Migraine

Source: Adapted from Knowing Your Options: The Definitive Guide to Choosing The Medical Treatments, Reader’s

What is a migraine?

During a migraine, blood vessels deliver too little blood to the brain, irritating the nerves around them. For centuries, migraines were seen as a psychological problem or, worse, a sign of weakness in those who had them. They are now recognized as a chronic disease, not just painful headaches. The excruciating, often debilitating pain is a symptom, not the underlying problem. This is a key distinction.

Most migraines have four stages. During the prodrome (the period before an attack), you may be sensitive to light, smell, or sound. About 20% of people with a migraine experience an aura’bright, flashing lights or partial loss of vision. During the attack, a throbbing or pulsating pain often starts on one side of the head and gradually worsens; sometimes it spreads to the other side. You may also have vomiting, blurred vision, neck and shoulder pain, tingling, or difficulty concentrating. An untreated migraine attack can last from a couple of hours to several days. Afterward, in the postdrome, you may feel drained, irritable, and foggy, or refreshed and even euphoric.

Who is at risk for migraines?

Women are three times more likely than men to have migraines, and an estimated 80% of people with migraines have a family history of the condition.

Although the exact cause of migraines is uncertain, if one of your parents has migraines, you have about a 50% chance of having them too. Many researchers say that people prone to migraines inherit an acutely sensitive nervous system. Changes in your body (diet, sleep, hormones, or stress) or in your environment (weather or lighting) can ‘trigger’ a migraine attack. Low levels of the brain chemical serotonin are also believed to play a role.

Treatment for migraines

There is no permanent cure for a predisposition to migraines. But treatments can prevent attacks and relieve symptoms, thereby restoring quality to your life. The key is understanding that a migraine isn’t just a headache you have to ride out. It’s a complex medical condition. You need to consult your doctor about the appropriate medication for you. There are many choices, and they can bring fast relief. One survey showed that those who took prescription medications were twice as likely to experience complete headache relief within two hours as those who used over-the-counter products. In addition, lifestyle factors such as food, stress, exercise, and sleep can make a big difference, and there are a number of natural methods that have helped many find relief from migraines.

Medications for migraines

Prescription drugs are the first-line treatment for migraine attacks, and the particular medication you end up taking will depend on your symptoms as well as your response to different medicines. The most effective are probably the triptans, a group of drugs that enhance levels of the brain chemical serotonin and constrict blood vessels. Sumatriptan (Imitrex), the key drug in this category, can be self-injected for fast relief, taken orally, or inhaled as a nasal spray. In clinical trials, up to 80% of those who had sumatriptan injections reported milder headaches or complete relief within an hour. When taken orally, two other triptans’rizatriptan (Maxalt) and zolmitriptan (Zomig ZMT)’work faster than sumatriptan.

Other triptans include almotriptan (Axert), eletriptan (Relpax), and frovatriptan (Frova), as well as the longer-lasting naratriptan (Naramig, Amerge). Some people who take triptan experience flushing, jaw tightness, neck pain, and other side effects. Because these drugs constrict blood vessels, people with heart disease should not use them without a doctor’s approval.

The next group is the ergot derivatives. Ergotamine (Ergomar, Wigraine, Ercaf) has been around longer than the triptans and also works by constricting blood vessels. But it can cause nausea and vomiting, so your doctor may prescribe an antinausea drug to go with it. Dihydroergotamine (D.H.E. 45), a nasal spray, has milder side effects and is less likely to upset your stomach. Methysergide (Sansert) is very effective, but used only if other choices don’t work. Its side effects range from nausea, vomiting, abdominal pain, diarrhea, and depression to a rare but potentially fatal lung fibrosis (excessive scar tissue). Lidocaine, a local anesthetic available as a nasal spray, can provide relief for many migraine sufferers within 15 minutes. If pain relief continues to elude you, the next step is a powerful opiate, such as morphine, codeine, meperidine (Demerol), or hydrocodone (Vicodin).

Less effective than prescription drugs but useful only for mild cases, OTC pain relievers include acetaminophen (Tylenol, Excedrin) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as acetylsalicylic acid (Aspirin), naproxen (Aleve), and ibuprofen (Motrin, Advil). Some OTC migraine formulations combine caffeine with acetaminophen and aspirin.

Preventive medications may stave off migraines. Options include a daily acetylsalicylic acid (ASA); prescription beta-blockers, such as propranolol (Inderal), which provides long-term relief for about half of those with frequent migraines; calcium channel blockers, such as verapamil; tricyclic antidepressants, such as amitriptyline (Elavil, Endep), nortryptiline, and protriptyline (Vivactil); and selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil). Divalproex sodium (Depakote)’a drug used to prevent epileptic seizures and control bipolar disease.

Lifestyle Changes

Medications aren’t your only defense. When a migraine strikes, lie down in a dark room. Place an ice pack or gel pack (Migraine Ice or TheraPatch Headache Cool Gel) wherever the pain is. A headband’either elastic or gel-filled (and cooled)’can also offer relief. Other lifestyle measures can minimize your attacks, too. The key is to identify and eliminate your migraine triggers. Here’s how:

• Watch your diet. Many foods have been linked to migraines. Among the likely suspects are foods with nitrates (bacon, corned beef, ham, hot dogs, lunch meats, and sausage); the chemical MSG (monosodium glutamate); aged cheeses (Cheddar, Swiss, Stilton, Brie); chocolate; nuts; peanut butter; sour cream; caffeinated beverages; aspartame (artificial sweetener); and alcohol.
• Eat regularly. Skipping meals is a common migraine trigger.
• Get a good night’s sleep. Too much or too little sleep can cause a migraine. Your best bet is to establish a consistent sleep pattern of seven to nine hours nightly. Keep in mind that changes to this pattern, including jet lag, can trigger a migraine.
• Exercise smart. Always warm up properly and ease into your workout. Aerobic exercise can sometimes make migraines worse.
• Relax. Stress can be a migraine trigger, so take time each day to sit quietly and relax your muscles. Learn to let go of things you can’t control.

Alternative Therapies for Migraines

One of the oldest non-drug approaches is feverfew, long recommended by herbalists to prevent migraines. Fresh leaves of this herb are very bitter, so you might want to try standardized capsules or a tea. Don’t use feverfew if you’re pregnant or taking ASA. Vitamin B2 (riboflavin) may help by boosting your brain’s energy reserves. Good food sources include mushrooms, poultry, and quinoa. It can also be taken in supplement form.

Several alternative therapies for migraine relief may be worth checking out. Biofeedback hooks you up to a small machine that allows you to monitor your ability to regulate muscle tension, skin temperature, and other things. The relaxation techniques you learn can then be applied without the machine. Some people learn to raise their hand temperature, which draws blood away from the constricted vessels in the head that cause migraine pain. Those using biofeedback techniques report reduced frequency, severity, and duration of migraine attacks.

A session with a chiropractor, who uses massage, spinal manipulation, and adjustments to joints and soft tissues, can provide relief for certain people. Proponents of acupuncture say this ancient Chinese technique can help relieve migraine pain by balancing serotonin levels and relaxing tense muscles.

Questions for Your Doctor

• How can I tell if certain foods are triggering my migraine attacks?
• Am I a candidate for a medication to prevent migraines?
• Does the medication I’m on have a rebound effect if used too often?
• Can I become addicted to my migraine painkillers?
• Is there a danger that beta-blockers or calcium channel blockers will cause my blood pressure to drop too low?

Living with Migraines

If you suffer from migraines, here are a few hints to help you take control:

• Have a cup of coffee‘strong and black’at the first sign of an attack. Too much caffeine can trigger a migraine attack, but a little bit can relieve oncoming pain. This is especially helpful for people who only rarely have caffeine.
• Avoid the rebound. Over-using headache medications’even common OTC products’can lead to a vicious cycle of rebound headaches. Your body becomes so dependent on the medication that you get a new headache as soon as the drug wears off. Anyone who uses migraine medication more than two or three times a week is at risk for this effect. Once you’re locked into the cycle, the best way to break out is to go off all medication, possibly in the hospital.
• Eat more fish. Varieties high in omega-3 fatty acids (salmon, tuna, sardines) may help prevent migraines from recurring. Omega-3s seem to alter blood chemicals, reducing the risk of blood vessel spasms associated with this type of headache.
• Watch out for additives. The artificial sweetener aspartame, found in many diet sodas, may trigger migraines in some people. Saccharin does not. The food coloring FD & C yellow #5, found in candy, beverages, some cereals, and ice cream, has also been known to trigger migraines in certain individuals.