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What Is The Treatment Of Migraine

What Is The Prognosis For People With Migraines

What Is a Migraine Headache?

Migraines are unique to each individual. Likewise, how migraines are managed is also unique. The best outcomes are usually achieved by learning and avoiding personal migraine triggers, managing symptoms, practicing preventive methods, following the advice of your healthcare provider and reporting any significant changes as soon as they occur.

Are You At Risk For Migraine

If you suffer from frequent headaches, then does it mean that you are at risk of migraine? There are risk factors that make you more prone to get a migraine. These are as follows.

  • Women are more likely than men to have migraines. Women are three times more prone to having migraines.
  • You are more prone to developing migraines if you already suffer from other medical problems such as epilepsy or depression.
  • If people in your family suffer from migraine problems then there is a high chance that you might develop migraine too.
  • Womens menstruation, pregnancy or menopause can cause migraines to develop. Hormonal changes in women trigger migraines.

What Does An Attack Look Like

There are four distinct phases of a migraine attack: prodrome, aura, headache, postdrome. You dont have to experience all the phases. In fact, only about 20% of people with migraine have an aura. Understanding the phases can help you manage the disease better.

The prodrome and aura phases usually occur before the headache develops. Prodrome may precede the migraine attack by several hours or even days. Typical prodrome symptoms include extreme tiredness and yawning, irritability or moodiness, difficulty concentrating, and food cravings. About 75% of people with migraine experience a prodromebut often they dont recognize it as the beginning of an attack. Aura is rarer and usually begins just before the headache starts. Most people experience changes in their vision, while others notice tingling, numbness or trouble speaking.

These symptoms can serve as a warning sign and allow you to take acute medication before the headache begins. Identifying and treating a migraine early can even help prevent further symptoms in some people.

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Treating And Preventing Migraines

The aims of treatment are to prevent them, if possible, and ease the symptoms when they do occur.

Once you’ve got a migraine, the only thing you want is for the pain to stop. Start treatment as soon as you feel the migraine pain whether its over-the-counter medication like Advil Liqui-Gels, for mild to moderate pain, or something your doctor prescribes.

You may be able to reduce your chances of suffering from a migraine attack by knowing your potential migraine triggers. A good place to begin is by keeping a headache diary Recording lifestyle factors such as what you eat, how much sleep you get, exercise routines, and stress levels along with when your headaches start and the type of pain you experience can help you monitor these patterns. That way you will be able to make lifestyle changes to reduce the number of migraines you get.

Important Migraine Treatment Safety Precautions

Migraine

Be aware of medication overuse for migraine treatment and headaches. Although painkillers are sometimes an essential way of treating headache or other pain, regular use can lead to medication overuse headaches.8 Overuse can cause your medication to stop relieving pain and start causing headaches.8 If you suspect this is the case, discuss your options with your doctor.

Do not make changes to your migraine treatment, or stop taking your prescribed medications without first consulting a doctor. Always take any medications as instructed

Be careful with taking medication if pregnant or breast-feeding. Discuss your options with your doctor or midwife as early in your pregnancy as possible.2

References

  • Katsarava Z, Buse D, Manack A, Lipton R. Defining the differences between episodic migraine and chronic migraine. Current Pain and Head Reports 2012 16: 86-92
  • NHS Choices. Treatment. http://www.nhs.uk/Conditions/Migraine/Pages/Treatment.aspx
  • NHS Choices. Migraine Prevention. http://www.nhs.uk/Conditions/Migraine/Pages/Prevention.aspx
  • NHS Choices. Causes. http://www.nhs.uk/Conditions/Migraine/Pages/Causes.aspx#triggers
  • The Migraine Trust. What is a trigger? https://www.migrainetrust.org/about-migraine/trigger-factors/what-is-a-trigger/
  • The Migraine Trust. Medication. https://www.migrainetrust.org/living-with-migraine/treatments/medication/
  • Russo AF. Calcitonin gene-related peptide : a new target for migraine. Annu Rev Pharmacol Toxicol. 2015 55: 533-552
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    Severe Migraine Treatment: What Are Your Options

    Migraine affects roughly 35 million people, or about 12 percent of the U.S. population. Typically, migraine affects more women than men. Yet, up to half of those with migraine dont have a diagnosis. Continue reading to learn more about severe or chronic migraine and treatment options.

    The symptoms of severe or acute migraine include pain, which is usually severe and often disabling, as well as intense throbbing. Some people experience nausea, vomiting, or extreme sensitivity to noise or light during attacks. Episodes of severe migraine may last from 4 hours to 3 days.

    Severe migraine may occur with or without aura. Aura refers to a perceptual disturbance. Examples include experiencing nonexistent smells, lights, or sounds. Migraine is often considered severe when pain, nausea, or other associated symptoms force a person to avoid normal daily activities.

    Also, migraine is classified as severe if the person affected has a history of two to five similar episodes. Migraine is most common among people ages 25 to 55, but it may also affect children and teens.

    Chronic migraine occurs at least 15 days a month, for more than 3 consecutive months. This type of migraine can cause a substantial loss in productivity and may result in a poor quality of life. Its important to treat acute migraine in order to prevent the development of chronic migraine.

    Heres a list of commonly prescribed medications in the triptan family:

    • eptinezumab
    • atogepant
    • erenumab

    What Questions Should I Ask My Healthcare Provider

    • Will my child grow out of their migraines?
    • What medications do you recommend for me?
    • What should I change about my lifestyle to prevent my migraine headaches?
    • Should I get tested?
    • What type of migraine do I have?
    • What can my friends and family do to help?
    • Are my migraines considered chronic?

    A note from Cleveland Clinic

    Migraine headaches can be devastating and make it impossible to go to work, school or experience other daily activities. Fortunately, there are some ways to possibly prevent a migraine and other ways to help you manage and endure the symptoms. Work with your healthcare provider to keep migraines from ruling your life.

    Last reviewed by a Cleveland Clinic medical professional on 03/03/2021.

    References

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    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.

    Preventive Medicines Are Not Forever

    What are Migraines? (HealthSketch)

    **If a preventive treatment works well, that medication can then be continued for several months . With better symptom control one may want to wean down the dose. When stopping a preventive medicine, there is a risk of the headaches returning. It is unusual for migraine frequency suddenly to bounce back again during weaning down. Migraine illness varies during a lifetime and the use of preventive medication may have to be adjusting for those variations.

    This information is NOT intended to endorse drugs or recommend therapy. While these reviews might be helpful, they are not a substitute for the expertise, skill, knowledge and judgment of healthcare practitioners in patient care. Only your doctor can decide which medications are right for you. Never stop, start or change the way you use a prescription medicine without first consulting your doctor.

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      Dont Be Afraid To Try These Medicines

      These drugs were first used for many other medical purposes, such as prevention of high blood pressure, depression or epilepsy. These medicines act on the transmission of information in our nervous system and, at the low doses needed for preventing migraine, they usually have little or no other effects.

      There are no firm rules on how any particular medication should be used. The Food and Drug Administration has approved only four of these drugs for prevention of migraine: propanolol, timolol, divalproex sodium and topiramate , but that does not mean that there has not been a great deal of research and success with a much larger number of migraine preventive drugs.

      A beta blocker or calcium channel antagonist may be more appropriate for a patient with hypertension, while a tricyclic antidepressant may benefit a migraine patient who is depressed or having difficulty sleeping.

      Q How Do You Stop Migraine Headaches

      A. Migraine often is accompanied by severe headache, nausea, dizziness, vomiting, and sensitivity to light, sound, & odours. With these few simple steps, prevent the condition of migraine-

      • Avoid bright lights and loud noises.
      • Maintain a strict diet. Include foods which are good for migraine.
      • Beware of the internal changes like the hormonal changes or external changes in the environment to figure out which conditions might trigger a migraine attack.
      • Eat and sleep on a regular schedule. Maintain a track of your headache. Keep note of your regular day to day activities like workout, medications, feelings and emotions which results in migraine.
      • Most importantly, avoid stress.

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      What Are The Signs And Symptoms Of Migraine

      There are a few signs and symptoms in accordance with migraines.

      • Pulsatile headaches or throbbing, with moderate pain that intensifies and becomes severe with either movement or physical activity.
      • Localized or unilateral pain in the ocular and frontotemporal area, the pain can be felt around the head or neck.
      • Headache lasting for 4-72 hours
      • Light-headedness, sensitivity to sound and light, progressive pain built up.
      • Sensitivity to sound, light and odours
      • Vomiting, feeling sick
      • Disturbed vision

      Classes Of Prophylactic Drugs

      Get the Migraine treatment in Jaipur by Dr. Vikram Bohra ...

      The classes of medications that are effective for migraine prevention include:

      • Antiepileptics

      • Botulinum toxin

      • Calcitonin gene-related peptide inhibitors

      Antiepileptics, antidepressants, and antihypertensives may be considered initially since they are more affordable. For any of these initial prophylactic agents, prophylaxis should not be considered a failure until it has been given at the maximum tolerable dose for at least 30 days.

      Antiepileptics

      Antiepileptics are generally well tolerated. The main adverse effects of topiramate are weight loss and dysesthesia. Valproic acid is useful as a first-line agent. It is a good mood stabilizer and can benefit patients with concomitant mood swings. However, it can cause weight gain, hair loss, and polycystic ovary disease therefore, it may not be ideal for young female patients who have a tendency to gain weight.

      Valproic acid also carries substantial risks in pregnancy it may be best suited for women who have had tubal ligation and who cannot tolerate calcium channel blockers because of dizziness. Data for other antiepileptics are limited in migraine.

      Topiramate is approved in the US for migraine prophylaxis in adults and adolescents aged 12 years or older. The safety and effectiveness of topiramate in preventing migraine headaches in adolescents were established in a clinical trial of 103 participants. Frequency of migraine decreased by approximately 72% in treated patients, compared with 44% in participants receiving placebo.

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      Triptans And Ergot Alkaloids

      The 2 categories of migraine-specific oral medications are triptans and ergot alkaloids. The specific ergot alkaloids include ergotamine and dihydroergotamine . The specific triptans include the following:

      • Sumatriptan

      • Eletriptan

      • Frovatriptan

      Although the triptans share a common mechanism of action, they differ in the available routes of administration, onset of action, and duration of action. Routes of administration include oral, intranasal, subcutaneous, and intramuscular. Transdermal patches have proved effective for the delivery of sumatriptan, and one such product has received FDA approval. The sumatriptan iontophoretic transdermal system was approved by the FDA in January 2013 for the acute treatment of migraine with or without aura in adults. The single-use patch also treats migraine-related nausea. In phase 3 trials involving 800 patients, the patches safely and effectively relieved migraine pain, migraine-related nausea, sonophobia, and photophobia within 2 hours of activation.

      The FDA approved a low-dose intranasal sumatriptan powder for migraine in January 2016. The product consists of 22 mg of sumatriptan powder and is the first breath-powered intranasal medication delivery system to treat migraines. Approval was based on data from phase 2 and phase 3 trials, reference data on the use of sumatriptan, and safety data from more than 300 patients.

      What Are The Common Symptoms Of Migraine

      How can you tell if your head pain is actually migraine? The symptoms vary from person to person. But if you agree with some or many of the statements below, your head pain may be migraine and you should think about seeing a doctor.

      • Your head pain is moderate or severe and often intense. The pain may be hard to endure and may be unbearable.
      • The pain may be on one side of the head or both. It could be in the front or in the back. Some patients experience migraine in or around their eyes and behind their cheeks.
      • Your head pain causes a throbbing, pounding, or pulsating sensation.
      • Your head pain gets worse with physical activity or any movement.
      • You experience nausea and/or vomiting
      • You are sensitive to light, noise and/or smells.
      • Your head pain is severe enough to make you miss school, work or other activities .
      • A migraine attack lasts anywhere from four hours to several days.

      Some people have migraine with aura. The most common type of aura is visual . Aura can also cause blurred vision or loss of vision. Typically, aura occurs before the head pain of the attack begins, and fully resolves in an hour or less.

      Migraine can be classified as episodic or chronic. People with episodic migraine have 14 or fewer headache days per month. People with chronic migraine experience more than 15 headache days per month with at least eight that include migraine features . In some people, episodic migraine can become chronic, which may happen if its not recognized and treated correctly.

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      Migraine With Aura Home Remedies

      Home remedies can help you deal with the symptoms of an aura migraine. Here are some frequently recommended home remedies for this condition.

      • Avoid working on a computer or using your phone at the first signs of an aura migraine. The light emitted by the screen may increase your light sensitivity and make visual disturbances worse.
      • Place an ice pack or a cold compress on your forehead.
      • Lie down in a quiet, dark room as soon as the first symptoms appear. If its a bright day outside, draw the curtains.
      • Cool down the room if its warm.
      • Practice simple deep breathing exercises by becoming aware of your breathing and following it to relax.
      • Take a nap or, if its evening, try to go to sleep.

      Medication For The Acute Treatment Of Migraines

      What is the best treatment for headaches?

      Acute or rescue medications are taken during a migraine attack ideally before symptoms have gotten severe to help lessen the severity and duration of symptoms, including pain, nausea, and vomiting.

      For some people with migraine, over-the-counter pain relievers are sufficient to treat migraine attacks, but for many others, prescription drugs are needed for adequate relief.

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      Changes In The Weather

      Many people report that changes in the weather, particularly changes in barometric pressure, trigger migraine attacks. Other weather-related migraine triggers include heat, humidity, wind, and reduced light exposure.

      Poor air quality, from wildfires or other sources of air pollution, can also be a trigger for some people.

      Medications To Treat And Prevent Migraine Attacks

      Medical treatment options for migraine are twofold: drugs that work to alleviate symptoms once an attack has started and medications that prevent attacks from happening or reduce their frequency and severity.

      Abortive Medications Acute, or abortive, treatments include over-the-counter pain relievers and prescription medications called triptans.

      CGRP is a protein in the brain and nervous system involved in the transmission of pain and the reaction of tissues and blood vessels to that pain. It has long been implicated in the process by which migraine occurs. It is hoped that the arrival of anti-CGRP therapies will open a new era in the acute and preventive treatment of primary headache disorders, including migraine disease.

      A newer abortive migraine treatment is Reyvow , which is taken as an oral tablet and is the only approved drug in the 5-HT1F receptor agonist class.

      Preventive Medications Most of the medications that have a preventive, or prophylactic, effect on migraine werent developed specifically for migraine theyre primarily used for treating cardiovascular conditions, seizures, and depression.

      Injections of Botox every 12 weeks may also help prevent migraine in some people with chronic migraine.

      Some pharmacological treatments that help with chronic migraine are not effective when it comes to episodic migraine. Treatment will depend on what type of migraine you have.

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      Neuromodulation Devices For Treatment And Prevention

      In nerve stimulation, or neuromodulation, electrical or magnetic pulses are delivered to specific nerves or areas of the brain to either prevent migraine attacks or reduce the severity of symptoms during attacks.

      Several nerve stimulation devices are already on the market for migraine, and others are in development.

      Cefaly The Cefaly Dual is an external trigeminal nerve stimulator that sends electrical impulses through a self-adhesive electrode placed on the forehead to stimulate the trigeminal nerve, reducing the frequency and intensity of migraine attacks. As of October 2020, it no longer requires a prescription to purchase and is also not covered by insurance.

      Nerivio Nerivio is a remote neuromodulation armband device for the acute treatment of migraine with or without aura in people age 12 and older, as of January 2021. The device is available only with a doctors prescription and is controlled by an app designed to provide personalized treatments.

      GammaCore The gammaCore Sapphire is a handheld device that delivers small electrical pulses to the vagus nerve on either side of the neck. The rechargeable and device requires a doctors prescription and is designed for multiyear use.

      Relivion The Relivion is a noninvasive headset device that delivers pulses of electrical current to stimulate the occipital and trigeminal nerves. For now, its only available in Europe.

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