There is no permanent cure for migraine and its treatment is basically symptomatic (to control migraine symptoms).
The treatment requires a little self-care effort by the patient besides taking the medication prescribed by your doctor. Described below are the various remedies and some steps, which the migraineur should himself follow to help cure his migraine.
Self-care at home
- Maintain a migraine diary in which you, the migraineur, maintains details of the onset and type of the headache and other symptoms, association with any migraine trigger factors, relationship to menstruation, etc. This will help your doctor to help diagnose the headache as migraine from the symptoms and give the appropriate treatment.
- Lose any excess weight.
- Avoid the factors that can trigger a migraine attack.
- Hot packs can relax tense muscles of the scalp. A warm shower can give a similar effect.
- A warm caffeinated beverage can relieve the pain of a migraine in the early stages. It will also enhance the pain-killing effect of acetaminophen.
- During a migraine attack, it is best to lie down in a quiet dark room and let the medicines work.
- Take the medicines prescribed to relieve the migraine headache. It is important to know that overuse or frequent of use of medicines can result in medication-overuse-headaches, which are more frequent and severe.
- Adopt preventive treatment, which involves taking the medication to prevent migraine.
Taking medication for migraine is also known as acute or abortive treatment for migraine. Medicines work best when taken early at the onset of the headache or just before its onset when the pre-headache symptoms start setting in.
Analgesics are painkiller drugs, which are used to relieve the pain of the headache. The following are the analgesics that are commonly used to treat a migraine headache.
- Paracetamol (acetaminophen) is a good and safe remedy, which can be used alone for pain or may be given in combination with metoclopramide (eg Reglan) to relieve nausea and vomiting.
- Nonsteroidal anti-inflammatory analgesics such as ibuprofen give relief in about 50% of the cases.
- Migraine-specific drugs, which are a combination of paracetamol, caffeine, and aspirin (Excedrin migraine) are effective against moderate pain and may not be enough alone for severe migraine.
Triptans – a popular migraine remedy
Triptans are drugs of choice in about 75% of people with migraine. They are available as oral drugs, injections, and nasal sprays. They act by constricting the blood vessels and reducing the inflammation, thus giving relief from pain. Their main action is on the serotonin receptors, which are present in the nerve endings as well as the blood vessels.
Examples of triptans include
- sumatriptan (Imitrex)
- rizatriptan (Maxalt)
- almotriptan (Axert)
- naratriptan (Amerge)
- zolmitriptan (Zomig)
- frovatriptan (Frova) and
- eletriptan (Relpax)
Triptans are known to abort a headache attack if used early in more than 80% of cases. Other advantages of using triptans early are that its side effects are reduced, its effectiveness is increased and the chances of recurrent attacks in the next 24 hours are reduced.
Ergotamine and its derivative, dihydroergotamine are the cheaper and older medications still being prescribed to treat migraine. They are particularly effective against longer lasting migraine attacks of more than 48 hours. Like triptans, they act by constricting the blood vessels.
Nausea is a common side effect but Dihydroergotamine has fewer side effects than its parent ergotamine and is more effective. However, when compared to triptans their effectiveness is less. It is available in injection form and as a nasal spray. It is also used in treating medication-overuse-headache.
Corticosteroids such as dexamethasone are sometimes used as a single dose injection along with the other standard treatment. It is found to reduce the incidence of a recurrent headache. However, though it is a good remedy, frequent use should be avoided because of potential side effects of steroids.
Other medicines such as anti-nausea and anti-emetics are given to control the accompanying symptoms of nausea and vomiting. These include drugs like metoclopramide (eg Reglan) mentioned above and promethazine (Phenergan).
Barbiturates and narcotics such as opiates are given when the patient cannot take triptans or ergotamines for some reason. These are reserved as a backup or last resort when other drugs do not work or cannot be taken because they are habit forming.
Botox has been approved in 2010 by the U.S. FDA to treat chronic migraine in adults. It is injected locally into the muscles of the forehead and neck. You’ll get several shots of Botox around your head and neck every 12 weeks to stop the headache pain and prevent migraine headaches
If found effective, it is repeated every three months.