Migraine Headache Treatment

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Doctor's View on Migraine Headache Treatment

Comment by Charles Patrick Davis, MD, PhD

What are migraine headaches?

Migraine headaches are common and usually more intense than most other headaches. They often are recurrent and have associated symptoms such as nausea, vomiting, sensitivity to light, and in some people, warning symptoms, termed auras, that a migraine headache is going to develop. Some people may have throbbing pain on one side of the head.

Migraine headache treatment and prevention

Once a migraine headache is diagnosed (with other conditions ruled out), treatment can begin. Because the headaches are usually recurrent, there is not much distinction between treatment and prevention so treatments will include prevention methods.

There are many treatments for migraine headaches. Drugs are used but some treatments do not use drugs. Nondrug treatments include ice to the head, biofeedback, adequate sleep, smoking cessation, and avoidance of your food and environmental triggers (for example, stress, flashing lights, and drinking red wine). Others recommend natural treatments such as herbs, acupressure, aromatherapy, group therapy, and many others.

While nondrug methods may work for some, many doctors find these methods work poorly for the majority of migraine patients. Consequently, drugs are used in the majority of patients with migraine headaches. In addition, patients do not respond to medications the same way. Unfortunately, sometimes doctors must try several different drugs to find what best works for you. The first drugs are analgesics like acetaminophen and NSAIDS. At best, they may help mild migraines. More severe migraines may respond to various triptans like sumatriptan (but not in pregnancy). Ergots like ergotamine or a combined drug like Midrin (isometheptene, acetaminophen and dichloralphenazone) may also be effective in stopping a migraine. Although not recommended as initial treatment, some clinicians use narcotics and butalbital-containing drugs when triptans or other drugs fail. Since nausea and vomiting often accompany migraines, antinausea drugs like metoclopramide are often used with triptans. Some clinicians add an antidepressant to the treatment plan for some patients.

Migraine headache guidelines

The medical experts (American Headache Society or AHS and American Academy of Neurology or AAN) that treat people with migraine headaches offered in 2012 extensive recommendations (guidelines) for medical treatments to prevent migraines. They are as follows:

AHS/AAN Migraine Prevention Guidelines: Drugs Recommended for Use

Level A: Established as effective

Should be offered to patients requiring migraine prophylaxis

  • Divalproex/sodium valproate: 400 to 1000 mg/day
  • Metoprolol: 47.5 to 200 mg/day
  • Petasites (butterbur): 50 to 75 mg bid
  • Propranolol: 120 to 240 mg/day
  • Timolol: 10 to 15 mg bid
  • Topiramate: 25 to 200 mg/day

Level B: Probably effective

Should be considered for patients requiring migraine prophylaxis

  • Amitriptyline: 25 to 150 mg/day
  • Fenoprofen: 200 to 600 mg tid
  • Feverfew: 50 to 300 mg bid; 2.08 to 18.75 mg tid for MIG-99 preparation
  • Histamine: 1 to 10 ng subcutaneously twice a week
  • Ibuprofen: 200 mg bid
  • Ketoprofen: 50 mg tid
  • Magnesium: 600 mg trimagnesium dicitrate qd
  • Naproxen/naproxen sodium: 500 to 1100 mg/day for naproxen or 550 mg bid for naproxen sodium
  • Riboflavin: 400 mg/day
  • Venlafaxine: 150 mg extended release/day
  • Atenolol: 100 mg/day

Level C: Possibly effective

May be considered for patients requiring migraine prophylaxis

  • Candesartan: 16 mg/day
  • Carbamazepine: 600 mg/day
  • Clonidine: 0.75 to 0.15 mg/day; patch formulations also studied
  • Guanfacine: 0.5 to 1 mg/day
  • Lisinopril: 10 to 20 mg/day
  • Nebivolol: 5 mg/day
  • Pindolol: 10 mg/day
  • Flurbiprofen: 200 mg/day
  • Mefenamic acid: 500 mg tid
  • Coenzyme Q-10: 100 mg tid
  • Cyproheptadine: 4 mg/day

There are many problems associated with medical treatment of migraines. The major problems are that the drugs used to treat have side effects and have potentially dangerous interactions when used with other medications. Some (narcotics and butalbital) can be addictive. Special care of children and pregnant females with migraines is possible but usually a specialist (pediatric neurologist, neurologist, or OB/GYN) should be consulted before any treatment. You and your doctor should carefully discuss the treatment methods to find the most effective treatment/prevention method that works for you.

Read what patients are saying about migraine headache treatment!

Migraine Headache Treatment Resources

Read patient comments on Migraine Headache - Effective Treatments

Doctor written main article on Migraine Headache

REFERENCES:

Loder, Elizabeth, et al. "The 2012 AHS/AAN guidelines for prevention of episodic migraine: a summary and comparison with other recent clinical practice guidelines." Headache 52.6 (2012): 930-945.

Taylor, Frederick R. "Acute treatment of migraine headaches." Seminars in Neurology 30.2 (2010): 145-153.


Last Editorial Review: 8/2/2013 8:08:19 PM




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