Migraine best treatment

Posted On April 17, 2020

Migraine is a very common problem. Every migraine patient’s situation is different, and treatment needs to be individualized.

Prodrome

One or two days before a migraine, you may notice subtle changes that warn of an upcoming migraine, including:

• Constipation
• Mood changes, from depression to euphoria
• Food cravings
• Neck stiffness
• Increased thirst and urination
• Frequent yawning

Aura

• Some people may have an aura: lasting 20-60 minutes before a headache
  • visual: shapes, bright spots or flashes
  • Vision loss
  • pins and needles in limbs
  • Weakness on numbness on face or one side of body
  • Speech problem
  • Hearing noises
  • Jerking

Attack

• Throbbing pain
• Sensitive to light, sound, smell or touch
• nausea and vomiting

After migraine

• feels drained, confused, up to a day

What to tell the doctor

• Onset: when was the first attack in your life
• In the past 3 months: how often do you have the
  • Mild attacks
  • Severe attacks
• What type of tests were done in the past
  • MRI, CT, EEG
• Which medication helps or does not help
  • The Attacks
  • Preventive medications tried in the past
• Do attacks always occur at a certain time of your period/menstruation

Evaluation

• May need a MRI scan to check for other problems in the brain especially if
  • unexplained abnormal finding on exam
  • atypical headache features
  • recent significant change in pattern, frequency or severity of headache
  • New onset headache after age 50
  • history of cancer, hiv, immue suppression
  • associated symptoms such as fever, stiff neck cogntive or personality change
• Additional testing may be needed depends on the history and symptoms

Treatment of an acute attacks

• First line: Anti-inflammatory such as Naprosyn, Aleve
• Anti-nausea medication: it reduces nausea and also help pain
• Tryptan: Imitrex injection, spray, pill
  • other tryptan
• Steroid
• Usually narcotic pain medications are reserved as the last option
• Avoid taking over the counter migraine medcations on a regular basis, it may aggravate your migraine

Life Style modifications

• Good sleep hygiene
• Regular meal
• Regular exercise
• Manage emotional stress

Preventive medications

• If you have frequent severe attacks
• You may need to take medication to prevent the attacks
• The safest preventive medications
  • SNRI: such as Venlafaxine, Duloxetine
  • Anti seizure medications: tends to have more side effect
    • Topiramate: may cause drowsinesss and tingling
    • Depakene: may cause weight gain
  • Blood pressure medication
    • Propranolol
    • Verpamil
  • CGRP antagonist: monthly injection, very expensive.
  • Transcutaneous supraorbital nerves stimulation
  • Your doctor will evaluate your condition to select the best medication for you.
• For child bearing age woman, beware of potential effect on fetus. A lot of medication cannot be used.

Special types of migraine

• Hormone related migraine
• Cluster headache
• Symptomatic migraine
  • vestibular migraine
  • hemiplegic migraine
  • basilar migraine
• Hemicrania continua, Trigeminal autonomic cephalagias

Other mimics of migraine

• Tension headache
• Chronic daily headache
• Pseudotumor cerebri