New Hope for Migraine Sufferers
The guidelines allow virtually any doctor to effectively take care of migraines. "It's the primary care physicians who take care of most headache patients," he says.
Silberstein himself has suffered migraine pain since childhood. Migraine headaches are basically the same -- yet each is unique, he tells WebMD. His migraines bring on "auras ... I start to see these flashing lights ... sometimes I actually can't see. You push through the day. That's what migraine patients do, they push."
The first crucial issue, says Silberstein, is for patients to get involved in their own care. "Patients should keep a headache calendar, start getting regular exercise, regular sleep," he advises. Aerobic exercise increases the brain's production of endorphins, chemicals that reduce pain and enhance mood. Exercise also helps people sleep better, which is important because insomnia can cause migraines.
Every patient and every migraine is different -- and should be treated as such. "Patients should tell doctors what they want and don't want with medications. Some are willing to accept more side effects to get rid of headache pain. Some are willing to accept more pain and discomfort as long as the medicine doesn't affect their ability to function."
As for medications, there is a wide variety for doctors to choose from -- to both prevent migraines and reduce disability and pain, says Silberstein. Most patients -- not all -- can be controlled with specific medicines like pain relievers such as Excedrin, Advil, or narcotics, or with drugs called "triptans," he says. "Not all pain medications work for all pain disorders."
Triptans are called "rescue medications" because they halt the kind of extreme pain that sends people to hospital emergency departments. Preventive medication, which is taken daily, "should be given for very frequent headaches or headaches which, despite acute treatment, produce disability."
When O'Connor finally was referred to Silberstein, "They took me off all the oral medications," she says. She found relief in an injectable medication that halts her migraines before they become full-blown.
"Migraine is not something you have to go to a super specialist for, although some patients may," David Hewett, MD, tells WebMD. "The guidelines are for emergency room and family physicians ... where migraine headaches are misdiagnosed a lot ... they will be a great boon to treatment, particularly in understanding [how to] individualize therapy." Hewett is assistant professor of neurology at Emory University School of Medicine in Atlanta.