Ask the experts
I have migraine headaches fairly frequently and nothing seems to work. What helps migraines?
The treatment of an acute migraine headache may vary from over-the-counter medicines (OTC), like acetaminophen (Tylenol and others), ibuprofen (Advil, Motrin, etc.), naproxen sodium (Aleve) 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. A combination of naproxen and sumatriptan is now available. Additionally, sumatriptan is now available as a patch which delivers the medication though the skin.
- 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 migraine headache.
- Some medications are appropriate for home use and others require a visit to the health-care professional's office or emergency department.
Other migraine treatments
- Dihydroergotamine (DHE 45) can be administered intravenously or by nasal spray; this medication cannot be used if a triptan has been used within the preceding 24 hours.
- Diclofenac potassium for oral solution (Cambia) is a potent nonsteroidal anti-inflammatory medication approved for treatment of migraine.
- Antiemetic medications, including intravenous (IV) metoclopramide, and IV or intramuscular (IM) chlorpromazine and prochlorperazine can be used both to relieve nausea and vomiting and migraine pain.
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.
Overuse of many of the medications used to treat migraine headache can lead to increased headache frequency, or even daily headaches. This type of headache phenomenon is known as 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, for example, propranolol (Inderal), nadolol (Corgard), verapamil (Clan, Covera, Isoptin, Verelan), and flunarizine),
- anti-seizure medications, for example, divalproex sodium (Depakote and others), topiramate (Topamax), and gabapentin (Neurontin, Gralise),
- 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.
What remedies and lifestyle changes help manage and decrease the frequency of migraines?
Individuals who experience migraines can play a significant role in managing their headache frequency and severity.
Keep track of when migraines occur by using a paper or digital headache diary or log to track pain levels, triggers, and symptoms. This can help identify patterns which precede a migraine, as well as help identify factors which contribute to the development of the headache. Once these contributing factors are known, lifestyle modifications can lessen their impact. These modifications may include:
- Maintain a regular schedule for eating and sleeping
- Avoid certain foods that might trigger a migraine
- Keep well hydrated since dehydration has been identified as a migraine trigger for some people
- Exercise regularly
Relaxation strategies and meditation also have been recognized as effective strategies to prevent migraines and decrease headache severity.
Exercise and migraine
Some people find that exercises that promote muscle relaxation can help manage the pain of migraines. Examples of types of mind-body exercises that can help encourage relaxation are:
- Progressive muscle relaxation
- Guided imagery
Diet and Migraine
There is no specific diet for people with migraine that helps with symptom relief. However, as mentioned previously, certain foods can be triggers for migraines in susceptible people. These foods include:
- red wines,
- aged cheeses,
- preservatives used in smoked meats (nitrates),
- monosodium glutamate,
- artificial sweeteners,
- chocolate, and
- dairy products.
Alcoholic beverages can also trigger migraine in some people.
Understanding the particular triggers of your migraines and avoiding these dietary triggers may help some sufferers decrease the frequency of attacks.
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