Migraines: Treatment for the pounding painPosted: Updated:
If you've ever had migraines, you know they're more than just a bad headache. Migraine pain affects up to 17% of women and 6% of men-nearly 30 million people in the United States alone.
For some, migraines are infrequent. On the other side of the spectrum are people who have frequent recurrences and whose lives can be debilitated by pain. Fortunately, progress is being made in migraine management. Although an individualized treatment approach is often necessary, most people can be helped.
What makes it a migraine?
Most headache pain is primary, which means it's not related to an underlying condition. Migraine is one of the three most common types of primary headaches.
Different types of headaches typically cause different types of pain. Tension-type headaches usually involve a dull, squeezing pain that builds slowly and may encompass the forehead, scalp, back of the neck and both sides of the head. Cluster headaches are much less common than are migraines, usually occurring on one side of the head as a stabbing sensation in the eye.
During a migraine, throbbing (pulsatile) pain may occur on one side of the head and gradually spread, but it's not uncommon to have pain on both sides of the head. Nausea with or without vomiting may occur. A migraine may last anywhere from a few hours to several days.
The pain of a migraine may be aggravated by light, sounds, odors, exercise and even routine physical activities. Some people experience a visual distortion (aura) - such as blurred vision, sparkling flashes or jagged lines - or localized numbness just before migraine pain. Sometimes, an aura occurs during a migraine, and occasionally auras may occur without headache pain.
The cause of migraines isn't fully understood. However, migraines often run in families, so it's generally thought that genetic predisposition likely plays a big role. Women are three times more likely to have migraines than are men.
Determining a treatment route depends on the characteristics and frequency of your migraines. Medications for migraine generally fall into two classes. There are drugs to prevent migraines, and drugs for pain relief (acute treatment).
Beyond medication there are several steps you can take to help reduce the number and severity of migraines you experience:
- Maintain a regular sleep pattern.
- Avoid migraine "triggers"such as scents that may be a problem or foods that seem to set off an attack.
- Get regular exercise - such as walking or running.
- If you smoke, stop. Smoking is a known migraine trigger.
- Practice muscle relaxation techniques such as yoga or spend time listening to music or reading.
Your doctor may recommend preventive medications if you have two or more debilitating attacks in a month, if you use pain-relieving medications more than twice a week, if those medications aren't helping, or if you have uncommon migraine attacks that include prolonged aura or numbness on one side of your body. Preventive medications typically are taken at regular intervals, often daily, whether you have a headache or not. Among the medications that may be considered for preventive use are:
- Cardiovascular drugs - Beta blockers, such as propranolol (Inderal), metoprolol (Lopressor, Toprol XL) and nadolo (Corgard), are commonly used. The calcium channel blockers verapamil (Calan, Verelan) may help. And one study has suggested an angiotensin receptor blocker (ARB) -- candesartan (Atacand) - may be beneficial in preventing migraine.
- Antidepressants - Tricyclic antidepressants such as amitriptyline, nortriptyline (Pamelor) and protriptyline (Vivactil) may be particularly helpful.
- Anti-seizure drugs - Some of these - divalproex sodium (Depakote), gabapentin (Neurontin, Gabarone) and topiramate (Topamax) - seem tyo prevent migraine, although the reason is unclear.
- Infrequently, nonprescription nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin, others) or naproxen sodium, (Aleve, others) may be tried as a migraine preventive, and are also used to treat migraines when they occur.
Another alternative that has been tried for people who can't take or don't respond well to other preventive medications is injections of botulinum toxin type A (Botox). However, use of this toxin hasn't been approved by the Food and Drug Administration and studies show mixed results.
Arrest the pain
Pain relief drugs for migraine are to be taken as soon as you experience signs or symptoms of a migraine. However, the overuse of pain relief drugs may interfere with migraine therapy. A good rule of thumb is to limit their use to no more than two days a week. Your doctor can help tailor a treatment plan to your situation and may recommend one or a combination of the following drugs to treat your acute migraine.
- NSAIDs - a mild migraine may respond to ibuprofen or aspirin. A moderate migraine may respond better to a nonprescription combination drug containing acetaminophen, aspirin and caffeine. Your doctor may prescribe stronger NSAIDs through regular use may carry risk of gastrointestinal bleeding and increased risk of heart attack or stroke.
- Triptans - Sumatriptan (Imitrex) was the first drug specifically developed to treat migraine by mimicking the action of a brain chemical called serotonin. Relief with this drug usually occurs within two hours of taking it. Some triptans are available as nasal sprays, orally disintegrating tablets, or injection and may work faster. Other triptans include rizatriptan (Maxalt), naratriptan (Amerge) almotriptan (Axert)eletriptan (Relpax), frovatriptan (forva) and zolmitriptan (Zomig). Triptans generally aren't an option if you have cardiovascular problems or known cardiovascular risks. Side effects may include nausea, dizziness and muscle weakness. A recent study has found that combining a single dose of sumatriptan with nsproxen sodium helped relieve migraine symptoms more effectively than did either medication taken alone.
- Anti-nausea (anti-emetics) and related drugs - If your migraine attacks typically include nausea and vomiting, anti-emetics taken early on with your headache medication may be helpful. Metoclopramide (Reglan) relieve nausea and vomiting. This drug also improves gastric emptying so there's better absorption of oral pain-relieving drugs and more rapid pain relief. In addition to oral anti-emetics, some can be taken as suppositories or by injection. Another option may be prochlorperazine (Compazine) injections given in a medical setting.
- Ergots - Ergotamine (Ergomar) was used for decades before the release of triptans. Today, an ergot may be used if triptans aren't helpful, in particular Dihydroergotamine (D.H.E. 45, Migranal), which is most helpful taken as a Nasal spray or by injection. Side effect may include anxiety, nausea and vomiting. As with triptans, ergots generally aren't prescribed if you have known cardiovascular risks or problems.
Beyond the Usual
In addition to medical treatments, you may find relief from alternative therapies, such as acupuncture, massage and biofeedback.
The National Institutes of Health concluded that acupuncture can play a role in controlling headaches.
Biofeedback may also be useful in helping you to understand how your body reacts during times of stress and then how to mentally "dial down" that stress. You may find biofeedback helps you to loosen tense muscles, slow your heart rate or even raise the temperature of your fingers and toes. This can help give you control of processes in your body that normally occur outside of your control.
Some have found meditation and yoga helpful. A study in the May 2007 issue of the Journal Headache showed that a combination of yoga, breathing exercises and relaxation reduced migraine frequency and pain among adults with migraines.
Some benefit from herbal remedies, such as butterbur, which appears to be relatively safe if taken for a short period to help prevent migraines. In addition, the supplement coenzyme Q10 appears to reduce migraine frequency for some.
Certain vitamins and minerals may also have a place in migraine treatment. Taken over time, riboflavin - vitamin B-2 - may help prevent migraine. Studies suggest maintaining adequate magnesium levels may also prevent migraines. When considering these or other alternative migraine remedies, consult your doctor first about the pros and cons, and to prevent possible drug interactions.
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