Prevention: The Future of Migraine Therapy
Stopping a migraine headache before it ever begins is the new focus of treatments.
Finding the Window of Vulnerability
In another approach to the goal of preventing migraine headaches, Silberstein and other researchers have looked at "drug timing." This involves finding the window of vulnerability, a critical time period for migraine headache sufferers. If patients can take their drugs just at this point instead of ongoing, some side effects can be offset. They'll also take less medication, cutting out-of-pocket costs.
Two recent studies of menstrual-related migraines produced the first scientific evidence for a pattern of vulnerability in migraine headaches. Researchers say their findings could apply to other types of migraines, not just menstrual headaches.
It's an exciting finding. If altitude changes are your nemesis, then taking a long-acting triptan drug twice a day on the day before you go skiing in Utah and continuing it for a week may nip your migraine from starting at all.
New migraine drugs are also on the horizon. "A lot of drugs are coming down the pipeline, drugs that work by different mechanisms," says Silberstein. One is a class of enzyme-blocker drugs, such as Aricept, currently prescribed to treat mild to moderate confusion related to Alzheimer's. This drug is a contender for migraine prevention, he tells WebMD.
Alternative Choices for Migraine Pain
While medications are the mainstay of migraine treatment, they're not a cure-all. For women who are pregnant or hoping to be, supplements are a safe alternative. For people who can't get enough relief from prescriptions or who dislike the side effects, supplements can also help.
"Almost anyone, including children, can take magnesium," DeRossett tells WebMD. "The only side effect is diarrhea. Some people get it, some don't. For some, it's dependent on how high the dosage is."
She recommends magnesium "more than other supplements, and have found it to have the most robust effect in preventing migraines," she says. "I advise vitamin B-2 if a patient has a predisposition to diarrhea." Some supplements combine magnesium, vitamin B-2, and the herb feverfew. Coenzyme Q10, which the body produces naturally, has also been shown to cut migraine attacks, but it's pricier than the others, she adds.
You have to take magnesium for three months to get a benefit, says DeRossett. "People sometimes give up on it too soon." Taking the correct dosage is important as well: 500 mg magnesium, 400 mg riboflavin (vitamin B-2), and 150 mg coenzyme Q10.
The herb butterbur can also help prevent migraine attacks, she adds. A recent study found that a daily 75 mg butterbur supplement cut migraine frequency by more than 50%.
"Our patients are on all kinds of high-powered migraine headache medications," DeRossett tells WebMD. "These [magnesium, etc.] aren't in the same ballpark as Depakote or Topamax. But for some people, magnesium might be enough. For others, it might provide added benefit in terms of relief."