Malgorzata Skiba

How can I treat migraines?

Migraine treatments vary and vastly depend on clinical presentation. We will go over classification system, risk factors and options available in terms of preventative, abortive and pharmacological treatment. The International Classification of Headache Disorders distinguishes between primary, and secondary, neuropathies & facial pains (ICHD, 2021), making treatment recommendations very specific. Migraine is a type of primary headache that can be further differentiated between with or without aura and chronic. Furthermore, migraines with aura that are recurrent and last >60 minutes commonly occur in migrainous strokes which affect the posterior circulation of the brain 71%-92% of the time, (Lee et al., 2016). The migrainous stroke risk increases in smokers, women taking oral contraceptives and patients younger than 45 years (Gryglas & Smigiel, 2017) A lot of what we currently know about the treatment of migraines has to do with research into prevention. Learning about risk factors and individual triggers for migraines is very important. Controlling risk factors such as blood pressure, smoking, oral contraceptive use and lifestyle changes reduce the risk of migraines and migrainous stroke events. Prevention of migraines includes identifying the food, drinks and lifestyle stressors triggering the incidents. The use of prescriptions such as antiepileptics, antidepressants, antiplatelet and antihypertensive drugs have been shown effectiveness in decreasing the number of episodes. Non-pharmacologic interventions reducing migraines include biofeedback, relaxation therapy, cognitive behavioral therapy. The pharmacologic approach includes abortive therapy where the acute treatment is most effective if taken within 15 minutes of pain onset. The type of drugs used depends on the severity of the headache and the best if stepped-care approach is used. Alternative therapies used in the treatment of migraines include massage, yoga, acupuncture, chiropractic maneuvers, herbal supplements and biofeedback. A detailed headache diary describing the frequency, intensity, and time of occurrence will help the neurologist determine the best course of action and support (Vgontzas & Burch, 2018)(Zhang et al., 2017)(Wilson,2014, pp. 19–60).