| How to prevent Migraine Attack?
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| Many effective headache remedies are now available for treating a migraine attack.
Still, a 2002 study that analyzed over 800,000 migraine cases reported that most migraines
are not treated according to any expert recommendations or accepted evidence. In the study,
30% of patients were treated with potentially addictive opioids--most often Demerol. Furthermore,
70% of these patients were not offered effective and available anti-migraine drugs. And anti-nausea
agents that have no effect on headaches were used six times more often than drugs that reduce headaches. |
| It should be noted that as many as 30% of migraine sufferers also have accompanying headaches resulting
from tension, drugs, infections, or other causes. It is important to distinguish between headache types in
order to determine appropriate treatment. |
| General Guidelines: The general goals of treatment are the following: |
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On the advice of the physician, choose drugs with as few side effects as possible.
Patients should discuss various methods for administering the medication (pills, injections, nasal
spray, or rectal suppositories) and begin with one they believe will be the least distressing. |
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Treat the attack rapidly, within an hour of symptom onset if possible. Start with low
doses first and build up dosage slowly. |
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Try to minimize the use of back-up or rescue medications. (A rescue medication is
typically an opiate, which the patient uses at home for pain relief when other medications fail.) |
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Try to guard against rebound effect. Nearly all drugs used for migraine can cause
rebound headache and none of the drugs should be taken for longer than two days per week. |
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It may take two to four months for an agent to be effective. |
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| Stepped-Up Treatment Approach: Some experts have advocated a stepped-up treatment
course for an acute migraine attack. This involves starting with the least potent
treatments and taking increasingly more potent drugs until the pain stops. In this
approach some patients need up to five different medications to achieve pain relief.
A typical stepped approach is the following: |
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Patients first try general pain relievers
(NSAIDs, Exedrin Migraine) and stress-reduction techniques.
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If these are not effective within two hours,
migraine-specific agents should be tried next. Triptans are the first choice,
then ergot derivatives (dihydroergotamine [DHE]). |
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Injected or rectally administered drugs may be used for
patients with migraines associated with severe nausea or vomiting. Nausea itself
should be treated with specific anti-nausea drugs, such as metoclopramide (Reglan). |
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If migraine medications fail to relieve symptoms within four hours,
rescue drugs (opioids, corticosteroids) may be used. |
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| Stratified Approach: Many physicians and patients now prefer the stratified
approach. The doctor first estimates the severity of the patient's condition based on his or
her history. Then, based on the severity of a typical attack, the physician decides whether the
patient should start with more or less potent agents at the first signs of the migraine: |
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Patients with less disabling migraines start with general pain relievers. |
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Patients with a history of moderate to severe migraines start with migraine-specific
prescription medicine, such as a triptans, at the onset of mild pain. |
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| Some studies report dramatic relief with the stratified approach. In one 2002 study, zolmitriptan,
a newer triptans, reduced the intensity of headaches within two hours in 70% of patients with moderate pain but in
only 44% of those with severe headaches. |
| For much more information ... |
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