05 Jul All About Migraines, Part Three: Treatment and Prevention

Migraines: everyone’s heard of them; many of us suffer from them—or will suffer a migraine at some point in our lives.

According to the Migraine Institute, 35 million Americans suffer from migraine headaches, and 43% of women and 18% of men will experience migraines at some point in their lives.

So what are migraines, exactly? How do they differ from “regular” headaches? How are they diagnosed, treated, avoided?

Part One of our All About Migraines mini-series looked at all the different types of migraines. Part Two examined causes and symptoms. And today, Part Three explores treatment options for migraines.

Migraine tests

Doctors diagnose migraines by listening to your symptoms, taking a thorough medical and family history, and performing a physical exam to rule out other potential causes. Imaging scans, such as a CT scan or MRI, can rule out other causes, including:

• tumors
• abnormal brain structures
• stroke

Migraine treatment

Migraines can’t be cured, but your doctor can help you manage them so you get them less often and treat symptoms when they occur. Treatment can also help make the migraines you have less severe.

Your treatment plan depends on:

• your age
• how often you have migraines
• the type of migraine you have
• how severe they are, based on how long they last, how much pain you have, and how often they keep you from going to school or work
• whether they include nausea or vomiting, as well as other symptoms
• other health conditions you may have and other medications you may take

Your treatment plan may include a combination of these:

• self-care migraine remedies
• lifestyle adjustments, including stress management and avoiding migraine triggers
• OTC pain or migraine medications, such as NSAIDs or acetaminophen (Tylenol)
• prescription migraine medications that you take every day to help prevent migraines and reduce how often you have headaches
• prescription migraine medications that you take as soon as a headache starts, to keep it from becoming severe and to ease symptoms
• prescription medications to help with nausea or vomiting
• hormone therapy if migraines seem to occur in relation to your menstrual cycle
• counseling
• alternative care, which may include biofeedback, meditation, acupressure, or acupuncture

Migraine remedies

You can try a few things at home that may also help remedy the pain from your migraines:

• Lie down in a quiet, dark room.
• Massage your scalp or temples.
• Place a cold cloth over your forehead or behind your neck.

Many people also try herbal home remedies to relieve their migraines.

Migraine medication

Medications can be used to either prevent a migraine from happening or treat it once it occurs. You may be able to get relief with OTC medication. However, if OTC medications aren’t effective, your doctor may decide to prescribe other medications.

These options will be based on the severity of your migraines and any of your other health conditions. Medication options include both those for prevention and those for treatment during an attack.

Medication overuse headache

The frequent and recurring use of any kind of headache drugs can cause what’s known as medication overuse headache (previously called a rebound headache). Persons with migraine are at higher risk of developing this complication.

When determining how to deal with your migraine headaches, talk to your doctor about the frequency of your medication intake and alternatives to medications. Learn more about medication overuse headaches.

Migraine surgery

There are a couple of surgical procedures that are used to treat migraine. However, they haven’t been approved by the U.S. Food and Drug Administration (FDA). The procedures include neurostimulation procedures and migraine trigger site decompression surgery (MTSDS).

The American Migraine Foundation encourages anyone considering migraine surgery to see a headache specialist. A headache specialist has completed an accredited headache medicine fellowship or is board certified in headache medicine.

Neurostimulation surgeries

During these procedures, a surgeon inserts electrodes under your skin. The electrodes deliver electrical stimulation to specific nerves. Several types of stimulators are currently being used. These include:

• occipital nerve stimulators
• deep brain stimulators
• vagal nerve stimulators
• sphenopalatine ganglion stimulators

Insurance coverage for stimulators is rare. Research is ongoing as to the ideal role of nerve stimulation in the treatment of headaches.

MTSDS

This surgical procedure involves releasing nerves around the head and face that may have a role as trigger sites for chronic migraines. Onabotulinumtoxin A (Botox) injections are typically used to identify the trigger point nerves involved during a migraine attack. Under sedation, the surgeon deactivates or decompresses the isolated nerves. Plastic surgeons usually perform these surgeries.

The American Headache Society doesn’t endorse treatment of migraine with MTSDS. They recommend that anyone considering this procedure have an evaluation by a headache specialist to learn the risks first.

These surgeries are considered experimental until further studies show they work consistently and safely. They may however have a role for people with chronic migraines that haven’t responded to other treatment. So, is plastic surgery the answer to your migraine woes?

Migraine prevention

You may want to take these actions to help prevent a migraine:

• Learn what triggers your migraines and avoid those things.
• Stay hydrated. Per day, Men should drink about 13 cups of fluids and women should drink 9 cups.
• Avoid skipping meals.
• Get quality sleep. A good night’s sleep is important for overall health.
• Quit smoking.
• Make it a priority to reduce stress in your life and learn to cope with it in helpful ways.
• Learn relaxation skills.
• Exercise regularly. Exercise may help you not only reduce stress but also lose weight. Experts believe obesity is linked to migraines. Be sure to start exercising slowly to warm up gradually. Starting too fast and intensely can trigger a migraine.

Talk to your doctor

Sometimes the symptoms of a migraine headache can mimic those of a stroke. It’s important to seek immediate medical attention if you or a loved one has a headache that:

• causes slurred speech or drooping on one side of the face
• causes new leg or arm weakness
• comes on very suddenly and severely with no lead-in symptoms or warning
• occurs with a fever, neck stiffness, confusion, seizure, double vision, weakness, numbness, or difficulty speaking
• has an aura where the symptoms last longer than an hour
• would be called the worst headache ever
• is accompanied by loss of consciousness

Make an appointment to see your doctor if your headaches start to affect your daily life. Tell them if you experience pain around your eyes or ears, or if you have multiple headaches a month that last for several hours or days.

Migraine headaches can be severe, debilitating, and uncomfortable. Many treatment options are available, so be patient finding the one or combination that’s best for you. Keep track of your headaches and symptoms in order to identify migraine triggers. Knowing how to prevent migraines can often be the first step in managing them.

This article was brought to you by the Proactive Health Management Plan in partnership with Healthline.