How to Treat Migraine Headaches?
The exact etiology of migraine headaches is not known. So, treating such headaches is not possible.
Doctors aim at controlling symptoms, to smoothen patient’s life, minimizing absenteeism from work.
Management of Migraine
Depending upon the frequency and severity of migraine headaches, the treatment modalities are decided.
Prophylaxis Is Required if:
- The frequency of headaches is more than four times in a month, or
- The duration of an attack of headache lasts for 12 hours or more, or
- The pain relieving medicines give no relief, or
- Aura associated with migraine is long and severe. it may include weakness or numbness of a limb.
However, if the frequency is less than this, aborting individual attacks of migraine headaches is enough.
Medicines Used for Prophylaxis
These are medicines used to manage high blood pressure. The mechanism how they benefit migraine patients is not clearly known.
These medicines lower the blood pressure, reduce the heart rate by block the action of adrenaline. They control the tone of blood vessels supplying the brain, the meningeal vessels.
During migraine attacks, the tone of meningeal blood vessels is disturbed. This is restored by these medicines.
When not to Give Beta Blockers
In patients suffering from COPD of any type, patients prone to conduction blocks in the heart, diabetics, low blood pressure patients.
If the patient is above 65 years of age and is having any heart problem, be cautious in prescribing these medicines.
Calcium Channel Blockers
Like verapamil, may also be useful in preventing repeated attacks of migraine. These medicines also control the tone of meningeal blood vessels. Also, they keep the blood pressure under control.
Among this class of medicines, amitriptyline is proved to be effective in treating migraine headaches.
They affect the levels of serotonin and other brain chemicals.
In patients who have much of nausea, or audio or visual aura preceding the headache, botox injections can be given.
These injections are given at different locations, including the nose bridge, temples, forehead, back of head or neck. The regimen is giving these injections every 3 months for a period of 15 months.
This injection works by relaxing the muscles affected. Also, it blocks the nociceptive (pain giving) receptors present in the affected area.
Medicines Used to Abort the Attack
Any potent non steroidal anti inflammatory medicine (NSAIDS) coupled with a pill to control vertigo/ dizziness may be given.
This may include combinations as stemetil and ibuprofen.
Sometimes, caffeine may be included in such pills.
The only problem with these drugs is that the patient may stop responding to them as the severity of the attacks increase.
Also, having too much of them may lead to gastric ulcer formation.
These medicines work by vasoconstricting the meningeal blood vessels. Also, they block the pain pathways in the brain by affecting the levels of chemical mediators.
These medications are quite effective in controlling the pain of headache, as well as other associated symptoms like nausea, and aura.
The class includes sumatriptans, rizatriptans etc.
A combination of sumatriptan and naproxen (treximet) controls the symptoms more effectively than any of these alone.
Used in patients where the headache attack is long, that is more than 48 hours in duration.
The side effects of this class of medicines include a strong feeling of nausea or vomiting.
This side effect may add up to the nauseating feeling already present in migraine patients and worsen the situation.
Therefore, these medicines are used judiciously.
Dihydroergotamine is a derivative of ergotamine. It is preferred to ergotamine as such because of lesser side effects.
It is sold by the name migranal or vasograin.