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Migraines Hurt: Make It Stop

Intensely and relentlessly painful, migraines leave sufferers desperate for relief.

In his memoir, “A Brain Wider Than the Sky,” author Andrew Levy wrote: “The migraine head wants to be cut open; it longs to be cut open.”

That, clearly, is not a solution. Though it once was considered. Trepanation, a technique of removing bone from the skull, is one of the most ancient treatments for migraines. The earliest “trepanned” skulls date to around 10,000 BCE. Much has been learned about migraines since then and, thankfully, trepanation has long been dismissed as a potential treatment.

Current Migraine Treatment Information

Today, migraines remain a common malady – occurring in 15 to 18% of children and a similar proportion of adults – effectively treating them can be challenging.

One reason may be due to the fact that what exactly causes these headaches is still being studied. They seem to arise due to dysfunctional regulation of the tone of blood vessels inside the head. There’s also a genetic component as two-thirds of childhood migraine sufferers have a family history as well.

The good news is we understand more than ever about these headaches and how to prevent and treat them.

The best results come from a many-pronged approach, which includes:

  • Identifying and avoiding triggers
  • Taking medications to prevent migraine occurrences
  • Treating the pain when migraines occur

For those who experience chronic migraines (headache at least 15 days a month), more advanced options are also available.

Avoiding Migraine Triggers

What triggers migraines differs from person to person. Common triggers include:

  • Stress
  • Lack of sleep/sleep changes
  • Caffeine and alcohol consumption - especially wine
  • Skipped meals
  • Sensory stimuli - bright/flashing lights, loud sounds, strong smells
  • Hormone changes in women around menstruation
  • Weather - including changes in barometric pressure
  • Foods - including aged cheeses and salty/processed food and food additives

Preventive Medications for Reducing Migraine Occurrences

The following options are used to reduce the number, severity and length of migraines:

  • Blood pressure-lowering medications - including beta blockers, metoprolol tartrate and calcium channel blockers can reduce migraine frequency.
  • Antidepressants - have been found to prevent migraines.
  • Anti-seizure drugs - including valproate and topiramate can help those with less frequent migraines, but are not recommended for pregnant women or women trying to get pregnant.
  • CGRP monoclonal antibodies - are newer drugs given monthly or quarterly by injection to prevent migraines or reduce migraine days for chronic migraine.

Pain Relief Options for Migraines

Relief from migraine pain and symptoms is best achieved if given at the first sign of a migraine. Options include:

  • Over-the-counter pain relievers - include aspirin or ibuprofen, and migraine-specific medications that combine caffeine, aspirin and acetaminophen are helpful for mild migraine pain.
  • Triptans (sumatriptan and rizatriptan) - are prescription medications that block pain pathways in the brain and are available as pills, shots or nasal sprays.
  • Dihydroergotamine - is a prescription nasal spray or injection that lessens migraine symptoms when taken shortly after symptoms start.
  • Lasmiditan - is a newer prescription tablet shown to significantly improve headache pain.
  • CGRP antagonists - including ubrogepant and rimegepant are oral medications that can relieve pain and other migraine symptoms (nausea, sensitivity to light and sound).

Treating Frequent/Chronic Migraines: More Advanced Options

New and more advanced options are available for those who have frequent, severe or chronic migraines. These include:

  • Botulinum toxin injections - are thought to block the pathways that transmit pain signals in your head.
  • Sphenocath - is an outpatient procedure in which local anesthetic is injected to the back of the nose, and produces significant symptom improvement in up to 80 percent of patients.
  • Neuromodulation devices - that sit on your head can target nerves related to migraine pain to prevent or treat migraine pain.

Making the pain stop or, even better, preventing a migraine from occurring in the first place, can significantly improve quality of life for migraine sufferers. With many options now available, there’s no reason to suffer in silence. If you experience severe headaches, talk to your primary care provider.

Kirti Gupta, MD
Kirti Gupta, MD

Kirti Gupta, MD is an Internal Medicine and Pediatrics provider with CHI Health.

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