How Prevalent Are Migraines
Migraines are about three times more common in women than men, and may affect more than 12 percent of the U.S. adult population. Migraines often run in families, and can start as early as elementary school but most often in early adulthood. They often fade away later in life, but can strike at any time. The most common cause of recurring, disabling headache pain, migraines are also the most common underlying cause of disabling chronic, daily headache pain. While migraines are the No. 1 reason that patients see a neurologist, most cases are handled by primary care physicians.
Things that can make the headaches more likely to occur include:
What Are The Risks
Opioids and butalbital can cause serious withdrawal symptoms if you stop taking them suddenly. People who use high doses for a long time may need to be in the hospital in order to stop using them.
Opioids, even at low doses, can make you feel sleepy or dizzy. Other side effects include constipation and nausea. Using them for a long time can lower your sex drive and cause depression and sleep problems.
Which drugs are good for migraines?
If you have migraine attacks, try one of the drugs listed below. They all work best if you use them when the migraine is just beginning.
- Start with a non-prescription pain drug like acetylsalicylic acid , ibuprofen or acetaminophen. If these are not helpful, you can try other non-steroidal anti-inflammatory drugs , some of which need a prescription, like diclofenac potassium and naproxen sodium.
- If these drugs do not help, or your headaches are more severe, try one of the prescription migraine drugs called triptans, such as sumatriptan .
- If a triptan is helpful but not as effective as you would like, you may combine a triptan with an NSAID .If the above options are not helpful, you can try dihydroergotamine nasal spray . This drug works even better as an injection . You can do the injections yourself once you are trained.
- If you have a lot of nausea with your attacks, all of the above medications can be combined with an anti-nausea medication, like metoclopramide.
When are opioids or butalbital useful for migraines?
What Else Do You Need To Make Your Decision
Check the facts
- That’s right. Medicine may not prevent every migraine. But it can reduce how many migraines you get, reduce the number of days that they last, and make your symptoms less severe.
- Sorry, that’s not right. Medicine may not prevent every migraine. But it can reduce how many migraines you get, reduce the number of days that they last, and make your symptoms less severe.
- It may help to go back and read “Get the Facts.” Medicine can reduce how many migraines you get, reduce the number of days that they last, and make your symptoms less severe.
- Sorry, that’s not right. Doctors recommend that you first try an over-the-counter pain medicine before you try a prescription medicine that can either prevent a migraine or stop a migraine after it has started.
- That’s right. Doctors recommend that you first try an over-the-counter pain medicine before you try a prescription medicine that can either prevent a migraine or stop a migraine after it has started.
- It may help to go back and read “Get the Facts.” Doctors recommend that you first try an over-the-counter pain medicine before you try a prescription medicine that can either prevent or stop a migraine.
- A drooping eyelid .
- Bruising on the face .
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Avoid Opioids For Migraine
Many people with migraine are given strong painkillers, called opioids, to treat migraines. Examples of opioid painkillers available in New Zealand include codeine, tramadol, morphine, oxycodone, fentanyl and pethidine. However, opioids are not preferred to relieve migraines for the following reasons:
- They can make headaches worse. Using opioids for migraine can cause more headaches and chronic migraines than you had to begin with. This is called medication-overuse headache. It is possible with all pain medicines, but is more likely with opioids.
- They are not as effective as other migraine medicines. There are medicines that are better than opioids to reduce the number of migraines you have and how severe they are. This includes medicines called triptans, which work directly on the blood vessels in your head to relieve the pain from migraine.
- They can be harmful. Opioids are strong medicines that may cause you harm, including dependence and addiction. Opioids can cause serious withdrawal symptoms if you stop taking them suddenly. People who use high doses for a long time may need to go to hospital while they stop using them. Opioids, even at low doses, can make you feel sleepy or dizzy. Other side effects include constipation and nausea. Using them for a long time can lower your sex drive and cause depression and sleep problems.
Opioids may be needed in some instances.
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What Should I Do When A Migraine Begins
Work with your doctor to come up with a plan for managing your migraines. Keeping a list of home treatment methods that have worked for you in the past also can help. When symptoms begin:
- If you take migraine medicine, take it right away.
- Drink fluids, if you don’t have nausea during your migraine.
- Lie down and rest in a dark, quiet room, if that is practical.
Some people find the following useful:
- A cold cloth on your head
- Rubbing or applying pressure to the spot where you feel pain
- Massage or other relaxation exercises
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Which Migraine Medications Are Safe To Use During Pregnancy
Migraine headaches may become less frequent during pregnancy. However, in rare cases, migraines may appear for the first time during pregnancy or become worse. Non-drug therapies are considered to be safer during pregnancy, they should be tried first. Non-drug therapies such as relaxation, sleep, massage, ice packs, and lifestyle changes are considered first-line options during pregnancy.
If drug treatment is required, acetaminophen is usually the treatment of choice. When used appropriately, acetaminophen treatment does not affect the pregnancy or the unborn baby.
Nonsteroidal anti-inflammatory drugs are considered second-line options and thought to be safest in the second trimester. They should not be used near the time of birth. Opioids are third-line options. Prolonged use of opioids may cause addiction and dependence in mothers and children.
Triptans are reserved for moderate-to-severe symptoms in women who have failed to adequately respond to other treatments. Sumatriptan is the oldest and most studied triptan in pregnancy. A pregnancy registry for sumatriptan did not find an increased risk of birth defects or miscarriage in 600 patients who were treated with sumatriptan during pregnancy.
Ergotamines should not be used during pregnancy as they may potentially induce hypertonic uterine contractions and vasospasms/vasoconstrictions which can cause harm to the unborn baby.
How Are Migraines Treated
Migraine headaches are chronic. They cant be cured, but they can be managed and possibly improved. There are two main treatment approaches that use medications: abortive and preventive.
- Abortive medications are most effective when you use them at the first sign of a migraine. Take them while the pain is mild. By possibly stopping the headache process, abortive medications help stop or decrease your migraine symptoms, including pain, nausea, light sensitivity, etc. Some abortive medications work by constricting your blood vessels, bringing them back to normal and relieving the throbbing pain.
- Preventive medications may be prescribed when your headaches are severe, occur more than four times a month and are significantly interfering with your normal activities. Preventive medications reduce the frequency and severity of the headaches. Medications are generally taken on a regular, daily basis to help prevent migraines.
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Antiemetics Available In Australia For Migraine
*Dosages apply to adults over 18. Take these medications only as directed by your doctor or pharmacist.
None of the above medications were developed specifically for migraine, except for those sold as a combined tablet with paracetamol. Metoclopramide and prochlorperazine are the antiemetics most commonly recommended for migraine, because they dont cause major blood pressure changes, require cardiac monitoring, and may themselves also bring additional pain relief .
There is also evidence to suggest that antiemetics can work synergistically with migraine treatments particularly in the setting of nausea or vomiting . One emergency department study showed that intravenous metoclopramide and prochlorperazine had a similar level of efficacy . Your doctor will be able to recommend which drug is more suitable based on your symptoms and reaction to previous medications.
Similar to triptans, ergotamine and dihydroergotamine are migraine-specific drugs that target serotonin receptors . However, triptans have mostly replaced ergotamines, because they are more effective and ergotamines tend to cause side effects such as nausea. There are no ergotamine compounds currently available in Australia .
What Else Can You Do To Prevent Migraines
There are other things you can try to prevent migraines. These work for some people:
- Acupuncture. This involves putting very thin needles into the skin at certain points on the body. Research shows that acupuncture can help prevent some headaches.footnote 3
- Biofeedback. This is a way to control a body functionâsuch as muscle tensionâthat you don’t normally control.
- Feverfew. This is an herb thatâsome small studies showâmay help prevent migraines in some people.footnote 4
- Magnesium. Studies have found that some people with migraines have low levels of magnesium in the brain. Taking magnesium may help prevent migraines.footnote 4
- Menthol. There is some evidence that a menthol solution rubbed on the forehead can stop or reduce migraine headache pain.footnote 5
- Riboflavin . This vitamin may help prevent migraines.footnote 4
- Coenzyme Q10. A small study showed that this supplement worked to reduce the number of migraines some people had.footnote 4
Here are some things you can do at home:
- Identify and avoid triggers, such as certain foods, alcohol, and smoking. It may help to keep a headache diary to track how often you have migraines, how painful they are, and what you think might be causing them.
- Practice relaxation and breathing exercises, such as meditation, guided imagery, tai chi, or qi gong, to help reduce stress and relax your mind and muscles.
- Exercise regularly, eat healthy foods, and get enough sleep.
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What Are The Four Stages Or Phases Of A Migraine Whats The Timeline
The four stages in chronological order are the prodrome , aura, headache and postdrome. About 30% of people experience symptoms before their headache starts.
The phases are:
It can take about eight to 72 hours to go through the four stages.
What Are The Warnings And Precautions With Migraine Medications
In 2006, the FDA warned about combining triptan drugs with selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors . Taking the drugs together could cause an overload of serotonin in the body, causing what is known as the “serotonin syndrome.â Symptoms of this life-threatening condition include a rapid increase in blood pressure, fast heart rate, and increased body temperature.
- Azole antifungals such as ketoconazole, fluconazole , itraconazole
The use of topiramate can result in decreased sweating and increased body temperature. This may be especially concerning during hot weather. Wearing light clothes and drinking plenty of fluids while using topiramate during warmer months is very important. A physician should be consulted if body temperature rises.
Serious complications of constipation and new-onset or worsening of pre-existing high blood pressure may occur with the calcitonin-gene related peptide antagonist erenumab .
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Drugs For Acute Treatment
These drugs are taken at the onset of migraine symptoms or auras to relieve a headache or reduce its severity.
Taking any of these drugs too often can lead to a rebound headache, headaches that arise from the overuse of medication, which then necessitates additional medication.
If you need to use acute migraine drugs more than 9 times per month, talk to your doctor about possible preventive treatments.
Address Teeth Grinding Or Excessive Chewing
People have to eat to survive, and chewing is an important part of eating. However, studies suggest that excessive chewing might be linked to more headaches and even migraine. Researchers focused on gum-chewing for the study and found that tension headaches and migraine were more common in people who chewed gum frequently.
While you cant avoid eating, you may want to rethink chewing gum if you regularly experience migraine. You may also want to consider if you clench or grind your teeth while sleeping, as this could have a similar effect.
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Works For Nearly Everyone: Fewer Painkillers
Migraine remedies dont automatically mean more painkillers. Although it sounds counter-intuitive, dont overdo your use of painkillers, or you could end up worse off. Using over-the-counter pain pills more than twice a week or taking migraine-easing triptans more than 17 times a month can eventually cause rebound migraines, warn German researchers.
Limit The Use Of All Pain Medicines
- Do not use prescription pain medicine for headaches for more than nine days in a month.
- Do not use non-prescription pain medicine for more than 14 days in a month.
This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
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Works For Most: Vitamin B Feverfew Melatonin Butterbur
Vitamin B2: A Belgian study found that 60 per cent of people who took 400 milligrams of this vitamin everyday had half their usual number of migraines.
Feverfew: This popular herb offers mild and transient benefits, according to British researchers, but in a recent study of a feverfew extract containing a consistent level of parthenolide, migraines were reduced from five per month to three. Further research shows there is conflicting evidence on the effectiveness of this herb.
Melatonin: Two-thirds of study participants who took melatonin before going to bed every night for three months said the number of migraines they experienced dropped by 50 per cent.
Butterbur-based remedies: One expert calls these the best safety-tested herbal to date for the treatment of headache. According to the journal Neurology, 68 per cent of those who took a butterbur product called Petadolex saw the number of migraines they experienced drop by 50 per cent.
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Devices Can Be Beneficial
The Food and Drug Administration has approved several neurostimulation devices for migraine treatment. These devices work by neutralizing the pain signals sent from the brain.
One is the Nerivio device, which is worn on the upper arm and sends signals to the brainstem pain center during an attack. Two-thirds of people report pain relief after two hours, and side effects are rare.
Another device that shows promise is the Cefaly. It delivers a mild electrical current to the trigeminal nerve on the forehead, which can lessen the frequency and intensity of migraine attacks. After one hour of treatment, patients experienced a nearly 60% reduction in pain intensity, and the relief lasted up to 24 hours. Side effects are uncommon and include sleepiness or skin irritation.
These alternative therapies help treat the person as a whole. In just my practice, many success stories come to mind: the college student who once had chronic migraine but now has rare occurrences after a regimen of vitamins the pregnant woman who avoided medication through acupuncture and physical therapy or the patient, already on numerous prescription medications, who uses a neurostimulation device for migraine instead of adding another prescription.
Granted, alternative approaches are not necessarily miracle therapies, but their potential to relieve pain and suffering is notable. As a physician, it is truly gratifying to see some of my patients respond to these treatments.
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For Some Medication Has Its Limits
A migraine can be debilitating. Those who are experiencing one are often curled up in a dark room accompanied by only their pain. Attacks can last for days life is put on hold. The sensitivity to light and sound, coupled with the unpredictability of the disease, causes many to forego work, school, social gatherings and time with family.
Numerous prescription medications are available for both the prevention and treatment of migraine. But for many people, conventional treatment has its limitations. Some people with migraine have a poor tolerance for certain medications. Many cant afford the high cost of the medicines or endure the side effects. Others are pregnant or breastfeeding and cant take the medications.
However, as a board-certified neurologist who specializes in headache medicine, Im always amazed at how open-minded and enthusiastic patients become when I discuss alternative options.
These approaches, collectively, are called complementary and alternative medicine. It might be surprising that a traditionally trained Western doctor like me would recommend things like yoga, acupuncture or meditation for people with migraine. Yet in my practice, I value these nontraditional treatments.