Migraine Headache (cont.)
What other medications are used for treating migraine
headaches?
Narcotics and
butalbital-containing medications sometimes are used to treat migraine headaches;
however, these medications are potentially addicting and are not used as initial
treatment. They are sometimes used for patients whose headaches fail to respond
to OTC medications but who are not candidates for triptans either due to
pregnancy or the risk of heart
attack and stroke.
In patients with severe nausea, a combination of a triptan and an anti-nausea
medication, for example, prochlorperazine (Compazine) or metoclopramide (Reglan) may be
used. When nausea is severe enough that oral medications are impractical,
intravenous medications such as DHE-45 (dihydroergotamine), prochlorperazine
(Compazine), and valproate (Depacon) are useful.
How are migraine headaches prevented?
There are two ways to prevent
migraine headaches: 1) by avoiding factors ("triggers") that cause the
headaches, and 2) by preventing headaches with medications (prophylactic
medications). Neither of these preventive strategies is 100% effective. The best
one can hope for is to reduce the frequency of headaches.
What are migraine triggers?
A migraine trigger is any factor that causes a headache in
individuals who are prone to develop headaches. Only a small proportion of
migraine sufferers, however, clearly can identify triggers. Examples of triggers
include stress, sleep
disturbances, fasting, hormones, bright or flickering lights, odors, cigarette
smoke, alcohol, aged cheeses, chocolate, monosodium glutamate, nitrites,
aspartame, and caffeine. For some women, the decline in the blood level of
estrogen during the onset of menstruation is a trigger for migraine headaches.
The interval between exposure to a trigger and the onset of headache varies from
hours to two days. Exposure to a trigger does not always lead to a headache.
Conversely, avoidance of triggers cannot completely prevent headaches. Different
migraine sufferers respond to different triggers, and any one trigger will not
induce a headache in every person who has migraine headaches.
Sleep and migraine
Disturbances such as sleep
deprivation, too much sleep, poor quality of sleep, and frequent awakening at
night are associated with both migraine and tension headaches, whereas improved
sleep habits have been shown to reduce the frequency of migraine headaches.
Sleep also has been reported to shorten the duration of migraine headaches.
Fasting and migraine
Fasting possibly may precipitate
migraine headaches by causing the release of stress-related hormones and
lowering blood sugar. Therefore, migraine sufferers should avoid prolonged
fasting.
Bright lights and migraine
Bright lights and other
high intensity visual stimuli can cause headaches in healthy subjects as well as
patients with migraine headaches, but migraine patients seem to have a lower
than normal threshold for light-induced pain. Sunlight, television, and flashing
lights all have been reported to precipitate migraine headaches.
Caffeine and migraine
Caffeine is contained in many
food products (cola, tea, chocolates, coffee) and OTC analgesics. Caffeine in
low doses can increase alertness and energy, but caffeine in high doses can
cause insomnia, irritability, anxiety, and headaches. The over-use of
caffeine-containing analgesics causes rebound headaches. Furthermore,
individuals who consume high levels of caffeine regularly are more prone to
develop withdrawal headaches when caffeine is stopped abruptly.
Chocolate, wine, tyramine, MSG, nitrites, aspartame and
migraine
Chocolate has been reported to cause migraine
headaches, but scientific studies have not consistently demonstrated an
association between chocolate consumption and headaches. Red wine has been shown
to cause migraine headaches in some migraine sufferers, but it is not clear
whether white wine also will cause migraine headaches. Tyramine (a chemical
found in cheese, wine, beer, dry sausage, and sauerkraut) can precipitate
migraine headaches, but there is no evidence that consuming a low-tyramine diet
can reduce migraine frequency. Monosodium glutamate (MSG) has been reported to
cause headaches, facial flushing, sweating, and palpitations when consumed in
high doses on an empty stomach. This phenomenon has been called Chinese
restaurant syndrome. Nitrates and nitrites (chemicals found in hotdogs, ham,
frankfurters, bacon and sausages) have been reported to cause migraine
headaches. Aspartame, a sugar-substitute sweetener found in diet drinks and
snacks, has been reported to trigger headaches when used in high doses for
prolonged periods.
Female hormones and migraine
Some women who suffer
from migraine headaches experience more headaches around the time of their
menstrual periods. Other women experience migraine headaches only during the
menstrual period. The term "menstrual migraine" is used mainly to describe
migraines that occur in women who have almost all of their headaches from two
days before to one day after their menstrual periods. Declining levels of
estrogen at the onset of menses is likely to be the cause of menstrual
migraines. Decreasing levels of estrogen also may be the cause of migraine
headaches that develop among users of birth control pills during the
week that estrogens are not
taken.
Next: What should migraine sufferers do? »
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