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Pain Medicine July 29, 2022

5 Things to Know About Treating Migraine Headaches

Headache disorders affect approximately 90 percent of people during their lifetime, with migraine disorder being the most debilitating.

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Migraines center around a severe throbbing headache that can last anywhere from four hours to three days. These headaches can be aggravated by triggers ranging from physical activity through specific trigger foods.

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Migraines are usually accompanied by symptoms such as nausea, vomiting, aura, sensitivity to bright light and loud noises, premonitory symptoms and a postdrome (sometimes called a “migraine hangover”) after the headache subsides.

How do you stop a migraine headache? Migraine therapy includes acute treatments—pain-relieving medications to stop symptoms during headache attacks—and preventive treatments, designed to reduce migraine frequency and/or severity.

Here are five things to know about treating migraine headaches from the JN Learning article, "Diagnosis and Management of Headache: A Review":

  1. Some effective treatments for acute migraine are available over the counter.

    Current treatments include acetaminophen, 1000 mg; NSAIDs, such as naproxen sodium, 550 mg; and combination products containing caffeine. If these are ineffective for a patient, prescribers may opt for triptans, such as rizatriptan, 10 mg, or eletriptan, 40 mg.

  2. Triptans are potentially safe for most people with migraine, but they should be avoided in some cases.

    Patients who may not tolerate tryptans well include those with established coronary artery disease, stroke, peripheral artery disease and uncontrolled or multiple risk factors for cardiovascular disease.

  3. Opioids and barbiturate combination products should be avoided.

    These drugs run a high risk of dependency and medication overuse, which become even more lethal if the patient has a history of mental health issues. Fortunately, other options are available.

  4. New preventive therapies are constantly in the works for migraine sufferers worldwide—and give patients more options.

    Among the first-line preventive therapies for patients with migraine are antihypertensives, such as candesartan or propranolol; antidepressants, such as venlafaxine or amitriptyline; and antiepileptic agents, such as topiramate. A typical therapy consists of candesartan, 16 mg, daily or topiramate, 50 mg, twice a day. As explained in this JN Learning podcast, over-the-counter supplements, such as magnesium and vitamin B2 (riboflavin), have also emerged as options for migraine prevention.

  5. Behavioral therapies, such as deep breathing and thermal biofeedback, are recommended by the American Academy of Neurology and the American Headache Society.

    This particularly applies to patients who are unable to take medications, prefer nondrug options, have acute medication overuse or could benefit from learning stress-coping skills.

Because headache disorders are one of the most common reasons patients visit medical offices and emergency rooms, it’s important for physicians and medical professionals stay up to date on effective treatment approaches to migraine.

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