“It’s an exciting time we’re in now, where new drugs and treatments are in development.”
Migraine is a very common and debilitating condition, affecting nearly 40 million people in the United States, and 1 billion worldwide, according to the Migraine Research Foundation.
Migraine attacks can be very frightening and can make a person feel a variety of symptoms, including severe headache, nausea, vomiting and visual disturbances. Learn more about the anatomy of a migraine.
While migraines can’t be cured, there are many medical and lifestyle treatment options to soothe migraine symptoms and prevent future attacks.
“We’ve come to recognize how debilitating migraines are,” says Mark Green, MD, a neurologist at the Mount Sinai Hospital in New York City. “It’s an exciting time we’re in now, where new drugs are in development and new treatments are in development, we want people to avail themselves to these.”
How Doctors Diagnose + Treat Migraines
Getting an accurate diagnosis is the first step to finding migraine relief. Migraine treatment depends upon the frequency, severity, and symptoms of your headaches, so if you’re experiencing migraines, talk to your doctor.
At your appointment, your doctor will likely take your medical history, such as the age at which you started having migraines and if they run in your family. “If both parents have migraines, the risk is 70 to 80 percent that you’ll get a migraine,” says Dr. Green.
Your doctor will also ask about your symptoms and lifestyle habits, such as if you’ve had any visual changes or what your relationship with alcohol or caffeine is like.
“[To treat migraines] we want people to keep a very regular routine,” says Dr. Green. That means getting enough sleep, managing your stress levels, and eating a well-rounded diet.
Medical Treatment Options for Migraines
Alongside a healthy lifestyle, your doctor may recommend certain medications to help treat individual migraine attacks (acute), as well as medications to reduce the number of attacks (preventative), says Dr. Green. “And these are entirely different medications.”
In some cases, both acute treatment and preventive treatment are necessary to control migraines successfully.
For acute treatment for mild migraines, your doctor may suggest an over-the-counter medicine such as:
- Acetaminophen (sample brand name: Tylenol)
- Ibuprofen (sample brand names: Advil, Motrin)
- Naproxen (sample brand name: Aleve)
- OTC meds that combine acetaminophen, aspirin, and caffeine (sample brand name: Excedrin)
Important: It’s a myth that you should treat frequent migraines on your own with non-prescription pain medicines. Taking non-prescription pain medicines too often may actually cause more headaches later.
“The earlier [you take your meds] the better, as long as it’s not very often, where you’re at risk of developing medication overuse headache,” says Dr. Green. Learn about more common migraine myths.
For more severe migraines that don’t respond to OTC painkillers, your doctor may suggest prescription medicines that are migraine-specific, like triptans or ergots.
Triptans. For most people, triptans are very effective. More than 70 percent of people get pain relief within one hour of injecting sumatriptan; by two hours, 90 percent of people notice improvement.
Examples of triptans are sumatriptan, zolmitriptan, naratriptan, rizatriptan, almotriptan, eletriptan, and frovatriptan. Depending on the drug, they may come as a shot, oral pill, or nasal spray.
Ergots are older drugs and often combined with caffeine. They’re not as effective as triptans and are more likely to cause side effects, but are often recommended for people who have migraines that last for longer than two days.
Preventive treatment controls migraine headaches in most people, although the benefits of this treatment may take a while, sometimes three to four weeks. Here are some of the medications available to help prevent migraines.
Calcitonin gene-related peptide (CGRP). CGRPs are a new class of drugs that work by blocking the activity of a molecule that is involved in migraine attacks.
- Aimovig is the first FDA-approved calcitonin-gene-related peptide (CGRP) blocker for the preventive treatment of migraine. This drug has been shown to reduce the frequency of migraines.
- Galcanezumab, another CGRP drug, is currently under review at the FDA.
Non-migraine specific drugs. Doctors may also suggest non-migraine specific drugs to help prevent migraines, like beta blockers, antidepressants, anticonvulsants, or botox.
- Beta blockers, most often used to lower high blood pressure, have been shown to reduce headaches in general.
- The tricyclic antidepressant amitriptyline has been shown to be effective for migraine prevention.
- The anticonvulsants sodium valproate and topiramate have been shown to reduce the frequency of migraine attacks.
- Botox. Studies have shown that botox injections don’t have much benefit for treating episodic migraines. However, there is evidence that botulinum toxin type A (onabotulinumtoxinA) injection is effective for the treatment of chronic migraine (headache on more than 15 days per month for at least three months).
Lifestyle Remedies for Treating Migraines
Along with maintaining a healthy lifestyle and taking your prescribed migraine medication, there are certain habits you can adopt that may help prevent or ease the pain of migraine attacks as well.
To help prevent a migraine:
Cope with migraine triggers. A number of environmental influences can trigger a migraine, and their effects vary from person to person. These migraine triggers may include:
- Strong smells or loud noises
- Too much sleep or lack of sleep
- Sudden changes in the weather
- Certain foods and additives
Foods and ingredients can provoke migraines for about 50 percent of migraine sufferers, but avoiding triggers completely may be unhealthy, since the list of potential migraine trigger foods is extensive. This list includes:
- Aspartame (artificial sweetener)
- Caffeine or caffeine withdrawal
- Wine and other types of alcohol
- Monosodium glutamate (MSG)
- Some fruits and nuts
- Fermented or pickled goods
- Cured or processed meats
- Aged cheeses
“We’re not recommending you stop everything that you enjoy,” says Dr. Green. “If you like something like aged cheese, which has tyramine, you can probably have it, except perhaps a times where other triggers are applicable, for example, like around the time of your period.”
Keep a headache diary. This can help you pinpoint your triggers and how you’re feeling each day so you can start to learn what symptoms may be alerting you to a migraine.
When you feel a migraine coming on, track your headache pain from 0 (no pain) to 3 (worst pain) in the morning, afternoon, and evening each day until you find relief. You can also write down any lifestyle changes (good or bad), such as your sleep habits, what foods you ate, or if you smoked, and what medicine you took and whether or not it helped.
To ease the pain of an existing migraine:
- Rest with your eyes closed in a quiet, darkened room
- Place a cool cloth or ice pack on your forehead
- Drink fluids
- Check out these science-backed migraine home remedies
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There's a lot to migraine
that is more than headache.
00:00:04,932 --> 00:00:09,549
And if you're nauseated, vomiting,
can't come out in the light,
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can't move around too much,
can't work, that's a real disability.
00:00:14,417 --> 00:00:20,015
Even if a headache wasn't the major
source of discomfort during the attack.
00:00:20,015 --> 00:00:23,789
00:00:23,789 --> 00:00:27,959
Well, in terms of migraine medications,
there are acute medications which we use
00:00:27,959 --> 00:00:30,936
to stop an attack, and
there are preventive medications,
00:00:30,936 --> 00:00:34,125
which we use to reduce the number and
severity of attacks.
00:00:34,125 --> 00:00:37,630
Acute migraine treatment means that you
take something as soon as an attack
00:00:37,630 --> 00:00:41,000
comes on with the hope that
you'll shorten the attack.
00:00:41,000 --> 00:00:44,700
Currently, likely the most effective
drugs we have are triptans.
00:00:44,700 --> 00:00:48,940
Triptans turn off the firing of
trigeminal nerves in the brain, and
00:00:48,940 --> 00:00:50,080
that's how they work.
00:00:50,080 --> 00:00:52,190
We still occasionally use ergots.
00:00:52,190 --> 00:00:55,665
They're probably not as effective,
and probably not as safe as a triptan.
00:00:55,665 --> 00:00:58,510
Anti-inflammatories are very important.
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Many of them are over the counter,
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although you often need a decent
dose in order to stop a migraine.
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Migraines are inflammatory, so
it's certainly rational to think
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that an anti-inflammatory
could help treat a migraine.
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With preventive medications, you need to
take something on a regular basis in order
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to reduce the number and
severity of attacks.
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Historically, we've had a few medications
that we've used to prevent migraines,
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including a few beta blockers, a few
antidepressants and a few epilepsy drugs.
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But none of them were developed for
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That's about to change.
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The newest drugs that we have
are called CGRP monoclonal antibodies.
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And these are injectable drugs that we've
never had anything like this before.
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There are four companies that
have these in development.
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One of the four has been approved by FDA,
and we're already prescribing it for
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CGRP stands for
calcitonin gene related peptide,
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which is a major transmitter of
migraine symptoms in the brain.
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When you get a migraine,
CGRP is clearly released in the blood,
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in the spinal fluid,
and even in the saliva.
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So it becomes a good marker
of having a migraine.
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And that became a obvious target for
00:02:08,800 --> 00:02:11,650
development to block
that particular chemical.
00:02:11,650 --> 00:02:15,100
We typically think about prevention
in people who get six or
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more headache days per month.
00:02:16,960 --> 00:02:18,860
That's not the only time we do it.
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But six or more headache days per
month is a reasonable target.
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There are people with fewer than
six headache days per month
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who may be candidates for prevention if
they don't respond to an acute therapy.
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There are several other agents that
are being looked at for prevention and for
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the acute therapy of migraine,
which are a few years away.
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So hopefully, the CGRP drugs will help
individuals, but there's even other things
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that may be available in
the near future should they fail.
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Migraine Headaches in Adults (The Basics). UpToDate. (Accessed on August 24, 2018 at https://www.uptodate.com/contents/migraine-headaches-in-adults-the-basics)
Migraine Headaches in Adults (Beyond the Basics). UpToDate. (Accessed on August 24, 2018 at https://www.uptodate.com/contents/migraine-headaches-in-adults-beyond-the-basics)
Preventative Treatment of Migraine in Adults. UpToDate. (Accessed on August 24, 2018 at https://www.uptodate.com/contents/preventive-treatment-of-migraine-in-adults )
FDA approves novel preventive treatment for migraine. Food and Drug Administration. (Accessed on August 24, 2018 at https://pi.amgen.com/~/media/amgen/repositorysites/pi-amgen-com/Aimovig/Aimovig_pi_hcp_english.pdf)