Migraine Headaches

Migraine headaches are a common disorder with multiple triggers. There are certain red flag symptoms that require additional lab tests but most patients can be diagnosed based on symptoms alone. Migraine headaches can’t be cured but it can be controlled with proper management.

Signs and symptoms of migraine headaches
Migraines are usually unilateral (they occur on 1 side), throbbing, pain that is worsened with exertion. About 25% of patients have an aura that precedes a migraine attack. Auras affect your sensations and you may feel changes in balance, speech, vision, or muscle coordination. Some auras last minutes while others can last an hour. Migraine headaches can last anywhere from 4 hours to several days and typically improve with sleep.

Migraine Triggers
Triggers for migraines include skipping meals, excessive stimuli, sleep deprivation, stress, weather changes, hormonal changes, and certain foods. Head trauma or neck pain can exacerbate migraines

Migraine Prevention
If you experience frequent migraines that interfere with your daily activity despite treatment, then consider speaking to your doctor about daily preventative therapy (ie. with onabotulinum toxin A). Patients who use analgesics or preventative drugs more than 2 times/week should talk to their doctor about trying medication that can stop their overuse of analgesics and prevent medication overuse headache. Some medications used in this situation include a low dose amitriptyline, beta-blockers, topiramate, or divalproex.

Migraine treatment
Keeping a diary of your timing and frequency of attacks, triggers, and treatment response is very helpful for determining your unique therapy. Eliminate and avoid triggers when possible. If stress or analgesic overuse is involved, then your doctor may recommend behavioral interventions. There’s evidence to show that yoga can help reduce headache frequency and severity. Relaxation techniques, staying hydrated, and exercising regularly can help reduce and prevent migraines.

Patients with mild to moderate migraine can try over the counter NSAIDS (ex. Ibuprofen, naproxen, aspirin) or acetaminophen. If the headaches are infrequent, your doctor may prescribe analgesics in combination with opioids, caffeine, or butalbital; however, due to their likelihood of being overused and causing medication overuse headache, these are not commonly prescribed. Antimetics, such as Gravol, can also be used to relieve symptoms.

Severe migraine attack management
Treatment of acute migraine is difficult because there is a high rate of nonresponse to medications. In addition, there’s little data available comparing different drug classes. Triptans are commonly used to help manage severe migraine attacks. Triptons are selective serotonin antagonists that block the release of neuropeptides that trigger migraine pain. Try to take your triptan as early as possible as they are most efficacious when taken at the onset of attacks, before the pain progresses. Overuse of triptans can also cause migraine overuse headache. There are many formulations of triptans available and they can be taken orally, subcutaneously, or intranasally. Examples of tripans include almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan.

In an emergency, you may be given IV antimetics with or without IV dihydroergotamine.

Migraine treatment during pregnancy
There is very little safety data for most medication used to treat migraine headache during pregnancy so prevention is a key aspect of therapy. Although it may not be the most effective, acetaminophen is still used for treating migraine headache in pregnant women because of its demonstrated safety. NSAIDs can be used until the third trimester. Triptans should be avoided because there is limited data for its safety. Opiates are only used for severe cases as they may cause dependence and neonatal withdrawal syndrome. Ergotamines are absolutely contraindicated.

Migraine treatment for children and adolescents.
Again, there is very little safety data for most medication used to manage migraine headache for children and adolescents so prevention is a key aspect of therapy. Studies have shown that acetaminophen and ibuprofen are safe and effective. Triptans are commonly used but they are not FDA-approved and not recommended by drug manufacturers.

CBD Oil and migraine treatment
Studies have shown that CBD oil can help with chronic pain and decrease inflammation and pain for patients with arthritis and it may have a similar effect for patients with migraines; however, there isn’t enough evidence to determine its efficacy, a safe dose, or to promote its use as a therapy for migraine headaches.

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