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To learn what may be triggering your migraine headaches, keep a headache diary. Write down:
- When your headaches occurred
- How severe they were
- Additional symptoms
- What you've eaten
- Sleep patterns
- Menstrual cycles
- Any other possible factors
For example, the diary may reveal that your headaches tend to occur more often on days when you awaken earlier than usual. Changing your sleep schedule may then result in fewer migraine attacks.
Some birth control pills and other medications may trigger headaches. Your health care provider should address questions regarding their use.
Even in the absence of a clear factor that triggers migraine attacks, try to keep a regular exercise and sleep schedule. Avoid smoking, caffeine, and alcohol. Some patients have found biofeedback and self-hypnosis to be effective at reducing the frequency of migraine attacks.
MEDICATION
Although there is no cure for migraine headaches, numerous medications are available. These medications are used to:
- Prevent migraines from occurring
- Stop the migraine once early symptoms develop
- Treat the symptoms of migraine (e.g., pain, nausea)
All medications have potential side effects and may be incompatible with other medications you are taking. Also, many migraine medications are associated with birth defects and are therefore not safe to use during pregnancy.
Often, a physician will try several classes of medications before one (or a combination) is found to be effective.
PREVENTING MIGRAINES
Many medications can reduce the frequency of migraines. Generally, these need to be taken daily in order to be effective. These medications are less useful and tolerable to patients with infrequent headaches. Medications in this category include:
- Beta-blockers (e.g., propanolol)
- Anti-depressants (e.g., amitriptyline)
- Anti-convulsants (e.g., valproic acid)
- Calcium-channel blockers (e.g., verapamil)
- Serotonin re-uptake inhibitors
STOPPING AN ATTACK
Other medications are taken when there is the first sign of an impending migraine attack. In the case of classic migraine, this is typically when visual disturbances are first noted. These medications can effectively stop the migraine in its tracks, preventing the progression to other migraine symptoms or reducing the severity of the attack.
Many of these medications cause constriction of blood vessels and cannot be given to patients at risk of heart attack or other conditions. These medications include:
- Ergots (e.g., DHE-45)
- Serotonin agonists / triptans (e.g., sumatriptan)
- Isometheptene
These medications come in various preparations to enable administration via different routes. For example, patients who experience vomiting and cannot keep pills down may benefit from a nasal spray or injectable dose.
Call for an appointment with your health care provider if taking an ergotamine-containing medication and you are likely to become pregnant (these medications can have serious side effects to a developing fetus).
TREATING SYMPTOMS
Other medications are primarily given to treat the symptoms of migraine. Used alone or in combinations, these drugs can minimize pain, nausea, or emotional distress caused by the migraine. Some of these medications may also have some effect on the underlying process in addition to providing symptomatic relief. Medications in this category include:
- Anti-emetics (e.g., prochlorperazine)
- Sedatives (e.g., butalbital)
- Anti-inflammatories (e.g., ibuprofen)
- Acetaminophen
- Narcotic analgesics (e.g., meperidine)
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