Migraine Headache Relief and Treatments

Treating Occasional Migraine Attacks

If you experience occasional migraine attacks that don’t knock you to your knees, you may find ample relief by taking an over-the-counter pain reliever when you feel an attack coming on. “No specific OTC pain reliever has proven to be more effective than others,” Dr. Boykoff says. “You can experiment to find the one you prefer.” Nonprescription pain relievers with “migraine” in the name usually contain caffeine, which may help alleviate pain. Drinking coffee or caffeinated tea can also be effective.

Being mindful of Common Migraine Triggers also helps keep attacks at bay.

There are also supplements researchers have studied and found to help migraine sufferers:

• Feverfew (Herb)
• Magnesium
• Coenzyme Q10
• B Vitamins:  B2 (riboflavin), B6 (pyridoxine) alone and with B12 (cobalamin), B9 (folic acid or folate)
• Vitamin E

“Be careful not to overdo it on the supplements,” Dr. Boykoff says. “More is not necessarily better and some supplements, especially vitamin B6, can be toxic at high doses.”

When Do You Need the Next Step?

If you’re taking OTC pain medications frequently, it’s time for a medical evaluation. Pain medications taken more than once or twice a week can create a rebound effect that results in more headaches.

Treating Frequent or Disabling Migraine Attacks

Talk to your doctor about medication options if you’re dealing with attacks more than twice a week or if migraine attacks are severe.  Doctors can prescribe two types of medications to provide relief.

• Abortive medications stop migraine attacks once they start.
• Preventive medications lower your chances that a migraine attack will begin.

Doctors usually start patients on abortive medications first and move to preventive medications if abortive medications don’t work or patients need to take them more than once or twice a week.

Abortive Medications

Triptans have been used for more than 20 years and have a proven track record for reducing migraine headache pain and decreasing nausea and vomiting.  Triptan formulations are available under many names and may be delivered through a pill, nasal spray or injection.  If your doctor prescribes a triptan medication, you should keep it with you at all times and take it at the first hint of a migraine.

Ergotamines were the first abortive medication used for migraine attacks. They’re not as effective as triptans and can cause side effects, but doctors may prescribe them to patients who can’t take triptans.

Be careful. Abortive medications used more than once or twice a week can cause rebound headaches. They can also contribute to a condition called “transformed migraines,” when migraine attacks become chronic and the cycle of pain becomes difficult to stop.

Preventive Medications

Several medications are available to lower your chances of experiencing migraine attacks. Interestingly, none of the medications used today was originally designed to treat migraines. Doctors began using the medications for migraine prevention after noticing that patients who took them for other conditions had fewer migraine attacks. The FDA has approved a few of these drugs for migraine prevention:

• Inderal® and Blocadren® – Beta blockers also used to treat heart disease and high blood pressure.
• Depakote®, Depakote® ER, and Topamax® – Anti-seizure medications also used to treat epilepsy and other seizure disorders.
• Onabotulinumtoxin A (Botox®) Injections – Also used to treat facial wrinkles, muscle spasms and other conditions.

The FDA allows doctors to prescribe legally approved drugs “off label.” That means doctors can use their best knowledge and judgment to prescribe a drug to treat conditions different than those it was originally approved to treat.  Migraine prevention drugs commonly prescribed off label include:

• Blood pressure medications
• Antihistamines
• Antidepressants
• Anti-inflammatory medications
• Muscle relaxers
• Asthma medications
• Attention deficit disorder medications

Doctors prescribe more than a hundred drugs for migraine prevention. Each medication has its benefits and side effects. The wide array of choices and cautions is one of the best reasons to work with a neurologist who specializes in headache treatment.

“There are many great doctors who can treat migraine, but doctors who see a high volume of patients with migraine gain the kind of knowledge you can only get by treating patients with migraine every day,” Dr. Boykoff says.

Applying that knowledge to each patient’s situation—gender, age, lifestyle, other medical conditions and medications, and willingness to tolerate side effects—allows headache specialists to quickly narrow down the treatment options.  Starting on a preventive medication requires time, patience and effort. It may take a few tries before you find a preventive medication that strikes a good balance between side effects and relief. You’ll need to take the medication as prescribed and be careful not to miss a dose.

Choosing Your Own Path

“Preventive medications work, but they’re not for everyone,” Dr. Boykoff says. “Some of my patients prefer to stay away from all medications. Instead, they pay careful attention to triggers, take supplements, make sure to eat a healthy diet and get plenty of rest. For those patients, I often prescribe an abortive medication to keep on hand for emergencies. Knowing they don’t have to suffer through a debilitating migraine attack can give people the confidence to take a more natural approach.”

Setting Realistic Expectations

A migraine is a complex neurological condition that varies from person to person and can be difficult to treat. It’s overly idealistic to expect any medication to make migraine attacks disappear. However, with good medical care, you can look forward to a life with far fewer and less severe attacks.