Migraines2

TREATMENT

Each individual has to develop a migraine management plan. This will probably involve lifestyle modifications, medication and complementary therapies.

Medication

For some, over-the-counter medications are sufficient. For many others, these are not strong enough. If this is the case, or if you are uncertain about the cause or nature of your headache, or if your headaches change, it is important you consult a doctor. It is believed that up to 50% of migraine sufferers have never been diagnosed. Even if you have previously consulted a doctor and the prescribed treatment has not been successful, it is worth going again.Some medications are given once the headache has begun (acute treatment) and others taken daily to reduce the frequency of attacks (preventative treatment).

Acute Treatment

Infrequent, less severe migraine may respond to over-the counter medications such as:

aspirin (not recommended for young children)

paracetamol

non-steroidal anti-inflammatory drugs such as ibuprofen (Nurofen, Brufen), naproxen (Naprosyn).

Medications that may be prescribed for more severe migraine include

triptans such as sumatriptan (Imigran), naratriptan (Naramig), zolmitriptan (Zomig) that are based on the serotonin molecule

ergotamine compounds (Cafergot) that appear to provide relief by constricting cranial blood vessels

stronger non-steroidal anti-inflammatory drugs

stronger narcotic-type analgesics.

Anti-emetic medications often prescribed with other forms of acute therapy to minimise the nausea that often accompanies migraine include

metoclopramide (Maxolon), prochlorperazine (Stemetil) or domperidone (Motilium) to increase absorption and reduce nausea.

Preventative Treatment

Preventative medication is taken daily, regardless or whether a headache is present., These include:

beta blockers such as propranolol (Inderal), timolol (Blocadren), atenolol (Tenormin) and metoprolol (Lopresor, Betaloc) that block the beta-receptors on which adrenaline works in the nervous system as well as on blood vessels

serotonin antagonists such as methysergide (Deseril), pizotifen (Sandomigran) and cyproheptadine (Periactin)

sodium valproate or valproic acid (eg Epilim), an anti-epileptic drug shown to reduce the intensity of migraine

calcium-channel blockers such as verapamil (Isoptin) that stop the constriction of blood vessels by preventing the use of calcium necessary for this reaction

antidepressants such as amitriptyline (eg. Tryptanol) have an action on headache that is independent of their antidepressant action

feverfew, a herbal remedy

riboflavin 200mgm twice daily has been reported as useful.

All are effective. All have side effects and, except feverfew and riboflavin, are prescription drugs.

Complementary Therapies

Acupuncture - Stimulating acupoints may ease pain by encouraging production of endorphins (natural painkillers).

Alexander Technique - Can help prevent tension headaches by relieving poor posture and pressure that results from it.

Aromatherapy - Combines various scented oils and promotes relaxation and eases tension.

Biofeedback - Can be used to treat tension-type and migraine headaches. By using a sensory device, patient learns to control blood pressure, heart rate, and spasms in the arteries supplying the brain.

Chiropractic Therapy - Based on the theory that most diseases of the body are a result of a misalignment of the vertebral column with pressure on the adjacent nerves that may affect blood vessel and muscle function. Manual techniques purport to adjust the misalignment.

Homeopathy - Uses highly diluted active substances found in certain medications.

Hydrotherapy - Splashing your face with cold water before lying down for an hour can ease headache. Alternating hot and cold showers dilates then constricts the blood vessels, stimulating circulation. Ice pack on head is another option.

Hypnotherapy - Can help sufferer deal with headache by altering the way the body interprets messages of pain. The use of self-hypnosis to relax can reduce the severity and frequency of headaches. Various studies (Anderson, Basker and Dalton 1975; Olness, 1987; Schlutter, 1980; Alladin, 1988; Gutfield and Rao, 1992) all report that hypnotherapy was effective in reducing the frequency and severity of migraine attack.

Massage - Can reduce muscle tension throughout the body, thereby reducing headache.

Meditation - A recent study on migraine prevention through meditation has had very promising results, all participants reported less severe migraines.

Naturopathy - Uses only natural substances in small amounts and aims to provide a healthier balance of bodily processes.

Osteopathy - Manipulation of the neck or cranial, osteopathy may be used to correct misalignments of the vertebrae that can cause migraines.

Physiotherapy - Treating muscle tension can release pressure that may lead to headache.

Shiatsu - Combination of massage and pressure can restore the “energy balance” and induce relaxation.

Yoga - Can relieve muscle tension in the back of the neck and correct posture.

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REFERENCES

Migraine Research Foundation

Headache Australia

Alladin, A. (1988). "Hypnosis in the Treatment of Severe Chronic Migraine. In M. Heap (ed.), Hypnosis: Current clinical, Experimental and Forensic Practices. London: Croom Helm. pp. 159-166.

Anderson, J.A., Basker, M.A. & Dalton, R. (1975). "Migraine and Hypnotherapy." International Journal of Clinical and Experimental Hypnosis, 23, 48-58.

Gutfeld, G. and Rao, L. (1992). "Use of Hypnosis with Patients Suffering from Chronic Headaches, Seriously Resistant to Other Treatment," As reported in Prevention, 44, 24-25.

Olness, K., MacDonald, J.T. & Uden, D.L. (1987). "Comparison of Self-Hypnosis and Propranolol in the Treatment of Juvenile Classic Migraine." Pediatrics, 79, 593- 597.

Schlutter, L.C., Golden, C.J. & Blume, H.G. (1980). "A Comparison of Treatments for Prefrontal Muscle Contraction Headache." British Journal of Medical Psychology, 53, 47-52.

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