Migraine (cont.)

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How are migraines diagnosed?

According to the International Classification of Headache Disorders II (ICHD-II) criteria for migraine without aura, a patient must have had at least five headache attacks fulfilling the following criteria:

  • Headache attacks lasting 4 to 72 hours (untreated or unsuccessfully treated)
  • The headache has at least two of the following characteristics:
    • Unilateral location
    • Pulsating quality
    • Moderate or severe pain intensity
    • Aggravation by or causing avoidance of routine physical activity (for example, walking or climbing stairs)
  • During the headache, at least one of the following characteristics:
    • Nausea and/or vomiting
    • Photophobia and/or phonophobia
  • The headache cannot be attributed to another disorder

Imaging the brain with an MRI and CT scans or performing a brain wave test (electroencephalogram [EEG]) is not necessary if the patient's physical examination is normal.

What is the treatment for migraines?

The treatment for migraines depends upon on how frequently the headaches occur and how long the headaches last.

The treatment of an acute migraine headache may vary from over-the-counter medicines, like acetaminophen or ibuprofen, to prescription medications. Triptans (sumatriptan, rizatriptan, eletriptan, zolmitriptan, naratriptan, almotriptan, and frovatriptan), may be extremely effective in treating migraines and may be prescribed to help the patient treat their migraine at home. Not every patient can take these medications and there are specific limitations regarding how often these medications can be used. Other medication regimens may also be used to control headache. Some medications are appropriate for home use and others require a visit to the health care professional's office or emergency department.

Narcotic pain medications are not necessarily appropriate for the treatment of migraine headaches and are associated with the phenomenon of rebound headache, where the headache returns -- sometimes more intensely -- when the narcotics wear off. In all cases of migraine, the use of acute pain therapies must be watched closely so that a patient does not develop medication overuse headache.

If an individual experiences frequent headaches, or if the headaches routinely last for several days, then preventive medications may be indicated. These may be prescribed on a daily basis in an effort to decrease the frequency, severity, and duration of migraine headaches. There are many different medications which have been shown to be effective in this role, including blood pressure medications (propranolol, nadolol, verapamil, and flunarizine), anti-seizure medications (divalproex sodium, topiramate and gabapentin), antidepressant medications (amitriptyline and venlafaxine) and other supplements (magnesium, butterbur, and riboflavin). The specific medication which is selected for a patient is dependent on many other factors, including age, sex, blood pressure, and other pre-existing medical conditions. Some patients who experience more than 15 headache days every month might benefit from Botox injections.

Medically Reviewed by a Doctor on 1/31/2014

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