Migraines are very common and tend to occur more frequently in women. Headache is the key feature of the migraine syndrome, and occurs along with other symptoms that can include sensitivity to light or sound, nausea, vomiting, or visual disturbances. Some people experience migrainous visual disturbances without headache (aura without migraine).
Many individuals can identify specific triggers for their migraines, although trigger avoidance alone may not be enough to control headaches. Commonly mentioned triggers include lack of sleep, skipping meals, caffeine withdrawal, emotional or physical stress, hormonal changes, or certain foods or drinks, particularly alcohol. For patients who have aura without migraine, the events can be very infrequent and no definite trigger can be determined.
Preventive migraine treatments can be helpful for patients with frequent, severe headaches. The main goal for preventive strategies is to reduce the overall frequency and severity of the headaches. Avoiding known triggers may be helpful. Many people find that regular exercise makes them feel better, although strong evidence is lacking to recommend this as a highly effective migraine treatment. Other strategies may include improving sleep habits or learning to cope more effectively with stress, for example by learning relaxation techniques such as biofeedback or meditation.
Numerous medications also can be used as a preventive treatment for migraine. It is often helpful to start with a low dose of medication and increase it slowly in order to find the best balance between benefits and side effects. Some commonly used medications include amitriptyline, propranolol, and topiramate. Valproic acid and lisinopril are less commonly used. For some patients with chronic migraine, botulinum (Botox®) injections can help reduce headaches. Some vitamins, minerals and herbal preparations are also used to help prevent migraines.
Some patients are able to tell when a headache is beginning. They may find that early use of simple strategies can stop a migraine before it starts. These simple strategies include such things as eating, having caffeine, meditating or taking an over-the-counter medication such as acetaminophen or ibuprofen.
When headaches are moderate or severe, additional treatment may be needed. Most headache medications work best when they are taken in time to stop the headache before it becomes too severe. Some patients find over-the-counter combinations of simple analgesics in combination with caffeine to be helpful. Other patients try a class of prescription medications known as “triptans.”
Triptans are specially designed to work on receptors on blood vessels and brain cells in order to halt a migraine at an early stage. Triptans are typically taken orally, but they also come as injections and nasal sprays. These medicines are generally not considered safe in patients with a history of stroke, heart attack, or other vascular diseases.
Migraine treatment for individual headaches must be limited in order to avoid causing medication overuse headache. Frequent use of these medicines can paradoxically increase the risk that episodic headache disorders will become chronic. To avoid this, medication should be limited to no more than two days per week on average. If headaches occur more frequently, preventive treatment should be considered to reduce the number of headaches and minimize the need for treatment of individual headache attacks.
An isolated aura without headache does not require any acute treatment, since the visual symptoms resolve on their own.
Physicians treating migraines include primary care physicians and headache specialists, who may be certified in the subspecialty of Headache Medicine by the United Council for Neurologic Subspecialties. Patients with migraines that do not respond to standard therapies often benefit from seeing a headache specialist.
The headache specialists at the John R. Graham Headache Center provide comprehensive evaluation for all types of headaches, including migraine, tension-type headache, cluster headache, chronic daily headache syndrome, and secondary headache. Evaluation begins with a detailed history and neurologic examination, and further workup may also include specialized imaging, lab work, or lumbar puncture, if indicated.
Established in 1970, the Graham Headache Center has received international recognition for clinical excellence, for pioneering new approaches to headache treatment, and for research on women's issues, as well as clinical trials for the treatment of headache disorders.
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Brigham and Women’s Hospital is committed to providing all of our patients with the safest, highest-quality, most-satisfying care possible and follow established protocols that have been shown to improve patient outcomes. Our inpatient satisfaction survey, sent to patients’ to assess their total care experience, helps us to monitor what we are doing well and areas for improvement. We pride ourselves in the quality of patient care we provide and how we are measured compared with other hospitals.
If you believe you should have an evaluation and would like to schedule an appointment with one of our experts regarding migraine treatment options, call 1-800-294-9999 to speak to one of our knowledgeable coordinators who can help to connect you to the doctor that best meets your needs, or fill out an online appointment request.
Carolyn A. Bernstein, MD, Department of Neurology at Brigham and Women’s Hospital, describes risk factors and treatments for migraine headaches. Read the Migraine Headaches: What You Need to Know transcript.
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