Migraine Headache Prevention
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Migraines can be treated in a few ways. In some cases, a change in diet or sleeping patterns may result in a decreased frequency of migraines. However, if there is a family history, then diet and sleeping patterns may not be as effective.
(This answer provided for NATA by the Georgia College & State University Athletic Training Education Program.)
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Many medications can prevent menstrually related migraines, and your overall migraine pattern will influence the choice of which medication to use. If the headaches only occur with your period, then hormone therapy with birth control pills can be useful. Treatment with triptans can be used as well. Other prophylactic medications could be used depending on patient preferences.
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The medication for migraines can be either for acute treatment of headache pain or for prevention (treatment of the underlying causes of the headaches). Medication for prevention is used daily by women who have very frequent headaches (usually more than two or three per month) or have severe headaches. For mild to moderately severe migraines, over-the-counter medication has been found to be effective. These include nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen sodium. Caffeine can also be helpful; however, sometimes too much caffeine can make the headache worse.
Medication for acute treatment is more effective when used early. Earlier treatment also leads to less severe headaches and fewer accompanying symptoms. Sometimes, you are reluctant to treat a headache until you are sure it is a migraine; but this allows the headache to become more severe and makes treatment less effective.
The simplest treatment is high-dose NSAIDs, which are effective for many women. Of all the prescription medications that are used to treat acute headaches, the newest and most widely used is a group of medications called triptans. All these drugs fall into two categories: those that take effect more quickly and wear off more quickly, and those that take longer to take effect but are effective longer. The drugs also vary with regard to adverse effects, and so the choice of triptan depends on individual women. Triptans can be administered by different routes: for example, sumatriptan may be taken as a pill, by injection, or in a nasal spray. Rizatriptan can be taken as a disintegrating tablet that dissolves in the mouth.
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The best way to prevent migraine is to find out what triggers your attacks and avoid or limit these triggers. Since migraine headaches are more common during times of stress, finding healthy ways to cut down on and cope with stress might help. Talk with your doctor about starting a fitness program or taking a class to learn relaxation skills.
Talk with your doctor if you need to take your pain-relief medicine more than twice a week. Doing so can lead to rebound headaches. If your doctor has prescribed medicine for you to help prevent migraine, take them exactly as prescribed. Ask what you should do if you miss a dose and how long you should take the medicine. Talk with your doctor if the amount of medicine you are prescribed is not helping your headaches.
The answer is based on source information from the National Women's Health Information Center.
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Beta blockers, such as propranolol and timolol, are used in preventive treatment of migraines.
These drugs work by blocking the effect of certain hormones associated with stress, reducing blood pressure and heart rate. The means by which they reduce migraine frequency is not completely understood, but they have been shown to halve the frequency of migraines. However, there are potential side effects, such as fatigue, depression, slow heart rhythms (bradycardia), low blood pressure (hypotension), and breathing problems. Beta blockers should never be discontinued abruptly. Also, they are usually not recommended for people with asthma, insulin-dependent diabetes, or heart failure, and their effect on pregnancy women and their babies is unknown.
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For migraines it is best to avoid certain food triggers which can be associated with migraines. Some of these include artificial flavoring, MSG, chocolate, sugar, certain types of cheese, cured meats, onions and bananas. It is important also to keep a food diary and to keep track of which specific foods can trigger migraine attacks individually.
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Effective therapy to prevent migraine aggravation with your menstrual period is call mini-prophylaxis. Prophylaxis is another word for prevention, so mini-prophylaxis means a short course of a prevention therapy. Menstrual migraines may improve by using mini-prophylaxis with hormonal therapy or standard migraine drugs.
Consider mini-prophylaxis only if your headache diary consistently shows a strong link between migraine aggravation and your menstrual periods:
- Mini-prophylaxis with perimenstrual hormone therapy: 1.5 mg transdermal estrogen patch worn for 7 days, starting 2-5 days before your period is expected to begin
- Mini-prophylaxis with standard headache therapies: All medications should be used at standard migraine treatment doses (unless otherwise specified by your healthcare provider) for 2-3 days before the expected menstrual period and during the first 2-4 days of menses.
Standard acute headache medications include:
- Nonsteroidal anti-inflammatory drugs (for example, naproxen sodium550 mg twice daily with food or mefenamic acid (Ponstel) 500 mg three times daily with food)
- 1 mg naratriptan (Amerge) twice daily
- 2.5 mg frovatriptan (Frova) once or twice daily
- Sumatriptan (Imitrex) 25 mg three times daily
Standard headache preventive medications include:
- Beta-blockers, such as propranolol (Inderal)
- Antidepressants, such as amitriptyline (Elavil) or imipramine
(Tofranil) - Calcium-channel blockers, such as verapamil (Calan and Isoptin), and flunarizine (Sibelium; not available in the United States)
- Neurostabilizing antiepileptics, such as topiramate (Topamax)
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The following things may help reduce or prevent migraines:
Magnesium inhibits inflammation in blood vessels and is proved to reduce migraine frequency. During the acute phase of attacks, 50% of migraine sufferers have lowered levels of magnesium. However, x and y are possible side effects.
Riboflavin (vitamin B2) appears to be a safe, low-cost, effective treatment for preventing migraine attacks. It reduces the frequency of migraine attacks with minimal side effects, including diarrhea and increased urination.
Ginger (Zingiber officinale) may decrease the severity and frequency of headache symptoms. It may prove to be beneficial due to its ability to inhibit inflammation in blood vessels. When taken after the onset of a migraine attack, ginger offers some relief of symptoms. Ginger may also reduce nausea. Individuals with gallstones should not use ginger supplements. Be aware that the safety of ginger supplements in pregnancy has not been established.
Feverfew (Tanacetum parthenium) is an herb with proven effectiveness in decreasing migraine frequency. It acts as both a serotonin antagonist (inhibits the inflammation of blood vessels that is associated with migraines) and a histamine antagonist (prevents the release of inflammatory substances that may be involved in migraine pain signaling). This herb also inhibits the synthesis of prostaglandins, compounds implicated in inflammatory responses. Feverfew may significantly reduce the nausea and vomiting that accompany migraine attacks. Note that possible side effects of feverfew are gastrointestinal ulceration and withdrawal symptoms when its use is discontinued. Withdrawal symptoms may include sleep disturbances, headaches, and muscle pain. Feverfew should not be used during pregnancy and nursing or by patients using blood-thinning(anticoagulant) medications.
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To prevent the aura phase and the migraine that follows it, you need to determine things that bring on your migraines. Medications, not getting enough sleep, and stress can all bring on a migraine attack. Medications and other treatment options can also help you prevent and manage migraines.
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Migraine headaches can last from four hours up to three days depending on the individual. People with this condition should avoid excessive physical exertion. Daily exercise is important to maintain good health, but your activities should not be so intense that they trigger a migraine. If you find that too much light or certain sounds or smells bring on your headaches, then you should take necessary measures to avoid those things as well.
