Choosing a strategy to manage your migraines depends on several factors: the frequency and severity of your headaches, the degree of disability your headaches cause, and your other medical conditions. Some medications aren’t recommended if you’re pregnant or breast-feeding, and others aren’t used for children. Speak to your doctor to help find the right medication for you.
For best results, you should take pain-relieving drugs as soon as you experience signs or symptoms of a migraine. Resting or sleeping in a dark room after taking them may be helpful:
Pain relievers. These medications, such as ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others) may help relieve mild migraines. Drugs marketed specifically for migraines, such as the combination of acetaminophen, aspirin and caffeine (Excedrin Migraine), also may ease moderate migraine pain but aren’t effective alone for severe migraines. If taken too often or for long periods of time, these medications can lead to ulcers, gastrointestinal bleeding and rebound headaches. The prescription pain reliever indomethacin may help thwart a migraine headache and is available in suppository form, which may be helpful if you’re nauseous.
Triptans. For many people with migraine attacks, triptans are the drug of choice. They are effective in relieving the pain, nausea, and sensitivity to light and sound that are associated with migraines. Medications include sumatriptan (Imitrex), rizatriptan (Maxalt), almotriptan (Axert), naratriptan (Amerge), zolmitriptan (Zomig), frovatriptan (Frova) and eletriptan (Relpax). Side effects of triptans include nausea, dizziness and muscle weakness. They aren’t recommended for people at risk for strokes and heart attacks. A single-tablet combination of sumatriptan and naproxen sodium (Treximet) has proved more effective in relieving migraine symptoms than either medication on its own.
Ergot. Ergotamine and caffeine combination drugs (Migergot, Cafergot) are much less expensive, but also less effective, than triptans. They seem most effective in those whose pain lasts for more than 48 hours. Dihydroergotamine (D.H.E. 45, Migranal) is an ergot derivative that is more effective and has fewer side effects than ergotamine. It’s also available as a nasal spray and in injection form.
Anti-nausea medications. Because migraines are often accompanied by nausea, with or without vomiting, medication for nausea is appropriate and is usually combined with other medications. Frequently prescribed medications are metoclopramide (Reglan) or prochlorperazine (Compro).
Opiates. Medications containing narcotics, particularly codeine, are sometimes used to treat migraine headache pain when people can’t take triptans or ergot. Narcotics are habit-forming and are usually used only as a last resort.
Dexamethasone. This corticosteroid may be used in conjunction with other medication to improve pain relief. Because of the risk of steroid toxicity, dexamethasone should not be used frequently.
If you have two or more debilitating attacks a month, if pain-relieving medications aren’t helping, or if your migraine signs and symptoms include a prolonged aura or numbness and weakness, you may be a candidate for preventive therapy.
Preventive medications and therapy can reduce the frequency, severity and length of migraines and may increase the effectiveness of symptom-relieving medicines used during migraine attacks. Your doctor may recommend that you take preventive medications daily, or only when a predictable trigger, such as menstruation, is approaching.
Note that in most cases, preventive medications don’t eliminate headaches completely, and some may cause serious side effects. If you have had good results from preventive medicine and have been migraine-free for six months to a year, your doctor may recommend tapering off the medication to see if your migraines return without it.
Cardiovascular drugs. Beta blockers — commonly used to treat high blood pressure and coronary artery disease — can reduce the frequency and severity of migraines. The beta blocker propranolol (Inderal La, Innopran XL, others) has proved effective for preventing migraines. Calcium channel blockers, another class of cardiovascular drugs, especially verapamil (Calan, Verelan, others), also may be helpful in preventing migraines and relieving symptoms from aura. In addition, the antihypertensive medication lisinopril (Zestril) has been found useful in reducing the length and severity of migraines. Researchers don’t understand exactly why these cardiovascular drugs prevent migraine attacks. Side effects can include dizziness, drowsiness or lightheadedness.
Antidepressants. Certain antidepressants are good at helping to prevent some types of headaches, including migraines. Tricyclic antidepressants, such as amitriptyline, nortriptyline (Pamelor) and protriptyline (Vivactil) are often prescribed for migraine prevention. Tricyclic antidepressants may reduce migraine headaches by affecting the level of serotonin and other brain chemicals, though amitriptyline is the only one proved to be effective for migraine headaches. You don’t have to have depression to benefit from these drugs. Other classes of antidepressants called selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) haven’t been proved as effective for migraine headache prevention. However, preliminary research suggests that one SNRI, venlafaxine (Effexor, Venlafaxine HCL), may be helpful in preventing migraines.
Anti-seizure drugs. Some anti-seizure drugs, such as valproate (Depacon), topiramate (Topamax) and gabapentin (Neurontin), seem to reduce the frequency of migraines. Lamotrigine (Lamictal) may be helpful if you have migraines with aura. In high doses, however, these anti-seizure drugs may cause side effects, such as nausea and vomiting, diarrhea, cramps, hair loss, and dizziness.
Cyproheptadine. This antihistamine specifically affects serotonin activity. Doctors sometimes give it to children as a preventive measure.
Botulinum toxin type A (Botox). The FDA has approved botulinum toxin type A for treatment of chronic migraine headaches in adults. During this procedure, injections are made in muscles of the forehead and neck. When this is effective, the treatment typically needs to be repeated every 12 weeks.
The goal in treating a migraine is to be headache-free within two hours, and have relief of any associated symptoms, such as nausea, sensitivity to light, facial pain/pressure, neck pain, low chance of headache recurrence, little to no side-effects with the medication and return to full function.If you feel you may be suffering from migraines, Hoag can help: Contact Pickup Family Neurosciences Institute today.