Migraines can be debilitating and impact many aspects of daily life, yet there are treatment options available to lessen both their frequency and severity.
Preventive medication are often the best treatments for migraine, targeting both its pain and its related symptoms like nausea. Recent advances offer new options for both relief and prevention.
Over-the-Counter (OTC) Pain Medications
Over-the-counter (OTC) medicines may be convenient, but they still pose risks. It’s essential that you read and follow label instructions when taking OTC painkillers, particularly if you take prescription medicines as well. Some over-the-counter pain medicines contain acetaminophen and/or nonsteroidal anti-inflammatory drugs (NSAIDs). Beware mixing them together, as this could result in overdose.
OTC pain relievers include acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs, or NSAIDs, like ibuprofen (Advil, Motrin) and naproxen sodium (Aleve). These work by blocking or suppressing prostaglandins production – chemicals responsible for swelling, inflammation and pain. Be sure to follow all label directions, not exceeding maximum daily dosage of approximately 4,000 mg daily dose. To learn more about OTC medications speak to your pharmacist or primary care provider – they will help find you the appropriate OTC pain relief medication that suits you!
Prescription Drugs
There are various prescription drugs that can be used as abortive treatments for migraine, such as NSAIDs/acetaminophen, triptans and antiemetics. Newer agents called gepants that reduce CGRP pain transmission have received FDA approval and appear effective; however, more studies of their long-term effectiveness need to be completed.
Triptans such as sumatriptan and rizatriptan (Imitrex, Maxalt) work by blocking pain pathways in the brain. Triptans may be taken in pill form or sublingual tablets dissolved under the tongue for immediate effects under the tongue, nasal sprays or even suppositories and are most effective when taken at the first sign of migraine headache.
Other abortive drugs for migraine prevention may include blood pressure medications like propranolol and innopranol; calcium channel blockers like verapamil (Verelan, Calan) and hydralazine (Nizane); antidepressants like amitriptyline may help to prevent migraines; anticonvulsants like valproate and topiramate may reduce migraine frequency and symptoms by relaxing overactive nerves in the brain; while Botulinum Toxin A injections (Botox) offer some adults an excellent migraine prevention option.
Behavioral Changes
Migraine is a biological condition, yet psychological factors such as emotional stressors, anxiety and depression may aggravate symptoms or trigger headaches. Psychological or behavioral therapy may reduce their impact.
Biofeedback and acupuncture are proven relaxation techniques for relieving migraine pain, with biofeedback utilizing sensors or instruments to measure functions that may otherwise remain unconscious, then providing feedback that allows patients to learn how to control them such as their heart rate or muscle tension levels.
Sleep and diet are also critical components to managing migraine attacks. Establishing a consistent sleep routine and eating at the same times every day may help minimize migraine attacks.
Due to physiologic stressors being key migraine triggers, most behavioral migraine treatments begin with stress management training. The goal is to teach your brain a different response when facing stressful stimuli in order to help avoid future episodes and increase patient collaboration through this form of education. It may even increase their acceptance of these strategies!
Lifestyle Changes
Research1-10 indicates that adopting healthy behaviors such as getting adequate rest and eating a well-rounded diet can dramatically decrease migraine headache frequency and intensity, according to studies conducted. As per American Academy of Neurology recommendations, providers should discuss behavior change strategies with migraine patients at each visit.
As well as avoiding foods and drinks that trigger migraine attacks, your patient should also engage in regular physical activity and follow a regular sleep cycle. He/she should drink adequate quantities of water (see patient handout on Hydration for Migraines from Ctrl M Health for guidance).
Stress can be a trigger of migraine attacks, so your patient must practice stress management techniques such as cognitive behavioral therapy – which teaches patients to alter negative thought processes that increase tension and headache risk – or acceptance and commitment therapy, which teaches patients to identify goals and values they wish to work toward in life and commit themselves to reaching them.
Women are three times more likely to suffer from migraine, with hormonal fluctuations during menstruation or pregnancy possibly being responsible. Your patient should keep a diary to record both migraine symptoms and monthly cycles to help monitor them effectively.
