Migraine Therapies:
While migraine thankfully does not affect fertility, it can complicate conversations about family planning and infertility treatments. Learn more about the relationship between migraine and family planning. Whether we’re talking about our oral preventive medications that we’ve had for decades or these newer CGRP monoclonal antibodies, none of them will work for every person. But the list of available treatments is expanding along with increased knowledge of what is happening in the brain with migraine.
Migraine management includes acute and preventive therapies, in addition to mitigation of lifestyle and environmental factors. Once patients are provided with an acute treatment regimen, counseling on when and how often to use treatments is required to avoid over- or underuse of therapies. We review an approach to acute migraine management including available pharmacologic and nonpharmacologic acute migraine therapies and those on the horizon. Migraine attacks can be disabling, but there are ways to manage the disease and to empower yourself to get the care and the support that you need.
Sudden head movement might bring on the pain again briefly. Nontraditional therapies might help with chronic migraine pain. Some drugs are used for headache pain but are not specific for migraines. Since some of these can be habit forming, they are less desirable than specific headache drugs listed above. These drugs should be used primarily as a “backup” for the occasions when a specific drug does not work. 5-HT1f drugs such as lasmiditan (Reyvow) work on pain pathways and stop pain and other bothersome migraine symptoms.
Six different injected or oral medicines that target the protein CGRP should be among the first drugs people try to prevent migraine, the American Headache Society advises. Factors to consider when choosing acute migraine therapy are listed in Table 1. Highly skilled pediatric experts diagnose and treat all types of conditions in children. As a team, we work together to find answers, set goals and develop a treatment plan tailored to your child’s needs. If your support system is lacking, consider joining a support group. Finding a community of people who understand exactly what you’re going through is like being welcomed home after a long, tiring day.
Receiving a formal migraine diagnosis is the first milestone when working with your doctor to identify a personalized and effective treatment plan. Continuing to talk with your doctor throughout the course of your treatment is important for determining the strategies that prove beneficial via and those that may not be as effective. It’s important to work with your obstetrician and your headache doctor when you have migraine to establish a safe treatment plan. If you’re not already working with a headache doctor, use our Find a Doctor tool to find someone in your area.
Researchers haven’t identified a definitive cause for migraine. But they still believe the condition is due to ‘abnormal’ brain activity that affects nerve signaling, and chemicals and blood vessels in the brain. It’s usually on one side of the head, but it can occur on both sides or shift. Medications can help prevent some migraines and make them less painful.
The vast majority of patients (92%) have episodic migraines, which occur less than 15 days in a month. Another new class of medications is the ditans like lasmiditan (REYVOW’). While gepants work outside the brain, lasmiditan goes into the brain and essentially ‘turns off’ the migraine during an acute attack.
Additionally, it is important to communicate with your doctor if you experience any adverse effects or if the medication does not seem to be working as expected. Nausea and/or vomiting is just one of many symptoms a person living with migraine might experience. Because migraine is a highly nuanced disease, it is important to learn about all possible symptoms that may appear before, during or after a migraine attack, including less common ones such as aura. For many years, preventive options for managing migraine were limited to medications originally intended to treat other conditions. These included certain drugs to lower blood pressure, antidepressants and anti-seizure drugs.
While DHE is not new, methods of administering it are evolving. The FDA recently approved dihydroergotamine mesylate nasal spray (TRUDHESA’). This medication uses a proprietary nasal delivery system, which allows the medication to go deeper into the nasal cavity, source offering better absorption. This offers a potentially new option for some people with migraine. Finally, while many people with migraine use over-the-counter NSAIDs, like ibuprofen, these can take time to work and aren’t always effective for everyone.
It stops muscles from tensing, which can help prevent the onset of migraine. This consensus statement published by the American Headache Society (AHS) is an assessment of current scientific and clinical information that is provided as an educational service. The information should not be considered inclusive of all appropriate treatments. New evidence may develop between the time this statement is submitted and when it is published or read. This statement addresses only the question that is specifically identified. It does not mandate any particular course of medical care and is not intended to substitute for the independent professional judgment of the treating provider.
However, there are many different preventive treatment options. And it is important for you to speak with your doctor about which option is best for you. With preventive treatment, we can reduce the frequency as well as the severity of attacks so that you’re not having attacks more than two times per week.
In fact, it is the second leading cause of disability worldwide. Disabling symptoms are not just the pain, but also the sensitivity to light and sound, as well as the nausea and vomiting. Regularly getting the advantage about 8 hours a night may cut down the number and strength of your migraine attacks. Keep a bedtime routine, avoid screen time just before turning in, and wake up at the same time every morning.
Even when they are covered and the copay is reasonable, individuals typically have to try multiple other medications and find them ineffective before they’re allowed to try CGRP drugs. And these are also newer medications, so we don’t know about long-term side effects. You should also develop a support system to lean on when a migraine strikes. You may be limited in what you’re able to do while dealing with migraine pain, and support from others is a powerful coping tool. Intense pain isn’t usually considered an emergency, but if that pain is interfering with your ability to complete your daily tasks, it’s definitely a situation that requires more care. If you can’t get an appointment with your doctor, you may want to consider emergency or urgent care services.