Medical Edge Newspaper Column

Migraine Headaches Can Be Prevented, Treated

January 14, 2008
Dear Mayo Clinic:
I get headaches frequently, but sometimes I get a migraine. Should I see a doctor?

Answer:
Although there's still no cure for migraine headaches, management of migraine pain has improved dramatically in the past 10 years. I would recommend that you see a physician about your headaches. Changes in lifestyle, prompt medical treatment of acute attacks and preventive therapy can help reduce the frequency of migraine and help stop the pain once it has started.

As you well know, a migraine is more than a bad headache. Migraines can be debilitating and last anywhere from a few hours to several days. The condition can be aggravated by light, sounds, odors, exercise and even routine physical activities. Migraines are often accompanied by nausea and vomiting.

Lifestyle changes have been shown to help in the management of migraine headaches. Such changes include learning to recognize and then avoid the things that can trigger your migraine headaches. For example, certain foods, lack of sleep, stress, smells, fasting, bright lights and alcohol are all possible triggers. A healthy routine should include the right foods, proper rest and exercise. Also, women should notice if estrogen (or estrogen withdrawal) triggers headaches. If it does, you may want to avoid or reduce the amount of medications you take that contain estrogen, such as birth control pills and hormone replacement therapy.

For acute migraine attacks, pain relief drugs should be taken as soon as symptoms begin. Mild migraine headaches may respond to nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen. A moderate migraine may respond to a nonprescription combination of a drug containing acetaminophen, aspirin and caffeine or a prescription analgesic. Other drug categories used to treat pain include triptans, which mimic the action of the brain chemical serotonin; anti-nausea and related drugs; and ergots, which were used for decades before the more recent introduction of triptans.

If you have four or more migraine episodes a month, your doctor may recommend medications that can help reduce the frequency, severity and duration of the attacks. Typically they are taken every day. Examples of such medications include antidepressants, anti-seizure medications and cardiovascular drugs.

Botulinum toxin type A (Botox) injections into the scalp muscles have been investigated as an alternative for people who can't take or don't respond well to the preventive medications mentioned above. Some people receiving Botox injections have noticed an improvement in their migraine headaches, but study results are mixed and more research needs to be done. The use of Botox injections as a treatment for migraine has not yet been approved by the U.S. Food and Drug Administration.

And finally, some patients find relief from alternative therapies. The National Institutes of Health has concluded that acupuncture may help control headaches. A study in the journal Headache showed that a combination of yoga, breathing exercises and relaxation techniques reduces migraine frequency and pain. Similarly, biofeedback — a method of understanding and working with your body's unconscious processes — has proven helpful in managing migraine headaches. For some, supplements such as coenzyme Q10, vitamin B2 and magnesium appear to reduce migraine frequency, and herbal remedies include feverfew or butterbur. Do not take butterbur if you're pregnant and, in fact, be sure to consult with your physician before using any alternative therapies, especially to prevent drug interactions.

— Jerry Swanson, M.D., Neurology, Mayo Clinic, Rochester, Minn.