Migraine

Migraine Treatment

We’re In a New Era of True & Specific Migraine Treatment

The past 26 years have been a long-awaited and welcome period for migraine treatment. In this regard, if you’re having migraines and you’re younger than about age 35, you’re lucky. You’re living during the age of modern migraine medications. Our understanding of migraines has greatly increased. Way back in 1993 the first “triptan”, sumatriptan (Imitrex®), became available in the U.S. Before that the migraine medications didn’t work very well and had some miserable side effects. Things like meperidine (Demerol®), propoxyphene (Darvon®), and others. In comparison, Imitrex® felt like a miracle drug to migraine sufferers. Since then we have many more triptans, and they’ve been on the market so long that inexpensive generic versions of many are available. Patients with migraines and doctors who treat them now have good and effective tools.

Migraine Treatment – The Triptans – Sumatriptan Was First

As we mentioned above, sumatriptan (Imitrex®) came out in 1993. This started a revolution in helping people with migraines. The other triptans are:

• rizatriptan (Maxalt®)
• almotriptan (Axert®)
• naratriptan (Amerge®) – slower onset, lasts longer in your body
• zolmitriptan (Zomig®)
• eletriptan (Relpax®)
• frovatriptan (Frova®) – slower onset, lasts longer in your body
• eletriptan (Relpax®)

Though all of these medications are triptans, they’re not all the same. Some work better for some people and others in the list work better for others. In fact, it’s often true that for any one person, one triptan works better than another. It’s a very individual matching of medicine and person. When a triptan works as it is supposed to, it will stop the headache, the nausea, and the general awful feeling of migraine syndrome. When it works a person can go from miserably ill to perky and well in a few hours.

We Need More and Better Meds for Migraine Treatment

Even with the medications we have now and all the ways we have of getting the medication into the person, like by mouth, nasal spray, injection, and skin patch, there are still people with migraines who are not helped. More needs to be done. New medications have become available, like the CGRP blockers (see more on these below), and more are being found.

A Reader Asks:

When I broke my arm at work, falling off a fork lift, the doctor gave me Vicodin for the pain. It worked great. My wife has painful migraines and some of the drugs they give her take hours to work. Why don’t they just give her Vicodin for the pain?

There are several good reasons why narcotic drugs like Vicodin®, Percocet®, and Demerol® don’t work for migraines. As we mention above, these were the drugs used in the “bad old days” before we had specific migraine medicines. We mention this a bit more below. The opioid-based (narcotic) drugs are of surprisingly little use for migraine. It’s far better to use CGRP blockers to keep from getting migraines at all, and then a triptan or a different CGRP blocker if a migraine comes despite the prevention. And, of course, narcotic drugs can be addictive, and with better treatments that have zero addiction potential, why take a chance on developing a drug problem.

It is Surprising How Little Plain Pain Medications Help Treat Migraine

Usually when someone has a pain you would first think about taking a pain medication. So it’s surprising that usual, regular medications for pain don’t help migraine pain much at all. Medications like ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin help somewhat on occasion. Many people with migraines like to take one of these with their triptan. One very popular combination is taking a naproxen with a triptan. (For years there was a medical rumor that naproxen had an effect on brain chemistry that helped the triptans, but this likely was a medical myth and not true. Naproxen is still quite a good medication, though.)

Not Even Opioid Narcotics Help Much                                                             

Narcotic pain killers are of surprisingly little use. Migraine is much more than headache pain. The nausea, vomiting, and general awful feeling are a big part of the problem in migraine attacks. Motrin, Aleve, and narcotics can cause stomach upset and nausea in some people, which makes them even less useful in migraine.

We All Want Fast-Acting Migraine Treatment

How quickly can one expect one or another form of a triptan to take your migraine away?

The tablets you take by mouth need about one to two hours to work completely. The two hour wait is more common. The fastest acting formulation is the shot, the injection under the skin, such as with sumatriptan injectable. The injection can work as fast as twenty minutes. Twenty minutes and, wow, headache, nausea, and yucky feeling are gone.

The nasal sprays are almost as fast as the injections, starting to work in as little as twenty or thirty minutes. Many people don’t like needles and find the nasal spray a much more to their liking. Also, it’s easier to use a nasal spray in places where you are around other people. There are some people, however, that don’t seem to mind giving themselves the injection and say that the nasal spray leaves a bad taste in their mouth

The skin patch is slower, taking about as long to start working as the tablet you take by mouth, that is, one to two hours.

You can get sumatriptan as a type of “injection” that does not use a needle. But in truth, it is “needle-free” but it is not pain-free. It does hurt. If you are really afraid of the needles themselves and the pain of an injection is not the problem, this needle-free Sumavel DosePro® might be a good choice for you.

We Can Block Migraines from Ever Starting

The “triptans” and the older medications were made to treat a migraine that you have now. That’s great, but now there’s a way to go one step better. Stop the damned migraine attacks before they even start.

CGRP Blockers Prevent Migraines

CGRP blockers are a whole new type of migraine medication. The first of this medicine family was FDA-approved in May, 2018. The CGRP blockers have to be given by injection. One of them is erenumab (Aimovig®). Erenumab is given by injection just a once-a-month, and then, no more migraines. That’s the plan, but, in fact, a person actually might have just a few mild migraines. Nothing’s perfect. As with any new medication, the CGRP blockers are expensive. If you’re a paid subscriber to the site you can see the specific page on these blockers.

Beta Blockers

The “beta blockers” have been around for a long time. They’re used to treat high blood pressure. And, in addition, people have been using beta blockers for migraine prevention for many years. For some individuals who get frequent severe migraines, beta blockers can lessen the severity and frequency of attacks. Among the beta blockers the three that are often used for migraine prevention are propranolol (Inderal®), metoprolol (Lopressor®), and timolol (Betimol®). They don’t help everyone, however, and some people say the beta blockers make them feel slow and tired, and that they’re useless to prevent migraines.

Other High Blood Pressure Medications Used to Prevent Migraines

There are other classes of medication that, while made to treat high blood pressure, might work to prevent migraines. They are the “calcium channel blockers” like verapamil (Calan®) and the “ACE-inhibitors” like lisinopril (Zestril®). That is, some migraine sufferers find calcium channel blockers or ACE inhibitors helpful to prevent migraines. As with the beta blockers, it’s not a guarantee.

Migraines Prevented by Medications for Depression

And, No, This Does Not Mean You’re Depressed

Most people who get migraines are not depressed (except maybe bummed that they get migraines). That said, it could be that as many as three out of ten people with migraines also have a medical depression. But depressed or not, there are medications for depression that are useful for preventing migraine headaches. Two examples are amitriptyline (Elavil®) and nortriptyline (Pamelor®), and there are others. It might seem odd that a medication for one problem would work for another. But it’s not that unusual. Brains are complicated organs and there is overlap among what goes wrong in the many ways a brain works. (See our FREE page on Your Mind & Your Brain for more on how complicated the brain/body connection is.)

There Are People with Migraines and Depression

Yes, there are people with migraines who also have depression. If a person has both it’s important for the depression to get separate and specific treatment. If the depression is not recognized and treated the migraines will likely be much worse and stay worse. After the depression is successfully treated it will be easier to treat the migraines. The migraines will respond better to migraine medications.

Medications Usually Used to Treat Seizures Can Help Prevent Migraines

Here’s another example of medications made to do one thing that later are found to help in other ways. There are two medications used to treat epilepsy, valproate (Depakote®) and topiramate (Topamax®), have been found to be helpful in preventing migraines. As with the medications for hypertension and for depression, we don’t know exactly how these medicines for epilepsy work to prevent migraine, but they do work, at least for some people.

Other Things You Can Do to Prevent Migraines

Don’t Trigger the Triggers

Often migraines are set off by foods, weather, or situations. For example, some individuals who get migraines realize that the things going on around them, things they do or foods they eat, or other changes around them, can trigger a migraine attack. If you haven’t noticed this yourself, you might try keeping a “headache diary” for awhile.

The Headache Diary

A headache diary is a daily record, or even several-times-a-day record, of foods eaten, the weather that day, social situations, and stressful events along with whether or not you had a migraine that day, and was it a bad headache or a mild one. Maybe you can discover what triggers your headaches. Bad weather predicted in the next few days, or changes from good weather to bad or vice versa, can trigger migraines. Hot dogs and other meats containing nitrites can trigger them. And other things like skipping meals, too much or too little coffee or tea, hard exercise, beer or wine, too much sleep, or being overly tired.

Stay Healthy

We’re not just saying this to keep you healthy, it’s really true. Some people eventually realize that when they are run down and tired they get more migraines. When life is going better, when they feel good and are full of energy, they get fewer headaches. So, do your best to take really good care of yourself in every way that you can. Put yourself first in getting what you need. Get enough sleep at night but don’t oversleep. Try to avoid stress, or, if you’re already stressed, try to lower the intensity. Rest and relax when you feel a headache might be coming on. Or, for that matter, rest and relax every chance you get. But, as we all know, there are times when life’s stress is unavoidable. For these tense times it might help to learn and practice some muscle relaxation exercises like yoga or meditation.

Alternate Medication Treatments

We can’t recommend these treatments because there’s too little good, hard information to do so. They’re not part of “Evidence-based Medicine”. But some people swear by them. And, if they help and don’t cause a problem, one of these “alternative medication” ideas might be on a list for you to think about. For example, Cognitive-Behavioral Therapy, biofeedback, message therapy, some vitamins or herbs (be careful in this area), and/or even acupuncture.

To Sum It Up Migraine Treatment

Help is available for both preventing migraines and treating a migraine you already have. It might, and probably will, take time and patience on your part to find all your best answers, but something will work to treat your painful attacks and to lessen the likelihood of future attacks.

Helpful links:

Clinical Trials.gov – recruiting and not yet recruiting studies of migraine in the U.S.

The Mayo Clinic on Migraine

American Migraine Foundation on Commonly Used Acute Migraine Treatments

FDA on Approving Aimovig (erenumab)

NIH Medline Plus magazine on migraine

 

Full Steam Ahead on Migraine Prevention and Treatment

Those of us who have been either suffering with or treating migraine syndrome for a number of years are stunned by the advances of the past few years. One great help in getting research funding to find better treatments and get those treatments to patients is the new wide understanding that migraine syndrome is a major source of neurologic disability. There is nothing like new money pouring into an area and major pharmaceutical firms spending billions on migraine research to get the attention of ambitious, bright, young scientists excited and energized to make a difference. They’re discovering where migraine pain really comes from (and it’s not blood vessel expansion). Migraine is a complex brain network disorder, a brain condition with overlapping phases that build to a migraine pain attack. This intricate mechanism which has gone awry has been overlooked too long and managed poorly.

Welcome to the Neuroscience Research and Development Consultancy website. How’s your headache doctor doing? Have a question or a comment? Send it to us at: Comment@NeuroSciRandD.com

Migraine Headaches and Migraine Syndrome

Migraine is a neurological disorder. Worldwide about 10% of the population have migraines. It’s common and debilitating. The main symptom of migraine syndrome is the headache, which typically lasts from four to 72 hours. The pain is severe and typically affects one side of the head. Often described as intense and at times throbbing, it is worsened by routine physical activity. Nausea and painful sensitivity to light and sounds are part of the syndrome. These are not your usual garden-variety tension or sinus headaches. The nausea can progress to vomiting. Motivation to do anything is gone. There’s no desire to do anything except hide somewhere and try to make the world to go away. A migraine headache can drive a person into their bed, and maybe even to the Emergency Department.

Migraine Headaches With and Without “Aura”

Okay, so what’s an “aura”? The term can confuse people because dictionaries give as the first definition something like an invisible emanation or field of energy believed to radiate from a person or object. A later definition, fit for our purpose, is that an aura is something like a sensation of a bright light or cool breeze that comes before the onset of some medical disorders, such as an attack of migraine or an epileptic seizure. An aura before a migraine is an experience or sensation that comes just before the headache starts. About a third of the people with migraines have an aura before the headache, the other two-thirds don’t. So, migraine attacks are often divided into two types, with or without aura. A common aura is bright lines or lights flashing before one’s eyes. Other auras can be odd odors or smell, or odd tastes, or even an unusual feeling when you touch something. Yet another type can be tingling in the hands or face, or changes as simple as feeling foggy-minded, not mentally alert.

The Warning Signs Before a Migraine

Some individuals who get migraines can tell the day before or the evening before that a headache is on the way. They might feel irritable, or “blue” (depressed), or yawn a lot. Or they might feel fatigue, or an upset stomach. Their neck might feel uncomfortable and stiff. Or, the evening before the attack they might feel even better than normal, more mentally clear and full of energy.

A Reader Asked: Since migraine headaches are so painful and awful, can they actually hurt you or kill you?

A migraine attack won’t kill you in the way your question implies. There are rare, rare case reports of someone having a stroke during a migraine attack, but whether the headache caused the stroke is never known. However, there is good evidence from many studies that people who get migraines have a higher risk of eventually dying from heart disease or from a stroke. It’s not known why migraine would increase the risk for these vascular diseases that might eventually result in a fatal outcome.

How to Stop the Migraine Pain

Medications designed specifically to treat acute migraine headaches have been around since 1991. Even better medications have recently been FDA approved. Some of the newer ones are designed for prevention. Or, if while taking them the person does get a headache, it will be milder and they will come less often. Others of these newer ones treat the acute migraine that you have now. If you use a medication to prevent a headache and still get one you can still take one of your tried-and-true medications to treat it. For more information on medicines for migraines go to our free page on migraine treatments. The “triptans” are well known and often used. Sumatriptan (Imitrex®) in 1991 was the first. It started a revolution in migraine headache treatment. The newest medications work by blocking CGRP, blocking it so that it can’t make the nerves involved in migraine more sensitive.

(CGRP is calcitonin gene-related peptide.)

First Steps Treating the Headache While Waiting for the Medications to Work

In the first 30 to 90 minutes of a headache, while waiting for any of the needed medications to start working, many people get a bit of relief from a cold pack on the aching side of the head and lying down in a quiet, darkened room.

The Tendency to Have Migraine Headaches Is Inherited from Family Members

The risk for getting or the tendency to get migraines is often genetically inherited. About 67% of the people with migraine syndrome have a parent or grandparent, or an aunt or uncle, or other family members who also suffer with migraines.

The World Around You Can Affect Your Headaches

Doctors who treat people with migraines describe headache “triggers”, things that bring on a migraine. Many things around you can trigger a headache and the list of known possible triggers is long. It’s up to each person who gets migraines to discover if they have any triggers and, if so, what are their triggers. For some it’s one or another food, like hot dogs because of the nitrates in them. For others it’s alcohol or smoking. Stress, being stressed out, is another pressure that can bring on a migraine in some people. Or, being overly tired. There are people for whom skipping meals invites a migraine. For others, weather changes, when sunny skies turn to clouds and rain, or the other way ’round, can bring on a headache.

Hormones Going Up and Down Can Cause a Migraine

Before teenage years and the onset of girls’ periods the percentage of boys who get migraines is a bit higher that the percentage of girls. After puberty about twice as many or three times as many women have migraine headaches as men. The variable levels of estrogen and progesterone through the month that start in puberty can be problems for those susceptible to migraine syndrome. Another medical term for migraines linked to the menstrual period is catamenial migraines.

How to Tell If That Headache is Really a Migraine

The way in which a migraine starts, the way the pain and other symptoms develop over time, and then the pattern with which they go away are so typical of migraine that just this information can be a big part of knowing a headache is a real migraine. If the headaches you get don’t fit the picture they might not be migraines. It could be something more than migraine syndrome, so see your doctor. She might need to do tests or brain imaging to confirm that no other medical condition, such as a sinus headache or tension headache, is the cause of the pain occasional pain.

Beyond the Head Pain – More About Migraine Syndrome

Everyone knows about migraines because the headaches are so severe. However, mild or severe, a migraine is not just the headache, as we mentioned above. When a person has a migraine a lot changes in their body. For example, the nausea and maybe vomiting are from gastric/digestive system changes. The aura mentioned above, that starts before the headache, is from altered vision circuitry and other brain changes. There are changes in energy level, in motivation, and in the ability to think clearly. That’s why a person with a migraine has no desire to do anything. Some people who don’t get migraines view them as just “bad headaches”. They are so, so much different than bad headaches.

More Migraine Details

There are mild and moderate migraines, but when people say migraine they’re usually talking about the severe ones. The pounding, pulsating pain, which usually affects only one side, is made worse by movement or action. During a migraine people want to stay still and be left alone. These headaches can be as short as two hours or last as long as 72 hours. Many people say they go to sleep with a migraine and wake the next morning feeling fine. Others are not so lucky. When there’s nausea at times some sufferers feel a bit better once they can “lose the contents of the stomach.” In addition to being sensitive to lights and sounds, there can be sensitivity to aromas and odors. Sometimes even a good smell, like the aroma of food cooking, can seem awful and “turn one’s stomach”.

As We Keep Saying – It’s Not Just a Headache

With the good medications we have now people have noticed another thing about migraine headaches. After taking the right medication, the headache, nausea, and other more obvious and awful symptoms ease and within a few hours go away. But there are other less obvious symptoms of which we become aware when those worse symptoms are gone. Such as no motivation, little energy, and dragging tiredness that might stay around a bit longer as the medicine starts to work. When one is crushed by a headache and nauseated to near vomiting it’s hard to worry about or maybe even notice these other symptoms. But people who get migraines have noticed that when the bigger problems are gone the smaller ones are easier to see. It’s not just a headache, it’s a whole body illness. Once the right medicine has time to be fully effective the person feels just fine.

The Benefit, If There is One, of Migraine Headaches and Migraine Syndrome

There’s an old folklore saying in medicine. If you want to live a long and healthy life, develop a minor medical condition at a young age, and then take care of that condition and yourself for the rest of your life. Though you might feel like you want to just plain die and get it over with in the midst of that worst migraine, migraine syndrome is one of those minor medical conditions.

The Lifelong Migraine Syndrome Benefit

Migraines don’t kill you. They make you sensitive to your surroundings and sort of force you get to know yourself. Migraines can make you aware of what is good for your health and what bad behaviors you need to avoid. They make you examine more carefully what and when you eat and drink. Maybe you’ll decide to cut back on alcoholic beverages or to smoke less. You might considered following a better schedule and to get regular exercise and reserve adequate time for sleep. Realize that you need to stay away from too much stress and get away from stress if it comes your way. And, last but not least, you’re motivated to see your doctor now and again for your headaches. Pain is a great motivator. So, oddly enough, your suffering provides for you a good roadmap for a long and healthy life.

Helpful links:

NIH, National Institute of Neurological Disease and Stroke Migraine Information Page

National Library of Medicine Medline Plus on Migraine

The Mayo Clinic on Migraine

The Journal of Headache and Pain article Evidence-based Treatment Options in Chronic Migraine

American Headache Society journal Headache article on A Phase-by-Phase Review of Migraine Pathophysiology

Journal of Neurology article on Migraine: Current Understanding and Future Directions

Therapeutic Advances in Chronic Disease: The Diagnosis and Treatment of Chronic Migraine