Treatments

Unfortunately there is no universal cure for migraines. That doesn’t mean that you cannot eliminate migraines, significantly reduce them or otherwise live migraine free for extended periods of time.

Migraines can be managed.

There is always hope for a solution. There are a many different ways you can bring your migraines under control.

Studies show that over 50% of migraine sufferers have not even been diagnosed1.

Effective migraine management involves a partnership between you and your doctor. If you have been to a doctor, but haven’t found a solution, it is worth another visit or finding a migraine specialist who comes recommended. Different treatments affect people differently. We are all unique and you will need to find what works for you with the help of a doctor or specialist to get the best results.

Below is a good starting point to evaluate different options, treatment strategies and consider what may work for you.

There are two main types of migraine treatment

  1. Acute treatments -treating as soon as an attack happens; and
  2. Preventative treatments- stopping attacks from happening in the first place.

Acute treatments

Some over the counter medications to treat a migraine attack include painkillers (also called analgesics):

- Aspirin – a common and effective first option for migraines. A single oral dose of 1000mg of aspirin has been shown to reduce pain to none for 1 in 4 migraine sufferers. For roughly 50% of sufferers, pain was reduced to mild.  It is best used in a soluble form for maximum effect2.

The European Headache Federation recommends soluble aspirin as the first option for migraine sufferers given its success rate. Aspirin is not recommended for children.

Non-steroidal anti-inflammatory drugs – for example ibuprofen, these reduce inflammation by inhibiting the production of certain chemicals in the body.  Ibuprofen has been found to provide relief for about 50% of sufferers, but complete relief from pain and symptoms in a minority (around 1 in 4 sufferers). It is good option for those experiencing minor to moderate migraines.3 This is particularly so for children and adolescents for whom aspirin is not recommended. If children are suffering from migraine then ibuprofen is commonly recommended as the first option.

- Paracetamol – caution should be taken with Paracetamol. There is conflicting evidence about its efficacy for migraine relief. Paracetamol is widely known to relieve pain, fever and reduces stiffness but there is a lack of strong evidence to support its effectiveness with migraines. Some research shows that it can offer relief but not to the same level as aspirin or ibuprofen. Despite this, paracetamol remains one of the most commonly use drugs for migraine worldwide alongside aspirin due to its relative low cost and widespread availability4.

Painkillers that can be dissolved in water often work faster

Painkillers can more effective for migraines when taken as soluble (dissolvable in water) or liquid format so they can be absorbed faster. This is important because migraines can prevent the effective absorption of medication once the symptoms occur (such as nausea) which then block the action of the medicine if left too late before a migraine attack.

There could be a very big difference in effectiveness of the same medication when taking the medication at the first signs of a migraine…. versus 5-10 mins after the migraine headache has already begun.

Options for more severe migraines

For more severe migraines, the following medications may be prescribed:

- Triptans – for a non-responder to aspirin, the 2nd option may be a triptan. This is effective for approximately 50% of those who try it according to the 17th Expert Committee on the Selection and Use of Essential Medicines to the World Health Organisation (WHO), Geneva, March 20095.

There are several types of triptans available. Sumatriptan has the strongest supporting evidence for its efficacy according to the WHO Expert Committee.

- Ergotamine Compounds – ergots like Triptans constrict blood vessels but tend to cause more constriction in the heart and other parts of the body that lead to the head. Their affect on the heart is more prolonged than Triptans, therefore they are not deemed as safe. Side effects exist for both, but may be more pronounced for the ergots.

- Stronger narcotic-type painkillers (analgesics) – this kind of painkiller is sometimes used to treat migraines. But given they are potentially addictive they are not recommended for initial treatment.

- Medication that acts on nausea may be taken alongside a migraine medicine to allow for the absorption of the migraine medicine.  Metoclopramide is an example.

Preventative treatments

Even after serious attempts have been made to reduce your migraines by identifying and avoiding triggers, disabling migraine attacks may continue. In these severe cases, if appropriate, your doctor may advise medication to try to stop the attacks from happening. This medication is taken daily regardless of whether a migraine is present or not to reduce migraine attacks.

Doctors may look not only at the frequency of your attacks, but the severity and broader impact that migraines are having on your quality of life. The prescribed medications have different costs and many have noticeable side effects.

There are different types of preventative migraine drugs available. Many have originally been developed for other purposes but have been found to be helpful for migraine sufferers.

You may be prescribed:

- Anticonvulsant –  are anti-seizure medications. Mode of action in migraine is not clear. They may reduce the capacity of the nerves to transmit pain signals to the brain.

- Antidepressants – can help prevent migraines which alter the levels of serotonin, a brain chemical that regulates mood.

- Beta-blockers – are a class of drugs which block the effects of beta-adrenergic substances produced by the body like adrenaline. It is not known exactly how beta blockers help prevent migraine headaches. It is thought that by decreasing production of these substances, they affect serotonin and/or the arteries.  The most common beta-blocker for migraine is propranolol.

Herbal remedies and supplements

- Riboflavin- also known as Vitamin B2. Riboflavin has being reported as useful in migraine treatment due to its role in helping heal and strengthening brain cells. This can be taken as a supplement or you can simply eat foods high in Vitamin B (such as Milk, Cheese, Leafy Vegetables, Liver, Kidneys, Legumes, Yeast, Mushrooms & Almonds, Soybeans, Wheat Bran, Salmon or Sun-dried Tomatoes).

- Feverfew – is a herb whose leaves contain natural anti-inflammatory qualities which may help obstruct the release of blood vessel dilating substances in the brain and may reduce inflammatory substances from developing which may increase pain levels. It does provide relief for some sufferers and given its low side effects it is a relatively low risk option.

- Butterbur – is a herbal supplement which has been reported to be effective in reducing the frequency and severity of migraines in some migraine sufferers. However caution should be exercised with Butterbur as it contains components called pyrrolizidine alkaloids which are toxic to the liver and may cause cancers. The concentrations of this toxin vary depending on which part of the plant is harvested and where the plant is grown. Getting butterbur from a reputable source is important. The long term health effects of butterbur have not been studied.

Complementary Migraine Treatments

The benefit of many of these complementary treatments is their comparative lack of side effects to the medical options. However, the level of relief from migraines may vary widely for different options and by person. Expect a greater variance in their success rates for migraine sufferers. Some treatments have more side effects than others. Not all therapies listed here are appropriate for all people and medical advice should be sought prior to consultation if in doubt.

  • Acupuncture A traditional and ancient Chinese technique which involves the insertion of very fine, solid needles into certain points of the body. According to Chinese medicine, acupuncture helps headaches by encouraging the production the body’s natural pain killers called endorphins.
  • Alexander Technique Is a system designed to retrain poor posture to ensure minimum effort, strain and help prevent the headaches that can result.
  • Biofeedback A technique that teaches people how to control certain body functions like blood pressure, heart rate and spasms in the arteries supplying the brain with the help of a sensory device. Once skills are learnt they can be practiced anywhere.
  • Chiropractic Therapy Chiropractors seek to relieve headache disorders based on the diagnosis and manipulative treatment of misalignments of the joints, particularly those of the spinal column. Manual techniques on the re-alignment may benefit corresponding nerves, muscles or organs.
  • Dietitian/ Nutritionist What you eat can play a very significant role in your migraines. There are a number of foods that are problematic for a large number of migraine sufferers. Understanding which foods trigger your migraines are essential to successful migraine management. Common food triggers to be aware of are food additives such as nitrites and MSG (monosodium glutamate), food colouring, chocolate, aged cheese, red wine, beer, caffeine, citrus fruits, cured meats such as bacon, hot dogs, aspartame, ice cream. Not all trigger foods are listed here. If you are unsure, it may be worthwhile speaking with your doctor or seeing a dietitian or nutritionist to manage your diet, they can also help determine if you have any food allergies which may be contributing to your migraines.
  • Exercise / Personal Trainer Exercise helps with rest, relaxation and it also helps release stress – a common trigger for migraines. Most experts recommend you need at least 30mins of moderate exercise daily to get the best results for stress reduction. i.e. running, swimming, bike riding. If you can find things you enjoy doing then you’re more likely to be consistent, try Yoga or Pilates. Something is better than nothing. Start small and build slowly from there.
  • Hydrotherapy Using ice packs on the head, splashing the face with cold water can help provide relief. Having hot and cold showers dilates then constricts blood vessels which stimulates circulation.
  • Massage Can reduce headaches by relieving muscle tension throughout the body.
  • Meditation Recent research has shown very promising results for meditation with all participants reporting less severe migraines.
  • Optometrist Do you need prescription glasses? Could the glare from the fluorescent lights or computer screen at school or work be causing your migraines. It may be worth getting your eyes checked if you think you may need glasses. Or seeing a behaviour optometrist to see if you respond to coloured lenses. Glare from the sun may also be contributing to migraines. Ensuring you have sufficient sunglasses with UV protection and polarization to reduce glare may provide significant relief. Wear sunglasses even with the smallest amount of sunshine if you are sensitive to sunlight.
  • Osteopathy Can be used to correct misalignments which may cause migraines.
  • Physiotherapy A more scientific approach than plain ‘massage’ to treating muscle tension to release pressure that may lead to headaches.
  • Relaxation Techniques Does your mind race after your head hits the pillow? Try relaxation techniques to put your mind at ease before you go to bed to fall asleep faster and in a more peaceful and calm state. With a little practice you’ll sleep better and feel more refreshed in the morning – you may even become a calmer, more balanced person.
  • Shiatsu A Japanese form of therapy which involves hand massage and pressure to certain body points to help restore the ‘energy balance’ and promote relaxation.
  • Yoga A form of exercise that involves stretching, poses, breathing control to strengthen muscles and increase blood flow. It can promote calmness and is often used in combination with meditation exercises.

How to manage your migraines

It takes a proactive effort to control of your migraines. But it is well worth it. Successfully managing your migraines means getting your life back.

Now that you have a number of options to consider, here are a few simple steps to manage your migraines.

Step 1) Keep a diary - start relying on the facts, not your brain fog for how well you’ve been feeling, migraine frequency, symptoms and medication effectiveness. If you’re looking for a diary- check out this one.

Step 2) Get a good doctor - develop a partnership with them to help put together a robust strategy and help reduce your attacks.

Step 3) Manage the migraine attacks – consult with your doctor about suitable migraine medicine to manage the pain. Work with your doctor until you find a satisfactory solution as there are a 100s of treatments available. If appropriate discuss a preventative daily medicine to break the chronic cycle of migraines in your life. Note: these all have different costs and side effects which need to be evaluated for your own individual circumstances, tolerances, side effects, health profile etc.

Step 4) Uncover your migraine triggers- To do this you will need to record these in some kind of migraine diary or journal each time you get an attack. Use each attack as a clue for suspected triggers that day and the day prior. Record as much as you can remember about what you eat, how you felt and what you did.

Step 5) Prevent future attacks- Once you identify your key triggers it becomes easier to prevent future attacks. For example, if caffeine is a key trigger- then gradually replace your morning coffee and soft drinks with herbal teas and water/juices. If it’s stress-related then explore ways to better cope with or manage stress in your life. This may include regular exercise, meditation, yoga, massages, vitamins or complementary therapies and any other stress management techniques or options your doctor may recommend.

What you should begin to see with a better management of your the key triggers is your migraines start to decrease in both severity and frequency. If this is not the case, then go back to step 3) as you have may not have discovered enough or all of your key triggers leading to your migraines.


 Free 5 Step Migraine Management Plan

Summary Checklist 

Click the download icon below to get access.

 


Sources

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  8. Bird S, Derry S, Moore R. “Zolmitriptan For Acute Migraine Attacks In Adults”. Cochrane Database of Systematic Reviews 2014, Issue 5. Art. No.: CD008616. DOI: 10.1002/14651858.CD008616.pub2
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