Migraines: Prevention and Treatment

Differentiating between migraines and headaches, and recognizing the symptoms is an initial milestone for migraine awareness. However, knowledge of different migraine treatment and preventative measures is also fundamental in fully understanding and reducing the rapidly rising statistics of the world’s 6^th most disabling condition.

Migraine Prevention

The following preventative measures are often employed alongside the avoidance of triggers, or in case of inability to avoid certain triggers such as blinking screens:

• Learn To Cope (LTC) is a recent preventative strategy that works by desensitizing patients through gradual exposure to common triggers, and is often combined with cognitive behavioural therapy.
• Establishing and follow regular daily routines, particularly sleeping and meal schedules.
• Stress is a common trigger of migraines. Regular aerobic exercises such as walking, swimming or cycling with slow warm-ups can reduce stress. Meditation and yoga are also very helpful in lowering stress.
• Migraine-prone women taking estrogen replacement or contraceptive medication may benefit from reducing their dosages or taking alternatives, with their doctor’s recommendation.
• The weather plays an important part. Sporadic weather patterns can induce headaches. Higher temperatures and humid conditions can cause migraines as well. If the weather is extreme, try and stay indoors as much as possible.
• The food you eat also impact your migraines. Foods that trigger headaches include sugary stuff, chocolate, and processed proteins among other. Caffeinated drinks also commonly lead to migraines. Experiment and figure out which food items you consume cause headaches and try to limit their consumption or eliminate them from your diet.

Migraine Treatment

The frequency, severity and length of migraine attacks determines the treatment approach, which can either consist of medicines for pain relief or prevention.

1- Pain Relieving Medications (aka Abortive Treatment)

Taken during the initial onset of an attack in order to stop symptoms from further intensifying, these medications are the most common migraine treatment and include:

• Painkillers: Over-The-Counter (OTC) acetaminophen, ibuprofen, and other painkillers, and a combination of two or more OTC painkillers with caffeine can provide effective relief from mild and moderate symptoms, respectively. However, those unable to take oral medications may opt for the prescription-grade indomethacin in suppository form. However, overdosing or prolonged use reverse their effectiveness, causing serious Medication-Overuse Headaches, abdominal pain, bleeding, and even ulcers.
• Triptans: Available as tablets, nasal sprays, and injections, triptans provide instant migraine and associated symptom relief by constricting the blood vessels and blocking the transmission of pain signals. However, excess use not only increases the risk for ‘Serotonin syndrome’, but may also induce, nausea, dizziness, drowsiness, and muscle weakness, making them unsuitable for those at high risk of strokes and heart attacks.
• Dihydroergotamine (D.H.E. 45, Migranal): Available as nasal sprays and injections, these derivatives of Ergots, that are known aggravators of nausea, vomiting, and headaches, are a comparatively more effective treatment for long-lasting migraines; with fewer side effects.
• Glucocorticoids: Although taken in accompaniment to the above medications for improved effectiveness, their use should be limited to avoid side effects.
• Opioids: Prescribed to patients who are unresponsive to triptans or D.H.E.s, these medications are composed of addictive narcotics and hence should be used only if all other treatments fail.

2- Preventative Medications

Prescribed to prevent or reduce the severity of migraines and auras that occur more than thrice a month for more than 12 hours, or aid the effectiveness of pain-relieving medications, these drugs are taken regularly, and include:

Cardiovascular Drugs

Commonly prescribed for hypotension and Coronary Artery Disease treatment, beta blockers and calcium channel blockers can also be used to reduce the severity or number of migraine attacks. However, those above 60, or who have certain cardiovascular disorders may have to look towards other treatment options.

Antidepressants

Tricyclic antidepressants, particularly Amitriptyline, can reduce migraine frequency by suppressing the activities of serotonin and other pain-response chemicals. However, other antidepressants are now being prescribed, as amitriptyline causes drowsiness, dry mouth, constipation, and weight gain.

Anti-Seizure Drugs

While also able to reduce the number of migraines per month, overdosing on Valproate and Topiramate, the representative anti-seizure drugs, can cause nausea, tremors, weight, hair loss, dizziness, memory and concentration difficulties, and weight loss (for Topiramate). Moreover, Valproate is not recommended for pregnant women.

OnabotulinumtoxinA

This primarily cosmetic treatment is injected into the forehead and neck muscles in adults for reducing the frequency of chronic migraines, with treatment repeated every 12 weeks.

Moreover, surgically compressing pain nerves in the brain can also help reduce or entirely eliminate migraines in patients who do not respond to medication.

Migraine treatment is important. If left untreated, they can cause severe complications such as stroke, brain hemorrhage, and tissue damage. If you experience any symptoms of migraines, or feel the attacks or symptoms worsening, consult your doctor immediately. You can also book an appointment with a Pain Management Specialist in Rawalpindi, Karachi and Islamabad through oladoc.com, or call our helpline at 042-3890-0939 for assistance to find the RIGHT Doctor for your neural concerns.