Migraine

The pain of a migraine headache is often described as an intense pulsing or throbbing pain in one area of the head. However, it is much more; the International Headache Society diagnoses a migraine by its pain and number of attacks (at least 5, lasting 4-72 hours if untreated), and additional symptoms including nausea and/or vomiting, or sensitivity to both light and sound. Migraine is three times more common in women than in men and affects more than 10 percent of people worldwide. Roughly one-third of affected individuals can predict the onset of a migraine because it is preceded by an "aura," visual disturbances that appear as flashing lights, zig-zag lines or a temporary loss of vision. People with migraine tend to have recurring attacks triggered by a number of different factors, including stress, anxiety, hormonal changes, bright or flashing lights, lack of food or sleep, and dietary substances.  Migraine in some women may relate to changes in hormones and hormonal levels during their menstrual cycle.  For many years, scientists believed that migraines were linked to the dilation and constriction of blood vessels in the head. Investigators now believe that migraine has a genetic cause.

Treatment

There is no absolute cure for migraine since its pathophysiology has yet to be fully understood.  There are two ways to approach the treatment of migraine headache with drugs: prevent the attacks, or relieve the symptoms during the attacks. Prevention involves the use of medications and behavioral changes.  Drugs originally developed for epilepsy, depression, or high blood pressure to prevent future attacks have been shown to be extremely effective in treating migraine. Botulinum toxin A has been shown to be effective in prevention of chronic migraine.  Behaviorally, stress management strategies, such as exercise, relaxation techniques, biofeedback mechanisms, and other therapies designed to limit daily discomfort, may reduce the number and severity of migraine attacks.  Making a log of personal triggers of migraine can also provide useful information for trigger-avoiding lifestyle changes, including dietary considerations, eating regularly scheduled meals with adequate hydration, stopping certain medications, and establishing a consistent sleep schedule. Hormone therapy may help some women whose migraines seem to be linked to their menstrual cycle. A weight loss program is recommended for obese individuals with migraine.Relief of symptoms, or acute treatments, during attacks consists of sumatrptan, ergotaime drugs, and analgesics such as ibuprofen and aspirin.  The sooner these treatments are administered, the more effective they are.

Prognosis

Responsive prevention and treatment of migraine is incredibly important.  Evidence shows an increased sensitivity after each successive attack, eventually leading to chronic daily migraine in some individuals  With proper combination of drugs for prevention and treatment of migraine attacks most individuals can overcome much of the discomfort from this debilitating disorder.  Women whose migraine attacks occur in association with their menstrual cycle are likely to have fewer attacks and milder symptoms after menopause.

Reference: American Academy of Neurology. AAN Patient Education Brochure.http://patients.aan.com/disorders/index.cfm?event=view&disorder_id=987

Treating Migraine Headaches

Migraine attacks can last for hours—or even days. They can cause intense pain, nausea, and vomiting. They can make you sensitive to light or noise, and they can affect your life and work.

To treat migraines, you may get a prescription for an opioid (narcotic) or a barbiturate (sedative) called butalbital. These are pain medicines. But you should think twice about using these drugs. Here’s why:

These drugs can make headaches worse.

Using too much pain medicine can lead to a condition called MOH, or medication overuse headache.

• Drugs containing opioids—such as hydrocodone (Norco, Vicodin, and generics) or oxycodone (Percocet and generics).


• Drugs containing butalbital (Fioricet, Fiorinal, and generics).

They are not as effective as other migraine drugs.

There are other drugs that can reduce the number of migraines you have and how severe they are— better than opioids and butalbital. Even in the emergency room—where people with severe migraines often ask for opioids—better drugs are available.

They have risks.

Opioids and butalbital can cause serious withdrawal symptoms if you stop taking them suddenly. People who use high doses for a long time may need to be in the hospital in order to stop using them.

Opioids, even at low doses, can make you feel sleepy or dizzy. Other side effects include constipation and nausea. Using them for a long time can lower your sex drive and cause depression and sleep problems.

They can be a waste of money.

Opioids and butalbital pills do not cost a lot. But why spend money on drugs you don’t need?

Also, if these drugs cause side effects and more headaches, you may have to go to extra doctors’ appointments. This will take time and may cost you money.

What drugs are good for migraines?

If you have migraine attacks, try one of the drugs listed below. They all work best if you use them when the migraine is just beginning.

1. Start with a non-prescription pain drug that combines aspirin, acetaminophen, and caffeine (Excedrin Migraine, Excedrin Extra Strength, and generics). Or try non-steroidal anti-inflammatory drugs such as ibuprofen (Advil and generic) or naproxen (Aleve and generic).


2. If these drugs do not help, or your headaches are more severe, try one of the prescription migraine drugs called triptans, such as sumatriptan (Imitrex and generic).


3. Start If triptans do not work, try dihydroergotamine nasal spray (Migranal). This drug works even better as an injection (DHE-45 and generic). You or your doctor can do the injection.

If you have migraines often, or if they are very severe, ask your doctor about drugs to prevent headaches.

When are opioids or butalbital useful for migraines?

Your doctor may suggest an opioid if none of the treatments listed above help, or if you have bad side effects.

It is not clear if butalbital should be used at all for treating migraines. If your doctor prescribes butalbital for your migraines, ask why. And ask if there are any other drugs that would work.

Limit the use of all pain medicines.

• Do not use prescription pain medicine for headaches for more than nine days in a month.


• Do not use non-prescription pain medicine for more than 14 days in a month.

This report is for you to use when talking with your health-care provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

© 2013 Consumer Reports. Developed in cooperation with the American Academy of Neurology. To learn more about the sources used in this report and terms and conditions of use, visit ConsumerHealthChoices.org/about-us/.