Effective migraine treatments depend upon accurate diagnosis, identification and avoidance of triggers, and management of coexisting or comorbid conditions.1
Preventive medication includes oral pills, injections, and nasal sprays.
A new class of drugs known as CGRP antagonists – including Ubrelvy and Nurtec ODT) have been demonstrated to alleviate migraine pain during drug trials. Triptans also may work quickly to stop an active headache.
Stress Management
Numerous pharmaceutical acute and prophylactic treatments exist to manage migraines. Acute medications include triptans (Imitrex, Maxalt, Relpax) and NSAIDs; for those unable to tolerate triptans due to nausea or vomiting clonidine is also an option; herbal remedies, vitamins or supplements have also been touted as preventive solutions, although their scientific efficacy remains questionable [120].
Preventive therapies have the ability to significantly decrease migraine frequency, severity, disability and associated costs while simultaneously decreasing acute treatment costs and potential toxicities. Patients considering preventive therapies for migraine should carefully consider:
Exercise
Numerous randomized control trials have demonstrated the benefits of regular exercise as a preventive therapy for migraines. Strength training appears to be especially effective at relieving migraine pain; high-intensity aerobics has also proven its worth; in one study, combined aerobics and strength training were even superior to daily pharmacologic prophylactic treatments such as topiramate.
However, sudden changes to your exercise regimen could trigger migraines if you are unprepared. Furthermore, strenuous infrequent exercise may cause stiff and sore muscles which act as migraine triggers. Furthermore, blows to the head during sports could result in instantaneous migraine aura.
As such, it’s crucial that you incorporate exercise gradually into your life and consult your physician prior to beginning any new routines. Also ensure you warm up and hydrate before exercise as this can decrease risk of exertional migraine headaches (EMHs).
Nutrition
Addition of nutrient rich foods will strengthen both your body and brain, reducing inflammation and helping you better manage migraines. Limiting sodium, fat and drinking plenty of fluids will also be helpful, while food additives like dyes and sweeteners may trigger headaches in some people. Moderation should be observed when drinking alcohol; especially red wines which have aged and sulfite free wines as they contain lower levels of tyramine.
Maintain a headache diary and share it with your physician; this is an effective way to identify triggers. Cognitive Behavioral Therapy (CBT) may also be an option if you can’t completely eradicate all your triggers but need help learning how to better control them.
Your migraine medication options can include analgesics such as paracetamol, NSAIDs such as ibuprofen, and antiseizure medications like topiramate; antiemetics like metoclopramide or domperidone may be taken alongside these analgesics to decrease nausea.
Sleep
Migraines and sleep are inextricably linked, both from an economic and health standpoint. A lack of restful slumber may trigger an attack and vice versa; shift work and jet lag may also increase migraine frequency and severity, so in addition to sleeping better you should also take preventive medicines to minimize your migraine episodes.
Ask your physician for these medications:
Triptans such as sumatriptan (Imitrex) or almotriptan (Arimed) can quickly reduce headaches when taken early during a migraine attack. Anticonvulsants like topiramate (Qudexy XR, Topamax), valproic acid (Depakene), and atenolol (Tenormin), metoprolol (Lopressor, Toprol XL), or propranolol (Inderal, Inderal XL or InnoPran) can relax blood vessels and slow heart rate while potentially causing side effects like dizziness or upset stomach.
Oral ergot alkaloids such as ergotamine or dihydroergotamine (Migranal, Trudhesa) are not effective and potentially toxic acute treatments for nausea and vomiting. Instead, your physician might suggest prokinetic antiemetics such as domperidone or metoclopramide to alleviate it.
