Classic Migraine
What is a Migraine?
Migraines are a variety of commonly diagnosed, although poorly understood, severe disabling headaches that are more common in females than males. Often, a migraine can be misunderstood as being “just another headache.” However, migraines can be distinguished from other headaches in that they are usually accompanied by problems with vision, sensitivity to light and sound, and nausea and vomiting. Without proper treatment, these headaches can last up to 72 hours before subsiding. A migraine is often described as a throbbing or pulsating pain on a single side of the head that severely affects daily life and work.
What Causes Migraines?
Although researchers are not sure of exactly what causes migraines, it is known that certain triggers (stress, odors, bright lights, wine, etc) cause blood vessels in the brain to expand (the culprit for the throbbing pain) and inflame surrounding tissues, causing many of the other symptoms such as nauseas and vomiting.
What Can I Do To Help Prevent Migraines?
Diet: The following foods and beverages are well known triggers for migraines:
- Chocolate
- Caffeine
- Ripened cheeses
- Smoked meats
- Processed meats
- MSG (commonly found in Chinese food)
- Diet sodas
- Alcoholic beverages
Exercise: Doctors have found that short amount of cardiovascular exercise such as running, walking, biking, or aerobics each day can make marked improvements in migraine patients.
Sleep: Waking up and going to sleep at the same time every day also contributes to better migraine control.
For more extensive information on lifestyle changes, visit www.headaches.org
What Medications are Commonly Prescribed for Migraine?
Triptans: (Imitrex, Frova, Relpax, Amerge, Maxalt, Zomig)
These medications are taken by mouth of injection at the first sign of a migraine. They typically take 20 minutes to 2 hours of work, so the earlier they are taken, the better. They work extremely well in many migraine patients, with very few side effects.
TCA’s:
Amitriptyline is included in a group of medications classified as tricyclic antidepressants (TCA). Amitriptyline is one of the first successful medications in this class to be developed. It influences the body’s use of serotonin and thus can lead to improvement in depression and several types of headache. It is usually used to treat chronic tension-type headache (muscle contraction headache) as well as a migraine headache. Amitriptyline and other antidepressant medications have been used to treat nine varieties of conditions, such as bed wetting in children, weight control (although it often causes weight gain), and smoking cessation. Its effectiveness in treating any of these conditions, especially headache, is not related to whether or not the individual has depression. Although side effects, such as dry mouth and constipation may occur, consultation with the physician may help minimize the likelihood and severity of these effects.
Beta Blockers:
The use of beta blockers for the treatment of migraine began in the late 60’s, when by accident migraine sufferers being treated for cardiovascular disease found that their migraine attacks lessened. Further research in the 70’s lead to propranolol to be the first of this class of medications to be approved by the FDA for migraine prevention. Subsequently the FDA also approved the use of timolol. Several other beta blockers have been shown in research trials to also be effective for migraine prevention. These include metoprolol, nadolol and atenolol. People who have coexisting respiratory diseases such as asthma or chronic bronchitis may not be able to use these medications. In general, beta blockers should not be stopped abruptly and should be discontinued under a physician’s supervision.
Calcium Channel Blockers:
The calcium channel blockers are a group of medications which have been used for treating a variety of cardiovascular disorders. These medications alter the movement of calcium ions into muscle cells of blood vessels. This effect can sometimes prevent blood vessel changes, which cause migraine, but research studies with verapamil have shown it to be effective in prevention of migraine and cluster headache. Verapamil is the most widely studied and in general is the drug of first choice within this group of medicines. Unlike beta blockers, calcium channel blockers may be used in patients with asthma and other respiratory diseases. Some researchers have suggested that calcium channel blockers may be more effective than beta blockers in migraine with aura (classical migraine) and in complicated migraine.
Depakote and Topamax:
The Food and Drug Administration has approved divalproex sodium (Depakote) from Abbott Laboratories as a prophylactic medication for migraine headache. Divalproex sodium is not a new compound however. It has been in use since 1983 for treating epilepsy. Several clinical trials have demonstrated its effectiveness in migraines. Those patients who have other medical problems in addition to migraine including cardiovascular diseases, seizures or bipolar disorder may be excellent candidates as well for selecting this agent. Side effects with the medication may include nausea, stomach upset, diarrhea, vomiting, weakness, fatigue, sleepiness, dizziness, hair loss, tremor and weight gain. These tend to be mild and transient in most patients and may be minimized by slow upward dosing. Women who are in their childbearing years and who are contemplating pregnancy or who are not using contraception should be especially cautious with this medication as it may cause birth defects if taken during pregnancy.
Topamax is another medication that is commonly prescribed for migraine prophylaxis, although it is not FDA approved for this purpose. While it is primarily useful in seizure disorders, many doctors have seen a remarkable improvement in migraine attacks with its use. Side effects are similar to Depakote, except that daytime restlessness and weight loss are more common than sleepiness and weight gain.