Treatments that stop the symptoms of migraines and prevent them
When it comes to the many treatment options available for migraines, there are two sides to the coin. All of these options can be reassuring – chances are you’ll find something that works for you – but they can also be very confusing when trying to figure out which one to use.
Nor do doctors have a crystal ball to help them make this decision. “We don’t have a test that will tell us which headache treatment will work best for which person,” says Jennifer Robblee, MD, a neurologist who specializes in the treatment of headaches and migraines at the Barrow Neurological Institute in Arizona. “So unfortunately that means it’s a trial and error process.”
That said, there are some guidelines that can help narrow things down. “There are a few factors that I consider when choosing a treatment for a patient,” says Juliana VanderPluym, MD, assistant professor and consultant in the department of neurology in the headache division at Mayo Clinic Arizona. “I first look at the efficacy or effectiveness of a drug, then I look at the side effects to make sure the patient is okay with the possibility of them happening. Then I look at the patient’s medical history to see if one treatment might be better than another. [if you’ve had a heart attack, for example, some medications can’t be used]. Finally, I look at patient preference. If a patient is not comfortable with a treatment, they are not successful.
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Here’s a look at what’s out there to both stop a migraine in its tracks and prevent those headaches from happening in the future.
These are medications or devices you can use during a migraine attack to help stop symptoms like pain and nausea. “We don’t use opioids for migraine management because they can make migraines worse,” says VanderPluym. This is what doctors do use:
- NSAIDs: Nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen, may be sold over the counter or by prescription. They tend to be the first treatment someone uses. “Most patients have tried them on themselves before coming to see me,” says VanderPluym.
- Triptans: After trying NSAIDs, triptans are the drug of choice for many migraine sufferers. “These are migraine-specific pain relievers,” says VanderPluym. “If you mistake them for back pain or knee pain, they won’t do anything.” Your doctor will not prescribe triptan if you have had a heart attack, stroke, or high blood pressure because they can constrict blood vessels in the heart.
- Gepants and Ditans: These new drugs block a neurochemical called CGRP, which can stop migraine pain. Just know that you probably won’t start here. “You usually have to try other drug options first to get insurance approval,” says VanderPluym.
- Devices: There are a few devices that might help if none of the other options work. For example, a cefaly device stimulates the nerves above the forehead, gamiCore stimulates the vagus nerve in your neck, and transcranial magnetic stimulation can be applied to the back of your head. “There’s even an armband you can wear, Nerivio, that sends a competing signal to your brain during an attack so you don’t feel the migraine,” says VanderPluym. “The research isn’t as strong on the effectiveness of devices versus drugs, but not everyone responds to first-line options, so it’s really important to have something else to offer them. ” Just be aware that you’ll likely be paying out of pocket as insurance usually doesn’t cover them.
An important note on lifesaving treatments: It is possible to abuse it. “You shouldn’t be on acute medication for more than 10 days a month,” says Nadia Hindiyeh, MD, a headache neurologist based in California. “If you do, it can cause more headaches, known as rebound headaches.”
Wouldn’t it be great if you didn’t need any of the above treatments because you’ve never had another migraine? This is the idea behind these options. “These are therapies taken to reduce the frequency or severity of migraine attacks,” says VanderPluym. You’re a good candidate if you have four or more headache days each month, if your headaches don’t respond to the treatments above, or if you find them particularly debilitating. Just be patient. “Everything takes time, so give three to six months of preventative treatment to take effect,” says Hindiyeh. “Think of them as a long-term method.”
- Proven drugs: “Older treatments that we used were drugs designed for other conditions that we realized helped prevent migraines,” says VanderPluym. These are options like anti-epileptic drugs, antidepressants, and antihypertensives.
- More recent approaches: CGRP antibodies, which are monthly injections, and Botox injections help block brain pathways used during a migraine attack.
- Vitamins/minerals: There are three commonly recommended supplements to help prevent migraines: magnesium, vitamin B2 (or riboflavin), and coenzyme Q10. Consult your doctor before heading down the vitamin aisle, as they will be able to recommend the right dosage for you.
- Behavioral interventions: “There is very strong evidence to support the use of cognitive behavioral therapy to prevent migraines,” says VanderPluym. During these sessions, a therapist will help you retrain thought patterns and behaviors that increase your risk of migraines.
Whatever approach you try, consult your doctor and discuss what works and what doesn’t with your current treatments. If things aren’t working any more than they are, maybe it’s time to change things up and try something else.