Treatment of Migraine
The treatment of migraine depends on individual circumstances. One needs to consider:
This will determine what happens next. Try to avoid situations that trigger migraine attacks, such as particular lights, sounds, or odors; changes in humidity or barometric pressure; alcohol; stress; estrogen therapy (30% of women have increased attacks when taking birth-control pills); alterations in eating habits; or eating certain foods (particularly chocolate or foods with nitrate preservatives).
Keep a diary of your headaches, recording what you were doing and the sensations you were having at the time. (See: How To Determine Your Migraine Trigger?)
There is also evidence that one aspirin every day (not just when you get a headache) can reduce the number of migraine attacks.
What if the avoidance of triggers does not completely prevent migraines or reduce their frequency? In that case, medication and other therapies are an important part of headache management.
Treatment typically begins with over-the-counter pain medications (See: OTC Remedies For Migraine), such as acetaminophen or NSAIDs (non-steroidal anti-inflammatory drugs). Aspirin is an NSAID, as is ibuprofen and naproxen. These pain medications are called simple analgesics because they contain a single ingredient, in contrast to combined analgesics, which contain additional ingredients such as caffeine. Non- prescription pain medicines containing a combination of aspirin, acetaminophen, and caffeine (proved to be effective in treating migraine headaches) are also useful sometimes.
Nonsteroidal anti-inflammatory drugs (NSAIDs), including those available without a prescription, work by reducing the inflammation of the cerebral blood vessels. Because pills tend to be absorbed more slowly during migraine attacks, you will have to take these when you suspect on onset of migraine or use it in a faster acting form such as injections, nasal sprays, or suppositories. Some of the most effective NSAIDs include indomethacin given as a rectal suppository and ketorolac, which is an injection that requires a doctors prescription.
As is the case with all medications, over-the-counter pain medications can have side effects, especially stomachaches in some patients. In addition, over-use of such medications can actually lead to more frequent headaches, a phenomenon known as rebound headache.
When over-the-counter medications are not helpful, the next step is often the use of more powerful prescription medications or alternative therapies.
The management of migraine can be divided into two categories; abortive and preventative.
Abortive treatment is used when you feel the onset of migraine. . They are taken to stop each migraine attack once it begins. They are often prescribed for patients who have infrequent attacks or mild symptoms. Ergotamines and sumitriptan are examples of abortive migraine medications.
Ergotamine can be taken as a pill, injection, suppository, or nasal spray. It is usually taken with an antinausea drug since it may cause or worsen nausea. Injections of dihydroergotamine, an ergotamine derivative with few side effects, have been particularly effective for migraines associated with menstrual periods. If you have coronary artery disease or diseases that narrow blood vessels do not take ergotamine (and related drugs) as they may constrict blood vessels throughout the body. Do not use if you have high blood pressure, kidney disease, or liver disease, or if you are pregnant.
A relatively new group of drugs called triptans (including sumatriptan, rizatriptan, zolmitriptan, and naratriptan) act at a receptor for the neurotransrnitter serotonin and can relieve both headache and nausea. They are available as pills, injections, or nasal sprays. They are given under a doctor's supervision to watch for serious side effects.
Sumatriptan (Imitrex), has shown great promise in fighting migraines. One study showed that 70 percent of patients who took sumatriptan during a migraine episode reported mild or no pain an hour later. The prescription drug is also free of most side effects common to migraine medication, such as sedation, nausea and vomiting. It does have other serious side effects. (See Sumatriptan for side effects, drug interactions and other information.)
People with heart disease (particularly related to angina), or people who have had heart attacks or who have risk factors for heart attack should generally avoid triptans. If you have high blood pressure that is not under control, triptans could make it worse. Compared to ergotamine, sumatriptan works faster but its effects are not as long-lasting.
Butorphanol, a rapidly acting opiate analgesic, is available by prescription as a nasal spray. It is a narcotic and can be addicting. So, it should be taken under medical supervision only.
Preventive Drug Therapies
Preventative drug strategies are employed only when the patients are experiencing frequent attacks and/or severe symptoms that interfere with their daily activities. Preventative medications include beta-blockers, calcium channel blockers, heterocyclic antidepressants, valproic acid, and methysergide (rarely used because of side effects).
Each of these types of drugs has side effects. Propranolol is widely prescribed in the United States as a treatment for migraine prevention. Although it has proven to be effective in migraine prevention, its side effects include fatigue, depression, impotence, insomnia, dizziness, and cold extremities.
Certain prescription medicines can reduce the number of migraine attacks: beta blockers, antidepressants , calcium channel blockers,
There are several alternative therapies available that can be used effectively as a preventive treatment for migraine. These are discussed in detail later in this website. Relaxation therapies used may range from simple breathing exercises to biofeedback. Biofeedback and relaxation therapies may, for some patients, be as helpful as medications. Herbal remedies have found to be remarkably successful in many cases without the side effects found in prescription drugs. Stress management, exercise, diet control, acupressure, acupuncture, meditation, yoga and numerous physical therapy techniques (e.g. massage, manipulation etc.) are other principal techniques employed.
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