What is a migraine?
Migraine is the second most common type of headache, experienced by as many as 16 percent of all Americans. This type of headache is classically described as pain on one side of the head and pulsating in quality.
Migraines are typically aggravated by activity and accompanied by sensitivity to light and sound and may be accompanied by nausea and vomiting. According to the International Headache Society, the minimum number of attacks for headaches to be considered migraines is five attacks lasting 4 to 72 hours if untreated.
Migraines can have numerous triggers, including:
- Stress
- Anxiety
- Hormonal changes
- Bright or flashing lights
- Lack of food
- Certain foods
- Lack of sleep
- Hormonal changes
- Certain medications
Keeping a headache diary may be beneficial to identify potential triggers.
How to treat a migraine
The approach to migraine treatment depends on the frequency and severity of your headaches. There are preventative medications taken daily to decrease the frequency and severity of migraines. There are also acute treatments taken at onset of a migraine to decrease the duration and severity of the migraine.
Preventative medications are typically recommended for those with frequent migraines. Some medications originally created for epilepsy, depression, and high blood pressure have been shown to be effective in decreasing the frequency and severity of migraines. Botulinum toxin A also has been shown to be effective in the prevention of chronic migraine.
Adjunctive therapies include stress management strategies including behavioral therapy, biofeedback, relaxation techniques, and lifestyle changes including a regular sleep schedule and exercise.
Preventative medications for migraines include:
- Beta blockers
- Tricyclic antidepressants (amitriptyline)
- Valproate
- Gabapentin
- Topiramate
- Verapamil
Acute treatments for migraines include:
- NSAIDS (ibuprofen, indomethacin, or naproxen)
- Aspirin
- Triptans
- Ergotamines
- Anti-nausea medications
The sooner the acute treatment medications are administered, the more effective they may be. These drugs should be used less than twice weekly to avoid medication-overuse headaches. Taking these medications more frequently can actually increase headache frequency.
You should talk with your doctor to determine the best medications to treat your migraines. This is individualized based upon your medical history. Some medications may not be safe for certain people. For example, triptans and ergotamines are contraindicated in older people, those with severe kidney or liver disease, pregnancy, and those with vascular risk factors (including stroke and coronary artery disease). Aspirin and NSAIDs are contraindicated in people with ulcers, gastritis, bleeding conditions, and kidney disease.
Handling migraines and living your life
While there is no cure for migraines, there are numerous treatment options that can decrease the severity and frequency of attacks. A combination of lifestyle changes and medications provide relief for most people who suffer from migraines. Some people have to try numerous medications before they find an effective regimen. This condition can be very disabling, particularly if untreated, so it is important to work with your doctor to formulate a treatment plan.