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Migraine Headaches Diagnosis Treatment Prevention Self-Help

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Updated January 06, 2009

What are the treatment options for migraine headaches?

Once you have identified your migraine triggers, you can work to eliminate as many as possible from your life. Most migraine sufferers require pharmacologic treatment, even after removing potential triggers. Several types of drugs are available to help migraine sufferers; however, the choice must be made on an individual basis.

One drug class that is particularly effective for abortive migraine therapy are serotonin receptor agonists such as the triptans; these include Imitrex (sumatriptan), Zomig (zolmitriptan), Amerge (naratriptan), and Maxalt (rizatriptan). Other categories of drugs which may be of benefit to migraine sufferers include analgesics, analgesic combinations, antiemetics for nausea, ergotamine derivatives, antiepileptics (such as Topamax) or antidepressants (such as the tricylics).

Prophylactic therapy is useful for women who experience at least 3 migraines monthly, or for those who have migraines that are unresponsive to other treatments. The intent of this type of treatment is to reduce the frequency, length, and/or severity of migraines. Women who experience menstrual migraines may benefit from an increase in the normal dose of drugs such as non-steriodal anti-inflammatory (NSAIDs) drugs or mefenamic acid, taken for 2 to 4 days before menstruation and continued through the third day of bleeding. Don't give up if one treatment doesn't work, another drug in the same class may be effective. Reports indicate that intermittent treatment with sumatriptan often helps to prevent menstrual migraines.

Estrogen may be prescribed to women with menstrual migraines that fail to respond to other treatments. The use of estrogen may stabilize the fluctuation of hormones that occurs premenstrually. Treatment is started several days before menstruation is expected; women with irregular periods are not appropriate candidates for this type of therapy. Again, the use of estrogen is controversial and should be made on an individual basis after careful consideration of risk factors versus benefits. You should also understand that estrogen may have the opposite affect and make your migraines worse, and as always the lowest effective dose of estrogen should be used.

Other prophylactic hormonal treatments include androgens, antiestrogens, bromocriptine, and gonadotropin-releasing hormone agonists; these treatments have not been clinically evaluated and have been tried with various degrees of success. Women who don't want to use drug treatments may find some relief with riboflavin (400 mg daily) and magnesium (400 mg daily). However, these seem to provide only limited benefit.

What can you do for yourself when a migraine strikes?

Self-treatment will not always work, but here are a few tips that may reduce the severity of a migraine headache:
  • At the first sign of headache, take an OTC product such as acetaminophen or aspirin with or without caffeine. However, if you find yourself taking such medications more than 2 to 3 times per week for headaches, consult your doctor.

  • If possible, lie down in a dark, quiet room.

  • Put a cold compress or pillow over your head.

Are there any special considerations for women who either are or might become pregnant?

Women who are or who could potentially become pregnant need to avoid certain treatments due to possible effects that certain pharmacological treatments could have on a fetus. Drugs to be avoided by pregnant or potentially pregnant women include meperidine during the third trimester; mefenamic acid; triptans, however, questions about the use of sumatriptian during pregnancy can be answered by calling the Sumatriptan Pregnancy Registry at 1-800-722-9292, extension 39441; barbiturates; propranolol; amitriptyline; and ergotamine.

Treatment for migraine headaches can be successful if both the patient and the physician refuse to give up. If you have migraines, call you physician and schedule an appointment for a headache evaluation. Don't forget to take your headache journal.

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