Significant
advances are occurring in migraine treatment.
Today, most migraine sufferers can better
control this disorder and relieve its impact. To
manage migraine effectively, you and your
physician will create an individualized
treatment plan that:
- Identifies and controls factors that may
provoke your migraine
- Describes medications to prevent and treat
migraine attacks
- Encourages healthy behavior and lifestyle
changes
Active participation in your care can spell
the difference between success and failure. Your
physician may suggest medications and other
measures. You also may be asked to keep a diary
to help track the effectiveness of medications,
to identify migraine-provoking factors in your
environment, and to monitor the benefits of
treatment and lifestyle changes. The more you
understand about your migraines, the greater the
likelihood of success. Regular follow-up visits
with your physician and understanding how best
to use medications leads to the most effective
care.
Targeting "provokers" of
migraine
Certain factors can provoke or trigger
migraine in some people. These factors are not
causes of migraine; they initiate attacks in
persons with migraine. If the pattern of your
attacks of migraine suggests that you are
sensitive to stimuli or triggers that you can
easily avoid, your physician may help you modify
your lifestyle. Not all migraines have the same
provoking factors nor do all these factors
necessarily provoke an attack.
Diet: An important part of your diary
will include foods that you eat. This will help
you and your physician identify associations
between your diet and migraine. You probably
will not have to severely restrict your diet,
but you should stay away from foods or additives
that you think may trigger headaches. Your
physician may recommend avoiding alcohol,
especially red wine; foods with monosodium
glutamate (MSG); foods that contain tyramine,
such as aged cheeses; and preserved meats with
nitrates and nitrites. Eating regularly is also
important; don't skip meals.
Sleep: Too much or too little sleep
can trigger a migraine attack. Be consistent in
your sleep patterns. Maintain a regular bedtime,
and try to wake up at the same time each
morning.
Hormones: Many women with migraine
have attacks linked to their menstrual cycles.
Fluctuating and especially declining estrogen
levels are thought to play a role. Menstrual
migraines can be more debilitating, difficult to
treat, and last longer than other migraines.
Migraine also may worsen in early pregnancy;
however, in later pregnancy, it often improves.
Migraine typically declines in frequency as
women age. There is evidence that oral
contraceptives or estrogen-replacement therapy
can provoke or worsen migraine in some women.
Stress and anxiety: A variety of
relaxation techniques can help you manage your
body's response to life's daily pressures. Learn
to pace your activities. Try to set aside time
each day to sit quietly with your eyes closed,
let your muscles relax, and give your mind a
break. Try not to worry about stress that is
beyond your control. Regular physical activity
also can help keep you on an even keel.
Environmental factors: Environmental
triggers of migraine headaches include weather
or temperature changes, glaring or fluorescent
lights, computer screens, strong odors and high
altitude.
Protective measures: Steps you can
take to increase your resistance to migraine
include regular sleep, a healthy diet, eating at
predictable times, regular exercise, not
smoking, relaxation and meditation.
Migraine management
A vital component of migraine management is
to provide therapy that consistently relieves
migraine symptoms, preserves your ability to
function at normal or near normal levels, and
lessens the frequency or duration of future
migraine attacks. You may receive treatment to
stop an attack when it occurs or to treat its
symptoms (known as acute treatment). For
individuals who experience frequent, disabling
attacks, a preventive treatment can be taken
regularly (every day) so that migraines will
strike less often and last for a shorter time.
While almost everyone needs acute treatment,
only one in five people with migraines needs a
preventive treatment. If you are on a preventive
medication, continue taking it while treating
yourself for an acute attack.
Some migraine medications also are used as
treatments for other medical conditions. For
example, beta-blockers are prescribed for
hypertension and tricyclic antidepressants for
depression. The benefits of these therapies in
migraine are not necessarily related to the
treatment of these other conditions. The dosages
of these drugs when used for migraine are
generally different from the dosages used in
these other conditions.
There are many migraine drugs available, and
it is important that therapy be individualized
just for you. Your physician will work with you
to determine which drugs are best for you.
Drug treatments
Many drugs that treat acute migraine attacks
work best when taken as soon as you feel a
migraine coming on. Do not take these
medications more often or in higher doses than
your physician recommends. Pain relievers such
as aspirin, acetaminophen and ibuprofen are
frequently recommended as initial treatments.
However, if they do not relieve the pain, your
physician may prescribe other drugs or drug
combinations.
Nonspecific (analgesic) drugs used to
relieve the pain of migraine attacks
- Nonprescription (over-the-counter)
medications, such as aspirin or
acetaminophen, alone or in combination with
antihistamines, decongestants or caffeine.
Of the nonprescription medications, the only
one approved by the Food and Drug
Administration for migraine is the
combination of aspirin, acetaminophen and
caffeine.
- Prescription analgesics, including
narcotics, nonnarcotics or both. These drugs
are often combined with sedatives or
medications to relieve anxiety.
- Nonsteroidal anti-inflammatory drugs, to
relieve both pain and inflammation. Many
different anti-inflammatory drugs are
effective in treating migraine.
- Antinausea drugs may be given in
combination with nonprescription and
prescription drugs. These drugs treat the
nausea caused by a migraine, improve the
absorption of the antimigraine drugs, and
may help relieve the pain.
Specific drugs used to stop migraine
attacks
Ergot alkaloids, such as ergotamine and
dihydroergotamine. Triptans are relatively new
drugs developed specifically to stop migraine
headaches. This family includes sumatriptan,
naratriptan, zolmitriptan and rizatriptan. These
drugs have important similarities, yet they
differ in routes of administration (eg, tablets,
shots, nasal sprays, melt-in-your-mouth
tablets), onset of action and side effects. If
one drug in this family does not work, another
drug may be quite effective.
Drugs used in hospital emergency
departments to stop migraine attacks
Drugs are often given by shots in the
hospital emergency department. Injectable
narcotics, antiemetics (antinausea drugs),
nonsteroidal anti-inflammatory drugs,
corticosteroids and sumatriptan are options.
Migraine prevention
If your migraine interferes with your life
several days per month, or treatments for acute
attacks do not offer adequate relief, your
physician may recommend preventive therapy.
While these drugs may not prevent all migraines,
they often can reduce the frequency, intensity
and/or duration of attacks.
Once your migraines are under control, your
physician may advise you to gradually reduce the
preventive medication. This is particularly true
when you have established successful lifestyle
modifications and adequate treatment of acute
attacks. Sometimes your doctor may recommend a
drug that can simultaneously treat your migraine
and another condition, such as depression.
Drugs used to prevent migraine
- Antidepressants (also used to treat
depression), such as amitriptyline,
nortriptyline and doxepin. These drugs
represent a class of antidepressants called
tricyclic antidepressants. Other
antidepressants called selective serotonin
reuptake inhibitors or monoamine oxidase
(MAO) inhibitors also may be used.
- Beta-blockers (also used to treat
hypertension and angina), such as
propranolol, metoprolol, timolol, nadolol or
atenolol.
- Calcium channel blockers, such as
verapamil, diltiazem or nifedipine.
- Serotonin antagonists, especially
methysergide and cyproheptadine.
- Anticonvulsants, specifically divalproex
