Treatment Of Acute Migraine Headache
BENJAMIN GILMORE, MD, David Geffen School of Medicine, University of California, Los Angeles, California
MAGDALENA MICHAEL, MD, Mountain Area Health Education Center, Hendersonville, North Carolina
Am Fam Physician. 2011 Feb 1 83:271-280.
Patient information: See related handout on this topic at .
Migraine headache is one of the most common, yet potentially debilitating disorders encountered in primary care. Approximately 18 percent of women and 6 percent of men in the United States have migraine headaches, and 51 percent of these persons report reduced work or school productivity.1 Patients typically describe recurrent headaches with similar symptoms, and approximately one-third describe an aura preceding the headache.1 This article reviews treatment options for acute migraine headache.
Can A Migraine Cause A Stroke What Are The Risk Factors
Migraine and stroke may occur at the same time, but a causal link has not been established. When an ischemic stroke occurs during a migraine attack it is called a “migrainous infarction.” The specific type of migraine associated with an increased risk of ischemic stroke is migraine with aura, a type of migraine that affects about one-quarter of all people with migraines. Rarely, people with specific migraine symptoms may be related to a higher risk of stroke.
Migraines may be a risk factor for stroke, in that strokes occur more frequently in people who have had migraines, but the strokes do not necessarily occur during migraine attacks.
How To Get Rid Of Rebound Headaches Regaining Control
This post may contain affiliate links. Migraine Strong, as an Amazon Affiliate, makes a small percentage from qualified sales made through affiliate links at no cost to you.
This is an evidence-based article from the authors of Migraine Strong. It includes scientific evidence from studies and peer-reviewed research papers. References to the evidence may be reviewed by clicking the hyperlinked words and/or numbers in parenthesis within the article.
This article was previously published and has been updated by the Migraine Strong team.
You need to take less medications to get rid of rebound headaches, a doctor I have never met before said to me when I was sitting in his office. I had my 2 year old son in a stroller with me. He was whining and I was trying to entertain and keep him quiet with a milk bottle and a rattle. I knew what that doctor saw that day. A stressed out, exhausted, mother of a toddler who was pregnant with another child who was over medicating with Excedrin. Of course shes having constant migraine attacks. Shes in rebound!
** While Migraine Strong writes about the latest in migraine treatments, this is not medical advice. We are patient educators and all information you read should be discussed with your doctor.
Also Check: What Can Help A Migraine
Who Is At Risk For Migraines
About 12% of Americans get migraines. They can affect anyone, but you are more likely to have them if you
- Are a woman. Women are three times more likely than men to get migraines.
- Have a family history of migraines. Most people with migraines have family members who have migraines.
- Have other medical conditions, such as depression, anxiety, bipolar disorder, sleep disorders, and epilepsy.
Treatment Approaches In The Er
The treatment you might receive in a hospital emergency department for a migraine headache will be based, for the most part, on your symptoms and personal health history. In other words, there’s no one-size-fits-all fix.
However, there are standards and recommendations. For one thing, medications given in the ER for migraine headache are typically administered parenterallyin some way other than by mouth, including by subcutaneous injection , intramuscularly , and intravenously .
These methods allow medications to work more quickly in the body, and they are more effective for someone who’s experiencing so much nausea and/or vomiting that keeping down a pill is almost impossible. Many people are also given fluids via IV to prevent dehydration.
In 2016, the American Headache Society put together a panel of experts to review clinical trials of the many diverse medications used in emergency settings to treat migraines in adults to determine which truly work best and are safest. The panel considered studies of 28 different medications to come up with recommendations for the acute treatment of migraines in adults.
Also Check: Why Is Excedrin Migraine Discontinued
Rebound Headache Home Remedies
When I was trying to get rid of rebound headaches over 4 years ago, I did not know about all the natural tools available that could have helped. Through the years, I have learned about so many rebound headache home remedies that can help get you through if your go to medication is not an option.
- Magnesium for rebound headaches there are so many ways to get magnesium into our bodies! In addition to Pure Encapsulations magnesium capsules, which you can get at our Supplement Dispensary at a discount, you can also try trans-dermal magnesium. We recommend doing foot soaks with Life Flo magnesium chloride flakes in a warming bubbly foot spa for about an hour. We also like using Life Flo magnesium lotion and body wash.
How To Treat Rebound Headaches
Frequent use of any acute headache medication, including OTC drugs, can cause what are known as rebound, or medication-overuse, headaches, says Rozental. By definition, a medication-overuse headache occurs on 15 or more days of the month as a consequence of regular overuse of acute or symptomatic headache medication.
The only way to stop medication-overuse headaches is to stop using the drug thats causing them. However, this process can be uncomfortable and can causing worsening of the headache, among other symptoms, according to The Migraine Trust. If you think you may have medication-overuse headache, speak to your doctor or a neurologist trained in chronic headache management.
Recommended Reading: Can You Take Naproxen With Excedrin Migraine
Why Would I Want To Get Behavioral Treatment For My Headaches
There are quite a few reasons why a patient could benefit from seeing a psychologist. Of all these reasons, the most important is that 30-60% of all patients who use biofeedback, relaxation, or cognitive-behavioral therapy have many fewer headaches than before they started. Ultimately, the reason would be so that you have fewer headaches and get back to living life the way you want.
However, not everyone finds behavioral treatment useful. So, how do you know whether you and behavioral treatment are a good fit?
Home Remedies To Ease A Headache Or Migraine Attack
Many headache symptoms can be at least partially alleviated without medication. Here are some tips for homemade headache and migraine relief:
Apply an ice pack to your head and neck. Cold compresses on the head and neck are a common home remedy to ease the pain of a migraine attack. Some people also find it helpful for tension headaches. To avoid skin injury, wrap the ice or cold pack in a cloth and apply it for no more than 15 to 20 minutes at a time.
Apply heat to the head, neck, or hands and feet. Applying heat may help relieve a tension headache or dull the pain of a migraine attack, according to the Mayo Clinic. Use a heating pad set on low, a hot-water bottle, a warm compress, or a hot towel. A hot bath or shower may also be helpful, or simply run warm water over your hands and feet.
Have a big glass of water.Dehydration can trigger a migraine attack or lead to a nonmigraine headache, says the National Headache Foundation. Replacing the liquids your body needs may help to relieve the pain.
Practice a relaxation technique. Meditate, breathe deeply, and try to visualize a peaceful image. “Various relaxation techniques can significantly help patients who suffer from ‘muscle contraction’ headaches,” says Rozental.
Give yourself a massage. Massage eases muscle tension, and sometimes helps to reduce headache pain, according to the Mayo Clinic. Gently massage your temples, scalp, neck, and shoulders with your fingertips, or gently stretch your neck.
Don’t Miss: What Causes Migraines In Children
Keep A Migraine Diary
Different people will have different migraine triggers. Avoiding triggers can help you prevent the headaches and lead a healthy life.
Maintaining a diary will help you determine what triggers your migraines. Keep a record of when your migraines start, what you were doing at the time, how long they last and how you got relief from the pain.
Some well-known migraine triggers are:
- Strong smells.
- If you get a âhangoverâ after one drink, it is better to avoid drinking completely.
- Smoking can trigger migraines. Quitting smoking can reduce your migraines and their severity.
- Stress can cause the body to release hormones that may affect your neurological system and in turn trigger migraine headaches. So, try to manage your stress.
- Get at least 30 minutes of exercise on most days of the week.
- Riboflavin supplements can also be considered. Consult your doctor first.
- The herb butterbur can prevent migraines, possibly because it supports healthy blood flow to the brain.
Nasty Weather Doesn’t Have To Mean A Nasty Migraine For Many Of Us An Approaching Storm Signals The Start Of A Series Of Weather Related Migraines
Dark clouds don’t just mean “take cover” to a person with Migraine. For many of us, an approaching storm signals the unavoidable beginning of another raging attack.My friend Nan used to say she was a human barometer – she could predict a storm before the weatherman. Can you sense migraine weather on the horizon?
Also Check: Can You Faint From A Migraine
How Can I Tell If I Have A Migraine Or Just A Bad Tension
Compared with migraine, tension-type headache is generally less severe and rarely disabling. Compare your symptoms with those in this chart to see what type of headache you might be having.
|Aura before onset of headache||x|
Note: Rebound headache may have features of tension and/or migraine headache. Adapted from a table produced by the American Council for Headache Education.
Although fatigue and stress can bring on both tension and migraine headaches, migraines can be triggered by certain foods, changes in the body’s hormone levels, and even changes in the weather.
There also are differences in how types of headaches respond to treatment with medicines. Although some over-the-counter drugs used to treat tension-type headaches sometimes help migraine headaches, the drugs used to treat migraine attacks do not work for tension-type headaches for most people.
You can’t tell the difference between a migraine and a tension-type headache by how often they occur. Both can occur at irregular intervals. Also, in rare cases, both can occur daily or almost daily.
How Do You Treat Migraines
Its true that a migraine headache doesnt typically respond well to OTC drugs . But a doctor can prescribe effective prescription medication in the form of pills, nasal sprays, and injections that may bring you relief. There is also some evidence that magnesium supplements may be effective in preventing migraines: The American Migraine Foundation points out, In 2012, the American Headache Society and the American Academy of Neurology gave magnesium a Level B rating among medications used for migraine prevention.
Another smart step, in terms of preventing migraines from occurring in the first place: Establish a regular daily routine. “The gene for migraines gives us basically a hyperactive or overly sensitive brain,” Dr. Newman says. “Because of that, any change can induce migraines.”
To ward off migraine attacks, Dr. Newman recommends following the mnemonic SEEDS:
Sleep: Get enough sleep and follow roughly the same snoozing schedule every day.
Eat: Have three regular meals per day.
Exercise: Work out at least three days per week.
Drink: Stay hydrated and avoid too much caffeine and alcohol.
Stress Reduction: Try yoga, biofeedback, or other mindfulness exercises.
Recommended Reading: Which Condition Commonly Accompanies Migraine Headaches
What Are Some Migraine Risk Factors And Triggers
Some things make you more likely to get migraine headaches . Other things may bring on a migraine .
Common migraine risk factors include the following:
- Family history: You are much more likely to have migraines if one or both of your parents had migraines.
- Sex: Women are more likely than men to have migraines.
- Age: Most people have their first migraine during adolescence, but migraines can start at any age, usually before age 40.
Common migraine triggers include the following:
- Food and drink: Certain food and drink may cause migraines. Dehydration and dieting or skipping meals may also trigger migraines.
- Hormone changes: Women may experience migraines related to their menstrual cycles, to menopause, or to using hormonal birth control or hormone replacement therapy.
- Stress: Stress may trigger migraines. Stress includes feeling overwhelmed at home or work, but your body can also be stressed if you exercise too much or dont get enough sleep.
- Senses: Loud sounds, bright lights , or strong smells may trigger migraines.
- Medicines: Certain medicines may trigger migraines. If you think your migraines might be related to your medicine, talk to your doctor. Your doctor may be able to prescribe a different medicine.
- Illness: Infections, such as the cold or the flu, may trigger migraines, especially in children.
Foods that may trigger migraines:
- aged, canned, cured, or processed meat
- aged cheese
- soy sauce
Treating Migraine Headaches Starts With Prevention
Youre probably familiar with tension headaches an aching pain or pressure that is relatively mild. A migraine, on the other hand, is intense. The pain can be so incapacitating that you cant go to school or work. Its more than just a severe headache.
Over 37 million Americans suffer from migraines, according to the American Migraine Foundation. One in four households has a member who suffers from one of the types of migraines. Women are three times more likely than men to experience the neurological condition, and children also can develop it.
Fortunately, its something primary care providers see frequently and are comfortable treating.
A migraine attack is often preceded by whats called an aura, a sensation such as a funny smell or a visual disturbance like seeing wavy lines or lights. Not all migraine sufferers experience an aura beforehand.
After the migraine begins, symptoms can include:
- Sensitivity to light or sound
- Vision problems
- Nausea or vomiting
- Pulsing pain on one or both sides of the head
A migraine attack can last from a few hours to a several days. A person with symptoms for more than 15 days a month may be suffering from chronic migraines.
Migraine sufferers usually begin to experience them in their teenage years, but they can begin in childhood or middle age. Its especially important that you see a physician if you experience migraine-like symptoms later in life because it could be a sign of another illness.
What Causes Migraines?
Also Check: Why Do People Have Migraines
Who Is At Risk For Abdominal Migraine
Abdominal migraines mostly affect children, with the first episode occurring between 3 and 10 years old. Most children seem to outgrow the condition, though abdominal migraines in adulthood are just starting to be studied. A child with a family or personal history of migraine headache has an increased chance of developing abdominal migraine.
Limit The Use Of All Pain Medicines
- Do not use prescription pain medicine for headaches for more than nine days in a month.
- Do not use non-prescription pain medicine for more than 14 days in a month.
This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
Don’t Miss: What Is A Body Migraine
Caution For Pregnant Women
Some medications used in the emergency treatment of migraine headaches are known to cross the placenta of women who are expecting and cause possible harm to a developing baby. These include:
- NSAIDs: These are not considered safe for women in the third trimester of pregnancy, at which time these drugs can interfere with the healthy development of a baby’s lungs, cause low levels of amniotic fluid, or slow or stop labor during childbirth.
- Dihydroergotamine: Also known as an ergot alkaloid, this drug is on a long list of medications cited by the AHS panel as having too little available information to recommend or not recommend for pregnant women. Brand names in this class include D.H.E. 45 and Migranal.
- Opioids: Both oxycodone and morphine are opioid medications that carry a high risk of abuse and addiction. Studies have shown that opioids are also less effective at terminating migraines than the antiemetic, metoclopramide.
- Valproate: This anti-seizure drug is sometimes ordered to prevent recurrent migraines. Valproate is considered highly teratogenic, and is banned in many countries for use in pregnant women and women of childbearing age.
What Medications Contribute To Rebound Headaches
Rebound headaches are caused by excessive use of certain acute medications. However, the term excessive depends on the type of acute medication taken. Each medication class has a specific threshold.
According to American Migraine Foundation, the following situations may cause rebound headaches:
If you have a headache disorder, any medication you take for pain relief even for a different medical condition can cause rebound headaches. People without migraine, can take the same pain relieving medications for other conditions such as back or neck pain without triggering rebound headaches. Yes, that last part seems very unfair.
Don’t Miss: What Pressure Points Get Rid Of Migraines