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Is Your Migraine Treatment Working?

With a battalion of drugs to cut migraine frequency, are you making progress in your migraine treatment?
WebMD Feature

If you're battling frequent migraines, relief is in sight. It's possible to reduce the number of headaches by one-half, maybe more.

In recent years, doctors have discovered that certain drugs -- found among epilepsyepilepsy, blood pressure, anti-inflammatory, and antidepressant medicines -- can reduce headache frequency and severity.

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These drugs are believed to affect blood vessel and brain chemical activity involved in migraines. "We're not clear on exactly how these drugs work to prevent migraines, but we've had good success with them," says George R. Nissan, DO, director of research for the Diamond Headache Clinic in Chicago.

The pattern of migraine frequency is an important factor in treatment. Most migraine sufferers have four to six headaches a month. "Some have tension headaches every day – a background headache -- plus migraines," says Nissan.

Relentless migraines take a heavy toll on quality of life. "People lose jobs, drop out of school, get divorced," Nissan tells WebMD. "There can be a lot of depressiondepression and anxiety. Lives have been turned upside down by these headaches."

That's where preventive treatment can help, he says. Some people can eventually become headache-free, but that's pretty rare, says Nissan. "More often than not, we're helping people to be functional. We work to minimize, as much as possible, the frequency and severity of migraines."

The question is, how?

Migraine Treatment: Your Game Plan

Preventive medications have helped greatly, says Jerome Goldstein, MD, director of the San Francisco Clinical Research Center and Headache Clinic. "In our clinical trials of these drugs, we have achieved 50% to 60% reduction in migraine frequency and severity."

However, the preventive drugs aren't perfect. They must be taken every day to be effective. Also, some brand-name preventive medications can be costly. Many have side effects -- including weight gain, fatiguefatigue, sleepiness, numbness, tingling, and nausea.

If you have other health problems or take other medications, you might be limited in the preventive drugs you can use, says Nissan. However, if you have a seizure disorder like epilepsyepilepsy or high blood pressurehigh blood pressure, your migraine medication can overlap in treating that disorder, too.

In battling frequent migraines, Goldstein believes in bringing all migraine drugs to the table -- not just preventive medications. That includes:

  • Pain relievers
  • Anti-inflammatory drugs
  • Anti-nausea drugs
  • "Migraine-stopping" drugs
  • Certain supplements (feverfew, magnesium, and vitamin B-2 – may help curb migraines)

There is some evidence that even Botox can cut migraine frequency.

"The headache sufferer should have everything available to them to treat the headache effectively," Goldstein tells WebMD. "We have to weigh the benefits against the side effects of each drug. Also, does the patient want to take a medication on a daily basis?"

In deciding the strategy, "the question becomes, do we want to prevent migraines altogether -- if that's possible -- or do we aim toward treating each headache individually?" says Goldstein. "For most folks, it may be a combination of both."

For example, many women have menstrual migraines, says Goldstein. He says these women may need a daily preventive medication to control chronic migraine problem, plus another drug -- like an anti-inflammatory or migraine stopper -- to halt a menstrual migraine when it starts.

Stopping the headache is what matters most, Goldstein says. "My personal feeling is that if a patient can stop a headache within 15 or 20 minutes, it doesn't matter how many headaches they actually have. After all, there are people who have only a few migraines a month, but those migraines last three days."

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