Ways To Treat Migraine Headaches: A Neurologist’s Advice

Dr. Robert Pearlman, guest contributor to Family Savvy, will be sharing some helpful information on migraine headaches. A neurologist at Brookwood Medical Center, Dr. Pearlman sees myriad cases of chronic migraine.

Since migraines can be so disabling, I asked him to discuss this topic and offer any suggestions for sufferers. In addition to discussing various drug options, he also discusses some lifestyle changes that might also improve quality of life.


     Ways To Treat Migraine Headaches 

   Migraine is one of the most common disabling illnesses affecting people under the age of fifty. It is characterized by severe head pain, usually unilateral and throbbing, with nausea, vomiting, and sensitivity to light and noise.  A smaller number of sufferers may have an aura, which is usually visual. Some will describe flashing lights, colorful rainbows, wavy lines, jagged shapes and similar geometric forms prior to the beginning of the headache. Rarely, a few patients will note unilateral numbness, weakness, confusion, speech impairment, or vertigo as a prodrome to the headache.

Most episodes last a few hours to one day in duration, although some headaches may span multiple days. Most migraineurs have their headaches infrequently, but some will have them several times per month. This will cause them to miss work and ultimately can result in the loss of their job or livelihood.

Infrequent migraines (less than two per month) are best treated symptomatically. Medications in the triptan class such as sumatriptan (Imitrex) have revolutionized migraine treatment. Individuals who are intolerant of this class of drug may benefit from nonsteroidal anti-inflammatory agents such as ketorolac (Toradol) or narcotic medication. An antiemetic (anti-nausea), particularly one that promotes sleep, can also be beneficial.

Frequent migraines need to be suppressed with daily medication. Three classes of drugs are generally used, namely antidepressants, anticonvulsants, or antihypertensive medications, depending upon the patient’s medical history. In addition to medication, behavior modification is important for frequent migraine patients. I urge patients to sleep 7-8 hours per night, do aerobic exercise at least 30 minutes per day five days per week, and limit caffeine to no more than 3 cups per day. Stress is a potent generator of most patients’ migraines, and any lifestyle change that minimizes its impact will invariably reduce headache frequency.

A new treatment for chronic migraines (more than fifteen headache days per month) is botulinum toxin (Botox) injected into the forehead and scalp. Your physician can administer this in the office. The benefits include no side effects from oral ingestion of daily medication. The treatment can be repeated in three months if it is helpful.

Most people who suffer with migraine will observe that by age fifty or thereabouts the headaches will start to wane both in intensity and frequency. Although there is no cure for migraines, there are ways to lessen the severity and frequency of most patients’ symptoms. Ultimately, Mother Nature is kind to most sufferers so that by middle age, they are not as tormented by the migraines that may have afflicted them in their youth.

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