The physician analyzes the patient's migraine history to devise an appropriate treatment program. The goals of treatment are to prevent or reduce the number of migraines (called prophylactic treatment) and to alleviate symptoms and shorten the duration of the migraine (called abortive treatment).
Preventative medication may be prescribed for patients who have frequent headaches (3 or more a month) that do not respond to abortive treatment. Studies have shown that as many as 40% of these patients may benefit from preventative treatment.
Using one medication (monotherapy) is tried first, but a combination of medicines may be necessary. Many of these medications have adverse side effects. If migraines become controlled, the dosage is often reduced or the drug discontinued.
Beta blockers(e.g., propranolol [Inderal®], atenolol [Tenormin®]) are the preferred medications. These drugs produce an effect on heart rate. They should not be taken by patients with asthma and should be used with caution in patients with diabetes.
Side effectsinclude gastrointestinal upset, insomnia, low blood pressure (hypotension), slowed heart rate (bradycardia), and sexual dysfunction. Some beta blockers pass into breast milk and may cause problems in nursing infants.
Antiseizure drugssuch as valproic acid (Depakote®), topiramate (Topamax®), and gabapentin (Neurontin®) may be used to treat migraine.
Side effectsinclude nausea, gastrointestinal upset, sedation, liver damage, and tremors.
Calcium channel blockers(e.g., verapamil, amlodipine [Norvasc®]) inhibit artery dilation and block the release of serotonin. They should not be taken by patients with heart failure or heart block.
Side effectsinclude constipation, flushing, low blood pressure, rash, and nausea.
Tricyclic antidepressants(TCAs; e.g., amitryptaline [Elavil®], nortryptaline [Pamelor®], desipramine [Norpramin®]) block serotonin reabsorption and take 2–3 weeks be effective.
Side effectsinclude the following:
Low blood pressure (hypotension)
Increased heart rate (tachycardia)
High doses of TCAs have been implicated in seizures, stroke, and heart attack. Abrupt discontinuation of these medications may cause headache, nausea, and malaise, and may intensify side effects.
Selective serotonin reuptake inhibitors(SSRIs; e.g., paroxetine [Paxil®], fluoxetine [Prozac®], sertraline [Zoloft®]) are usually better tolerated than TCAs, but may not be as effective.
Side effectsinclude nausea, insomnia, sexual dysfunction, and loss of appetite.
Methysergide maleate(e.g., Deseril®, Sansert®) ma
y be prescribed for patients with frequent, severe migraines.
Side effectsinclude insomnia, drowsiness, lightheadedness, and hair loss. This drug should not be used by patients with coronary artery disease and must be discontinued for 3–4 weeks after 4–6 months of use because it can cause retroperitoneal fibrosis, a condition in which the blood vessels in the abdomen thicken, which reduces blood flow to organs.
Mild, infrequent migraines may be relieved using over-the-counter medication. Severe headaches with accompanying symptoms may require prescription medication.
During a migraine headache, people often prefer to rest or sleep alone in adark, quiet room. Applyingcold packsto the head or pressing on the bulging artery in front of the ear on the painful side of the head may provide temporary pain relief.
Analgesics(e.g., aspirin, ibuprofen, acetaminophen) provide symptomatic relief from headache pain and should be taken at the first sign of a migraine. They are most effective for infrequent migraines (less than 3 a month) and breakthrough headaches (i.e., headaches that occur despite using prophylactic medications).
Frequent use of analgesics (i.e., more than 4 times a week) can cause rebound headaches and may interfere with prophylactic treatment. Acetaminophen is sometimes combined with other drugs to form an analgesic compound (e.g.,Midrin®, Fioricet®).
Side effectscaused by aspirin and ibuprofen (e.g., Advil®, Motrin®) include gastrointestinal upset and bleeding. These drugs should be taken with food and used with caution. Ibuprofen is available in suppository form, which can be useful if the migraine is accompanied by severe nausea and vomiting.
Serotonin receptors(e.g., Imitrex®, Amerge®, Axert®, Zomig®), are fast-acting, usually well- tolerated medications commonly used to treat migraines. They are available in oral, injectable, and nasal spray forms and can be taken any time during the headache.
Side effectsinclude dizziness, drowsiness, flushing, discomfort, tingling, and nausea.
Ergots(e.g., Cafergot®, Mioranal®) may be administered orally, intranasally, or as a suppository and is often combined with antinausea drugs, such as prochlorperazine (Compazine®). This medication should be taken at the first sign of a migraine and may not be effective if the headache has moved into the throbbing stage.
Side effectsinclude gastrointestinal upset, dizziness, stroke, and high blood pressure (hypertension). Ergots should not be taken by patients with heart, vascular, liver, or kidney disease.
Avoiding triggers, managing stress, and taking prophylactic medications can help prevent migraine headaches. Keeping a migraine journal can help identify triggers and gauge the effectiveness of preventive measures. Patients should monitor the following:
Stress managementtechniques (e.g., biofeedback, hypnosis) and stress-reducing activities (e.g., meditation, yoga, exercise) may help prevent migraines.
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