More than 37 million Americans suffer from migraines, most commonly women. Migraines are recurrent headaches causing moderate to severe pain in the head. Often times, these headaches are on one side of the head and may be associated with nausea, vomiting, and sensitivity to light and sound. Symptoms can last from hours to days and be so debilitating that they disrupt daily activities.
Proper diagnosis of migraines involves seeing a healthcare provider who will examine and review your family history and symptoms. He or she may administer certain tests to rule out other medical conditions. Journaling of symptoms, as well as frequency and duration of headaches and “triggers” or causes is essential in developing a treatment plan. Unfortunately, there is no blood test or other diagnostic test to determine what is the exact cause of migraines.
The exact causes of migraines is not entirely understood yet but researchers believe that changes in the brainstem and involvement with the trigeminal nerve, a complex nerve in the face that is responsible for biting and chewing, could be a contributor. Additionally, chemicals created by nerve cells in the brain such as neurotransmitters like serotonin and calcitonin gene-related peptide or CGRP are believed to play a role. Similarly, hormones, such as estrogen, may play a role in migraines, possibly accounting for the preponderance of migraines in women.
Irrespective of the cause, migraine treatment falls generally into three categories: avoidance of triggers, acute medications, and preventive medicines. Some of the most common triggers include: hormonal changes, stress, alcohol or caffeine intake, certain foods or food additives, irregular eating or sleeping patterns, particular medication, and weather changes.
Obviously, several of these conditions are beyond one’s control, but controlling those that can be managed may reduce the incidence or intensity of migraines. When management of triggers and over-the-counter medications are insufficient for migraine relief, your healthcare provider may prescribe medications that fall into two classifications: acute or abortive treatment also known as pain-relieving medications or preventive medications.
Myriad pain-relieving medications fall into different classes including both prescription and over-the-counter medications, like aspirin or ibuprofen, and some may be combined with caffeine for greater efficacy. Generally these medications work best for mild migraine pain.
A second class of medications called triptans, such as Imitrex or Maxalt, help to block pain pathways in the brain. Dihydroergotamine is another medication in a class of ergot alkaloids which work by tightening blood vessels in the brain and inhibiting the release of substances that cause swelling. In extreme cases, when other pain relief medication fail, opioids may be necessary, but their addictive quality make them a treatment of last resort.
Preventive medications are prescribed to those who suffer from more frequent, severe, and resistant to abortive medicines. These include beta-blocker and other types of blood pressure-lowering medications, as well as antidepressants and anti-seizure medication such as Topamax. Botox injections have also shown some promise in preventing migraines for some. These drugs have been the stalwarts of the migraine treatment for decades, yet none was developed specifically for migraines.
Last year saw the introduction of a new class of drugs created just for migraine treatment and offers hope to those for whom other treatments either are ineffective, or the side effects are not well tolerated. Monoclonal antibodies are designed to block the receptor sites on blood vessels or attach to the CGRP to stop the cascading effect of pain associated with migraines. Ubrelvy is designed as an abortive medication, but its long-lasting effects may work as a preventative treatment. Ajovy and Aimovig are new injectable prophylactic drugs that offer the promise of relief.
If you suffer from migraines, speak with your healthcare provider to see if one of these new treatments might be right for you.