An in-depth report on the causes, diagnosis, treatment, and prevention of migraine.
Migraines can be triggered by many everyday things. Different people respond to different triggers, so it is important to track your migraine patterns to help you identify and avoid things that set off your migraine attacks. Common migraine triggers include:
- Emotional stress
- Intense physical exertion
- Abrupt weather changes
- Lack of sleep
- Skipping meals
- Certain foods and food additives (aged cheese, chocolate, red wine, MSG, and many others)
Migraine Treatment Approaches
Migraines need a two-pronged approach: treatment and prevention. Treatment uses medications that provide quick pain relief when attacks occur. These drugs include pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen (Tylenol, generic), triptans such as sumatriptan (Imitrex, generic), and ergotamine drugs.
Preventive strategies begin with non-drug approaches, including behavioral therapies and lifestyle changes. If headache attacks continue to occur at least once a week, or if your attacks do not respond well to treatment, your doctor may recommend you try preventive medication. Drugs used for migraine prevention include anticonvulsants, beta-blockers, antidepressants, and Botox. The herbal remedy butterbur may be effective.
New Devices Approved for Migraine Treatment and Prevention
In 2014, two first-of-a-kind stimulation devices were launched:
- Transcranial magnetic stimulation (TMS) device to stimulate the cortex in the brain for treatment of pain associated with migraine with aura.
- Transcutaneous electrical nerve stimulation (TENS) device to stimulate the trigeminal nerve for prevention of migraine.
- Both devices are small and portable. They will not be widely available for a while and will require a prescription. Insurance coverage is uncertain and their exact role in migraine treatment is not clear.
Five Migraine Don'ts
The American Headache Society recommends against these migraine tests and procedures because they are unnecessary, and potentially harmful:
- Don't perform imaging tests on people who have stable headaches that meet the criteria for migraine. People who have been diagnosed with migraine don't need an imaging test unless they have sudden new or worsening symptoms or abnormal findings on their neurological examination.
- Don't perform a computed tomography (CT) scan if a magnetic resonance imaging (MRI) test can be performed. CT scans expose people to radiation, but MRIs do not.
- Don't consider migraine surgery outside of a research trial. Surgical procedures to treat migraine are still considered experimental and are not part of standard clinical practice.
- Don't use opioid medications as first-line treatments for migraine. Narcotic drugs can be addictive and they can make episodic migraines become chronic. Likewise, medications that contain combinations of butalbital and caffeine can also be addictive and lead to worsening headaches.
- Don't overuse over-the-counter (OTC) medications for headache. Using OTC pain relievers more than twice a week can increase the risk for medication overuse headache. This is especially true for brands that contain caffeine.