Relief from Chronic Migraine: Medications and Other Treatments

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  • Chronic Migraine Affects About 2% of the Population

    Chronic Migraine Affects About 2% of the Population

    About 7 million Americans suffer from chronic migraine, which is defined as migraine headache that occurs 15 or more days a month, for at least three months. Episodes often last four hours or more. Depression, anxiety, and other issues, such as sleep problems, are also common among people with chronic migraine. Accordingly, treatment may consist of acute, preventive, and complementary therapies. Doctors may also prescribe therapies to address additional problems, such as depression. 

  • Acute Treatments for Chronic Migraine

    Acute Treatments for Chronic Migraine

    Acute treatments are medications taken at the first sign of migraine headache. These treatments don’t prevent migraine, but they offer relief from the debilitating pain associated with an episode. Most of these drugs must be taken at the first sign of headache for best results. The most commonly prescribed drugs for acute treatment are triptans. At least seven different triptans are presently available. They affect the activity of serotonin, an important signaling chemical in the brain. Examples include sumatriptan (Imitrex), naratriptan (Amerge), and eletriptan (Relpax).

  • Preventive Treatments for Chronic Migraine

    Preventive Treatments for Chronic Migraine

    Various drugs are available to help prevent migraine headaches from occurring. In 2010, doctors began prescribing botulinum toxin (Botox) for this purpose. A recent analysis concluded that this therapy reduces monthly attacks by 50% or more in some patients. But it may also cause adverse effects that could prompt some patients to discontinue therapy. Other effective preventive treatments include beta blockers, certain anticonvulsant drugs, and angiotensin inhibitors. These drugs are less likely to cause intolerable side effects, although some are not specifically approved for the prevention of migraine.

  • Topiramate for Prevention of Chronic Migraines

    Topiramate for Prevention of Chronic Migraines

    Topiramate (Topamax) is a drug originally approved for the treatment of seizures in people with epilepsy. It is now also FDA-approved to prevent chronic migraine. The drug can prevent headaches, but side effects may keep some patients from taking it on a long-term basis. Side effects, including confusion, slowed thinking, and slurred speech, are often cited as reasons for discontinuing the drug. Other potential side effects include drowsiness and dizziness. Nevertheless, researchers have concluded that it is “effective and reasonably well tolerated.” Similar drugs include valproate and gabapentin.

  • Beta Blockers for the Prevention of Migraine

    Beta Blockers for the Prevention of Migraine

    Many patients find that taking a beta-blocker drug can reduce the number of headaches. Although not specifically approved for this use, beta blockers such as propranolol are relatively inexpensive and have fewer side effects than some other drugs. They are ordinarily used to treat anxiety disorders and help control high blood pressure. Other drugs in this class include timolol, metoprolol, and atenolol. Beta blockers are considered first-line therapy for the prevention of chronic migraine, although it’s unclear exactly how they help prevent attacks.

  • Antidepressants and Migraine

    Antidepressants and Migraine

    Depression and anxiety disorders are common among people who suffer from migraine. Research suggests that worsening depression is frequently linked to a greater risk that episodic migraine will become chronic migraine. It’s important for doctors to evaluate and treat migraine patients for the presence of depression or anxiety. Certain antidepressant medications have been used successfully to treat depression and reduce migraine recurrence. Suitable drugs include older tricyclic antidepressants, such as amitriptyline or imipramine. Botox may also act as an antidepressant, according to emerging research.  

  • Complementary Approaches to Migraine Control

    Complementary Approaches to Migraine Control

    In addition to prescription medications, other therapies may offer some relief from chronic migraine. Evidence suggests that certain dietary supplements, such as coenzyme Q10, magnesium, butterbur, vitamin B-2 (riboflavin), and feverfew may be effective to some degree. Most of these remedies have the advantage of being well tolerated and less expensive than prescription drugs, with fewer known side effects. Additionally, aerobic exercise and acupuncture have been shown to offer some relief. Other promising alternative therapies include biofeedback, cognitive therapies, and relaxation techniques.

  • Future Trends in the Prevention and Treatment of Chronic Migraine

    Future Trends in the Prevention and Treatment of Chronic Migraine

    Preliminary clinical trials indicate that a device pioneered for use in spinal cord injury may prove useful for the prevention of chronic migraine. Known as an occipital nerve stimulator, the device delivers a weak electrical current directly to the brain through implanted electrodes. Broadly called peripheral neuromodulation, the technique of “shocking” the occipital nerve or other portions of the brain is an extreme, yet promising, new therapy. Although not yet approved for this use by the FDA, the technology is under investigation for the “off-label” treatment of chronic migraine.

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