Migraine

Migraine is a form of headache, usually very intense and disabling. It is a neurologic disease. The word "migraine" comes from the Greek construction ?????????? (hemikranion, pain affecting one side of the head) http://dictionary.reference.com/search?q=migraine&r=67.

Treatment

Conventional treatment focuses on three areas: trigger avoidance, symptomatic control, and preventive drugs.

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Elimination of triggers

In a minority of patients the incidence of migraine can be reduced through dietary changes to avoid certain chemicals present in such foods as cheddar cheese, chocolate, nuts and most alcoholic beverages. Some triggers (for example, hunger or stress) may be situational and can be avoided through lifestyle changes. However, other triggers such as particular points in the menstrual cycle or certain weather patterns are impossible or impractical to avoid.

Related Topics:
Cheddar cheese - Chocolate - Nut - Alcohol - Hunger - Stress - Menstrual cycle - Weather

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Avoid bright flashing lights if you notice these trigger attacks; most migraineurs are sensitive and avoid bright or flickering lights. Relaxation after stress, notably weekends and holidays, is a potent trigger; wind down gradually if possible.

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Tyramine

The monoamine compound tyramine has been implicated as a trigger in a significant number of migraine sufferers. This compound is present in many foods, although it is found in higher quantities of foods which have been fermented. Some foods which contain tyramine in significant quantities are: aged cheeses, yogurt, buttermilk, sour cream, dried milk, tofu, soy sauce, miso, tempeh, smoked, cured, or pickled fish or meat, beer and wine, lima beans, Italian beans, lentils, navy beans, pinto beans, fava beans, broad beans, snow peas, peanuts, eggplant, sauerkraut, oranges and other citrus fruit, cola drinks, bananas, grapes and raisins, plums, prunes, figs, pineapples, avocados and chocolate.

Related Topics:
Monoamine - Tyramine - Cheese - Yogurt - Buttermilk - Sour cream - Tofu - Soy sauce - Miso - Tempeh - Fish - Meat - Beer - Wine - Lima bean - Italian bean - Lentil - Navy bean - Pinto bean - Fava bean - Broad bean - Pea - Peanut - Eggplant - Sauerkraut - Orange - Citrus fruit - Cola - Banana - Grape - Raisin - Plum - Prune - Fig - Pineapple - Avocado - Chocolate

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Symptomatic control to abort attacks

Migraine sufferers usually develop their own coping mechanisms for intractable pain. A cold or hot shower directed at the head, less often a warm bath, or resting in a dark and silent room may be as helpful as medication for many patients, but both should be used when needed.

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For patients who have been diagnosed with recurring migraines, doctors recommend taking painkillers to treat the attack as soon as possible. Many patients avoid taking their medications when an attack is beginning, hoping that "it will go away". However in many cases once an attack is underway, it can become intensely painful, last for a long time, and become somewhat resistant to medical treatment. In contrast, treating the attack at the onset can often abort it before it becomes serious, and can reduce the frequency of subsequent attacks in the near-term.

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The first line of treatment is over-the-counter medications. Doctors start patients off with simple analgesics, such as paracetamol (acetaminophen), aspirin and caffeine. They may provide some relief, although they are not effective for most sufferers.

Related Topics:
Analgesic - Paracetamol - Aspirin - Caffeine

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Narcotic pain killers (for example, codeine, morphine or other opiates) provide variable relief, but their side effects, the possibility of causing rebound headaches or analgesic overuse headache, and the risk of addiction contraindicates their general use.

Related Topics:
Narcotic - Codeine - Morphine - Opiate - Rebound headache

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If over-the-counter medications do not work, the next step for many doctors is to prescribe fioricet or fiorinal, which is a combination of butalbital (a barbituate), acetaminophen (in fioricet) or acetylsalicylic acid (in fiorinal), and caffeine. While the risk of addiction is low, butalbital can be habit-forming if used daily, and it can also lead to rebound headaches.

Related Topics:
Fioricet - Fiorinal - Butalbital - Barbituate - Acetaminophen - Acetylsalicylic acid - Caffeine - Rebound headache

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Anti-emetics by suppository or injection may be needed in cases where vomiting dominates the symptoms. The earlier these drugs are taken in the attack, the better their effect.

Related Topics:
Anti-emetic - Suppository - Injection

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Until the introduction of sumatriptan (Imitrex®/Imigran®) around 1985, ergot derivatives (see ergoline) were the primary oral drugs available to abort a migraine once it is underway. However, ergotamine tablets (usually with caffeine), though sometimes effective, have fallen out of favour. Absorption is erratic unless taken by suppository or injection. Dihydroergotamine (DHE), which must be injected or inhaled, can also be effective. These drugs can be used either as a preventive or abortive therapy.

Related Topics:
Sumatriptan - 1985 - Ergot - Ergoline - Ergotamine - Dihydroergotamine

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Sumatriptan and related selective serotonin receptor agonists are now the therapy of choice for severe migraine attacks that cannot be controlled by other means. They are highly effective, reducing the symptoms or aborting the attack within 30 to 90 minutes in 70-80% of patients. Some patients have a rebound migraine later in the day, and only one such rebound in a day can be treated with a second dose of a triptan. They have few side effects if used in correct dosage and frequency. Some members of this family of drugs are:

Related Topics:
Sumatriptan - Serotonin - Agonist - Triptan

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• sumatriptan (Imitrex®, Imigran®)
• zolmitriptan (Zomig®)
• naratriptan (Amerge®, Naramig®)
• rizatriptan (Maxalt®)
• eletriptan (Relpax®)
• frovatriptan (Frova®)
• almotriptan (Almogran®)

Evidence is accumulating that these drugs are effective because they act on serotonin receptors in nerve endings as well as the blood vessels. This leads to a decrease in the release of a several peptides, including CGRP and Substance P.

Related Topics:
Peptide - CGRP - Substance P

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These drugs are available only by prescription (US and UK). Many migraine sufferers do not use them only because they have not sought treatment from a physician.

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Regarding comparative effectiveness of these drugs used to abort migraine atacks, a 2004 placebo-controlled trial (Cephalalgia. 2004 Nov;24(11):947-54) reveals that acetylsalicylic acid, sumatriptan and ibuprofen are equally effective.

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Triptan therapy has been shown to result in a reduction in lost productivity. Sumatriptan has been shown to result in an average of 0.5 fewer missed workdays during the first three months of therapy and 0.7 fewer missed workdays within the first six months, as well as a reduction in the number of days spent working while symptomatic. The average reduction in lost productivity has been estimated at $1,249, at a cost of $25 per day of disability avoided. The annual net savings in reduced health care costs and lost productivity, over the increased cost of triptan therapy, has been estimated at between $114 and $540 per patient; thus the use of these pharmaceuticals represents a cost savings as well as an improvement in the patients? quality of life.

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Preventive drugs

Patients who have more than two headache days per week are usually recommended to use preventatives and avoid overuse of acute pain medications.

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Preventive medication has to be taken on a daily basis, usually for a few weeks, before the effectiveness can be determined. It is used only if attacks occur more often than every two weeks. Supervision by a neurologist is advisable. A large number of medications with varying modes of action can be used. Selection of a suitable medication for any particular patient is a matter of trial and error, since the effectiveness of individual medications varies widely from one patient to the next.

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The most effective prescription medications include several classes of medications including beta blockers such as propranolol and atenolol, antidepressants such as amitriptyline, and anticonvulsants such as valproic acid and topiramate.

Related Topics:
Beta blockers - Propranolol - Atenolol - Antidepressant - Amitriptyline - Anticonvulsants - Valproic acid - Topiramate

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Alternative approaches

Some migraine sufferers find relief through acupuncture which is usually used to help prevent headaches from developing. Sometimes acupuncture is used to relieve the pain of an active migraine headache. In the only controlled trial of acupuncture with a sham control in migraine, the acupuncture was not more effective than the sham acupuncture but was more effective than delayed acupuncture.

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Biofeedback has been used successfully by some to control migraine symptoms through training and practice.

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Supplementation of coenzyme Q10 has been found to have a beneficial effect on the condition of some sufferers of migraines.

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The plant feverfew (Tanacetum parthenium) is a traditional herbal remedy believed to reduce the frequency of migraine attacks. Clinical trials have been carried out, and appear to confirm that the effect is genuine (though it does not completely prevent attacks).

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Kudzu root (Pueraria lobata) has been demonstrated to help with menstrual migraine headaches and cluster headaches. While the studies on menstrual migraine assumed that kudzu acted by imitating estrogen, it has since been shown that kudzu has significant effects on the serotonin receptors. Kudzu Monograph at Med-Owl.

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Diet, visualization, and self-hypnosis are also important alternative treatment and prevention approaches.

Related Topics:
Diet - Visualization - Self-hypnosis

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