Migraines

Diagnosis

Diagnosing migraines typically involves a comprehensive evaluation of the individual’s medical history, with a particular focus on personal and family headache history, as well as a discussion about symptoms related to migraines. Keeping a migraine journal can be helpful in preventing misdiagnosis and providing valuable insights for accurate diagnosis.

The healthcare provider may also conduct a physical and neurological examination. Tests may be ordered to rule out other possible reasons of the headache. This includes:

• Magnetic resonance imaging (MRI): MRI scans aid in the diagnosis of cancers, strokes, brain hemorrhage, infections, and other brain and nervous system problems. This test produces detailed images of the brain and blood vessels by using a high magnetic field and radio waves.
• Computerized tomography (CT) scan: This aids in identifying tumors, infections, brain trauma, cerebral hemorrhaging, and other potential health issues that could be responsible for headaches. A CT scan employs a sequence of X-ray images to generate precise cross-sectional pictures of the brain.

Treatment

Migraine headaches are chronic and cannot be cured, but they can be effectively managed and, in certain cases, improved. The goal of treatment is to alleviate the symptoms and prevent future migraine episodes. The specific type of treatment is typically determined based on factors such as the frequency and intensity of the headaches, accompanying symptoms, the level of disability caused by the pain, and any coexisting medical conditions the patient may have. The treatment plan is personalized to address the unique needs of each individual suffering from migraines.

Migraine medications are classified into two categories: abortive and preventive.

• Abortive medications: These medications, often known as acute or pain-reliving medications, work best when taken at the earliest symptoms of a migraine. It assists to stop or reduce migraine symptoms, such as pain, nausea, light sensitivity, and so on, by potentially terminating the headache process. Some abortion drugs operate by constricting your blood vessels, restoring them to normal and reducing the pain.
• Preventive medications: When the migraines are severe, occur more than four times per month, and severely interfere with one’s daily activities, preventive drugs may be administered. Medications are often given daily. Preventive drugs minimize the severity and frequency of headaches.
• Medications for relief: These medications are best taken while the pain is mild or as soon as the signs and symptoms of a migraine appear. However, it should be noted that certain medications are contraindicated during pregnancy. Prior consultation is recommended to those who are currently pregnant or attempting to conceive.

Common medications include:

• • Pain relievers: Some persons with mild to moderate migraines can benefit from over-the-counter drugs. However, over-the-counter pain relievers should be taken cautiously. When these drugs are taken for an extended period, they may cause medication-overuse headaches, as well as ulcers and bleeding in the gastrointestinal tract.

These pain relievers may be beneficial, but only for mild migraine pain. This includes ibuprofen or aspirin. Combination medications containing caffeine, aspirin, and acetaminophen, such as Excedrin Migraine, are often considered as potential options for relieving migraines. However, their effectiveness is generally more pronounced in addressing mild migraine pain rather than severe symptoms.

• • Triptans: These medications are available in the form of pills, injections, or nasal sprays, and can effectively alleviate various migraine symptoms as they block pain pathways in the brain. However, it is important to note that they may pose a risk for individuals who are susceptible to strokes or heart attacks. Triptan class of drugs include sumatriptan, rizatriptan, zolmitriptan, and naratriptan.
  • Dihydroergotamine: This medication, available in the form of a nasal spray or injection, is most beneficial when taken promptly after the onset of migraine symptoms, especially for migraines that typically endure for more than 24 hours. However, dihydroergotamine should be avoided by people who have coronary artery disease, high blood pressure, or renal or liver disease. Migraine-related vomiting and nausea may also intensify as a side effect.
  • Lasmiditan: Clinical studies have shown that lasmiditan effectively reduces headache pain, whether accompanied by aura or not. However, it is important to note that lasmiditan can induce drowsiness and dizziness. Driving or operating machinery for a minimum of eight hours is prohibited for individuals taking this medication.
  • CGRP antagonists: Clinical trials have demonstrated that these drugs are more effective than a placebo in providing relief from pain and other migraine symptoms such as nausea, light and sound sensitivity, within two hours of ingestion. Two oral medications, Ubrogepant and Rimegepant, have recently received approval for the treatment of acute migraines in adults, with or without aura.
    It is important to avoid taking these drugs with potent CYP3A4 inhibitor drugs.
  • Opioid medications: These medications are typically reserved as a last resort when other treatments have proven ineffective or for those who are unable to use other migraine medications. These are often prescribed with caution due to their high potential for addiction.
  • Anti-nausea medications: These medications are frequently taken in conjunction with pain relievers. Anti-nausea drugs such as chlorpromazine, metoclopramide, or prochlorperazine can provide relief from migraines with aura accompanied by symptoms like nausea and vomiting.

Consulting with a healthcare provider is crucial to assess the suitability of medications for an individual experiencing migraines. It is important to note that some medications may carry potential risks and should not be taken during pregnancy. Therefore, seeking professional medical advice is essential before using any medications to ensure their appropriateness and safety for the specific circumstances of the patient.

• Preventive medications: Preventive medications are often prescribed for headaches that are regular, long-lasting, severe, or unresponsive to treatment. Preventive medicine is intended to reduce the frequency of migraine attacks, as well as their severity and duration.

Common preventive medications include:

• • Medications to reduce blood pressure: Common beta blockers include propranolol, atenolol, nadolol, and metoprolol tartrate. Verapamil, a calcium channel blocker, can help avoid migraines with aura.
  • Antidepressants: Migraines can be avoided by using amitriptyline, a tricyclic antidepressant. However, other antidepressants such as nortriptyline, doxepin, venlafaxine, and duloxetine may be recommended to those who cannot tolerate amitriptyline’s negative effects, such as tiredness.
  • Anti-seizure medications: Those with fewer frequent headaches may benefit from these drugs. However, several side effects may include dizziness, weight changes, nausea, among others. Medications of this class include valproate and topiramate.
  • Botox injections: Some individuals find that receiving injections of onabotulinumtoxinA, commonly known as Botox, approximately every 12 weeks can effectively minimize episodes of migraines.
  • CGRP monoclonal antibodies: These drugs are administered through monthly or quarterly injections. Some may get a reaction at the injection site as a side effect. Among CGRP monoclonal antibodies that were recently approved for migraine treatment include erenumab, fremanezumab, galcanezumab and eptinezumab.