Migraine is one of the most prevalent and disabling conditions, with an estimated worldwide prevalence rate of 11 percent and ranking as one of the primary causes of years lived with disability.
An effective migraine treatment regimen combines acute pain-relief medications and preventive remedies. Furthermore, migraine headache patients should be screened for cardiovascular risk factors and provided information regarding modifiable risk mitigation strategies.
1. Triptans
Migraine pain varies among individuals, so some require prescription drugs to manage their symptoms. Migraine medications may prevent migraine attacks from starting in the first place while treating those that already started. One common class of triptan medications used to treat acute migraine headaches includes almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), sumatriptan (Imitrex) and zolmitriptan (Zomig).
These drugs first made available in the 1980s have proven their worth when taken immediately upon experiencing a migraine attack, as they work by vasoconstricting meningeal blood vessels and relieving pressure in them. Unfortunately, however, they have also been linked with an increased rate of stroke among people who combine migraine with other risk factors for stroke and are taking these medications; accordingly they should not be prescribed in people who have a history of ischemic stroke, basilar or hemiplegic migraine, uncontrolled high blood pressure or uncontrolled coronary syndrome as these medications should also not be recommended as treatment options.
2. Ergots
Ergot is a fungus found in rye grains that causes an acute headache known as Ergotism, often fatal for soldiers like Julius Caesar’s legions of soldiers during his military campaigns. Midwives later used Ergot to advance labor by increasing alkaloid levels in blood vessels narrowing blood flow to control bleeding; Ergot can also be used to treat migraines but only under specific dosing regimen and restrictions – otherwise unpurified forms could produce various symptoms including Gangrenous Gangrene.
Fungi produce numerous alkaloids, including ergotamine and related ergocryptine alkaloids as well as simpler lysergyl amides, that make up LSD, the famed hallucinogen. First synthesized from these alkaloids in 1938, its effects stemming from their structural similarity with neurotransmitters like serotonin, dopamine and noradrenalin neurotransmitters; their activation activates receptors throughout the central nervous system (CNS); they cause smooth muscle contraction which slows blood flow while depriving tissues of oxygen supply – LSD itself!
3. Sphenopalatine Ganglion Stimulation (SPG Stimulation)
The Sphenopalatine Ganglion (SPG) serves as a vital link between trigeminal nerve pain signals and brain processes, and chronic preventive stimulation of this area has proven successful for relieving medically resistant chronic cluster headaches (CCH).
Trigeminal Nociceptors activated by an attack of headache can trigger autonomic symptoms through preganglionic parasympathetic fibres from the superior salivatory nucleus that project to the superior salivatory ganglion (SPG) in the Pterygopalatine fossa (PPF), leading to preganglionic parasympathetic responses and vasodilation of meningeal arteries thereby reinforcing neurogenic inflammation, leading to further painful episodes.
Transnasal low-frequency stimulation of the SPG has been found to relieve headaches and autonomic symptoms by blocking parasympathetic outflow through this region of the spine. A double-blind randomised sham-controlled crossover study conducted in 33 patients with CCH showed at least one period of attack remission within three to four months, as measured by HIT-6 headache disability score improvements by 12.5 points – suggesting SPG stimulation could also benefit episodic CCH who do not respond well to other therapies.
4. Botox
Botox injections in the forehead, crow’s feet and frown lines between eyebrows may help adults suffering migraine headaches reduce moderate-to-severe wrinkles in the face while helping prevent headaches from returning. Studies have proven this treatment safe and effective without interfering with everyday activities, lasting approximately three months before repeating itself if necessary. Always check with your physician regarding potential side effects prior to injections; do not rub or massage treated areas after 24 hours from injections as this could increase chances of side effects as well as any prescription and over-the-counter medicines taken including vitamins/herbal remedies taken.
Neurologists experienced in treating headaches will diagnose migraines based on your medical history, symptoms and physical and neurological examination. An MRI scan, which uses magnetic fields and radio waves to create images of blood vessels and brain tissue, may be required in order to rule out conditions like stroke or other causes that cause headaches.
