Managing Migraines
by David Dunaief
Jan 23, 2019 | 1735 views | 0 0 comments | 216 216 recommendations | email to a friend | print
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
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Migraines are debilitating. Symptoms typically include nausea, photophobia and phonophobia, or sensitivity to light and sound, respectively. The corresponding headache usually is unilateral and has a throbbing or pulsating feeling.

They typically last anywhere from four to 72 hours, then, there is a postdrome recovery period, when the symptoms of fatigue can dog a patient for 24 hours after the original symptoms subside. Migraines are among the top reasons patients see a neurologist.

According to the American Migraine Foundation, approximately 36 million people suffer from migraines. Women are three times more likely to be affected than men, and the most common age range for migraine attacks is 30 to 50, although I have seen them in patients who are older.

Causes

The theory was once simple: migraine was caused by enlargement of the blood vessels. However, this may only be a symptom, and there are now other theories, such as inflammation of the meninges, the membrane coverings of the brain and spinal cord.

As one author wrote in the Annals of Neurology, “Migraine continues to be an elephant in the room of medicine: massively common and a heavy burden on patients and their healthcare providers, yet the recipient of relatively little attention for research, education, and clinical resources.”

There are many potential migraine triggers, and trying to avoid them all can be like navigating a minefield. Triggers include stress, hormones, alcohol, diet, exercise, weather, odor, and more.

Treatments

For those who want to avoid traditional medicines, a feverfew-ginger combination pill — an oil-based herbal supplement — as a first-line treatment showed promising results for those suffering from mild migraine prior to the onset of moderate to severe migraine, according to a study published in the journal Headache.

A sublingual preparation was the most beneficial. In this small, double-blind, placebo-controlled study, patients were aged 13 to 60 and suffered migraines from two to six times a month.

Sixty-four percent of patients in the treatment group rated their symptoms as mild to no pain, compared to 39 percent of those in the placebo group. The side-effect profile of the herbal remedy was similar to placebo.

The challenge is, if it doesn’t work, you may have lost your window to take traditional medications. There is a caution: Women who are pregnant should not take feverfew.

Mild treatments for migraines include aspirin, Tylenol (acetaminophen) and NSAIDs, such as ibuprofen. In a randomized controlled trial, 1000 mg of acetaminophen reduced symptom intensity in occasional and moderate migraine sufferers significantly more than placebo at the two-hour and six-hour marks.

It also reduced nausea, sensitivity to light and sound, and functional disability. However, if you have more intense migraines this may not be effective.

In a Cochrane Database meta-analysis of randomized control trials (RCTs), ibuprofen 400 mg provided at least partial relief to migraine patients, though complete relief to relatively few.

One of the most powerful and common treatments is the use of triptans, which include Imitrex (sumatriptan), Zomig (zolmitriptan) and Relpax (eletriptan). These drugs are 5HT-1 receptor agonists.

They stimulate a metabolite of serotonin to narrow the blood vessels. Sumatriptan, which is generic, was more effective in a 6 mg under the skin injection than as a 100 mg oral formulation in an RCT.

In another study, sumatriptan in combination with naproxen sodium, an NSAID, was more effective than either drug alone in treating acute migraine attacks at the two-hour and 24-hour marks, according to two randomized clinical trials.

These studies involved approximately 3,000 patients. Unfortunately, the sumatriptan-naproxen sodium at its best showed a complete reduction in nausea in 71 percent of patients, but only 25 percent of patients were pain-free overall.

Be cautious of drug overuse, which can cause rebound headaches, thus increasing migraine frequency.

For further information, visit medicalcompassmd.com or consult your personal physician.

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