A migraine is a common disorder and one of the leading causes of disability globally. For many, migraine pain can impact daily living, work, and relationships. Patients who suffer from migraines often seek advice from pharmacists on how to best treat and alleviate symptoms, control frequency of attacks, and improve their quality of life. 

Migraine vs. Headache

A headache is a throbbing or pulsing pain in your temples, sinuses, or other areas of your head. In comparison, while a migraine causes a severe headache, the headache is only one symptom of the disorder.

Headaches are common and come and go with stress, congestion, hunger, eyestrain, caffeine withdrawal, and other causes. They can be chronic and cause severe pain, but the pain is usually the only symptom.

Migraine, on the other hand, is a chronic genetic neurological disease characterized by overexcited neurons. Activation of the trigeminal nerve pathway causes changes in arteries, inflammation, nerve signaling, and neurochemicals. The result is severe pain and:

  • Nausea
  • Light sensitivity
  • Dizziness
  • Fatigue 
  • Trouble doing usual activities

Types and Phases of Migraine

Migraines are recurrent and may come with or without an aura and may be chronic, episodic, or frequent episodic, though there are many other types. A migraine also often occurs in five phases, though some can happen together or not at all. 

These phases include:

  • Prodromal or pre-headache phase, where you experience painless symptoms a few days before an attack
  • Aura phase, where you experience sensory disturbances
  • Headache phase, when the pain occurs and may be mild or severe
  • Postdromal phase, where the headache subsides, and you feel tired and unwell
  • Interictal phase, the time between attacks

How Common Is Migraine?

Migraine is the second leading cause of disability in men and women across all age groups and the leading cause in women between the ages of 15 to 49. It affects 12 percent of adults and is more common in women than men. 

Migraine is strongly associated with genetics. If one or both of your parents have migraine disorder, you have a 30 to 60 percent chance of also having it. 

What Triggers Migraines?

Healthcare providers sometimes classify migraines by triggers, but some neurology providers argue against this practice because it opens the diagnosis to too many categories. Instead, they suggest describing it simply as a brain disorder with known triggers.

Migraine triggers are different for everyone, but there are some common instigators. Many are lifestyle and environmental factors, including:

  • Stress
  • Poor sleep
  • Lack of sleep
  • Certain foods and drinks
  • Weather changes
  • Fluorescent lighting
  • Irregular schedules
  • Taking pain medications too often

Migraine Treatment Options

There are two approaches to migraine treatment: acute management during an attack and preventative treatment. The goal is to relieve pain and other symptoms and restore function. 

Acute Migraine Treatment

Managing symptoms as soon as a migraine starts can help with faster recovery. Patients are advised to rest in a quiet, dark room to help with light sensitivity, and place a cool cloth over the forehead. A massage or a few cups of strong coffee can sometimes help, but taking medication early on is often important. 

  • Over-the-counter treatments can include:
  • Pain relievers
  • Non-steroidal anti-inflammatory drugs
  • Anti-nausea drugs
  • Caffeine

Prescription pain relievers may also help with severe pain, but the risks must be considered, especially for long-term use. For example, opioid medications may cause medication overuse or rebound headaches and worsen migraine. 

Other prescription options may work better, such as:

  • Triptans
  • Ergot derivatives
  • Anti-nauseants

It is important to limit prescription pain medication use to nine days per month and over-the-counter pain relievers to a maximum of 14 days per month. This will help reduce the frequency of rebound headaches. 

Preventative Treatment

There are no set guidelines on when to prescribe preventative treatment. In general, it should be individualized and based on the effects of migraine on quality of life. 

However, experts suggest treatment when other medications aren’t working or cause rebound headaches, when migraine causes severe disability, or when there are three more moderate to severe headaches per month.

Lifestyle adjustments and prescription medication can help reduce the frequency of attacks and improve quality of life. Lifestyle changes include:

  • Regular exercise
  • Eating regular, healthy meals 
  • Drinking plenty of water
  • Seven to eight hours of sleep nightly
  • Avoiding trigger foods, bright lights, and strong smells

Experts recommend many different prescription medications, but guidelines suggest the following may be best for preventative treatment:

  • Gabapentin
  • Topiramate
  • Amitriptyline
  • Propranolol
  • Metoprolol
  • Nadolol
  • Candesartan

Some supplements and vitamins may help, including coenzyme Q10, riboflavin, magnesium, feverfew, and butterbur. Botulinum toxin injections may also provide migraine relief. 

Learn more about identifying and recommending effective treatments for patients with migraines in this free, accredited course on MDBriefCase: A New Pathway to Episodic Migraine Relief.

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