Understanding Migraine -- Diagnosis and Treatment

How Are Migraine Headaches Diagnosed?

No specific test can diagnose migraine. So your doctor needs to ask a lot of questions and rule out other problems to know if you have them.

She may ask you to keep track of your headaches for a few weeks -- when you get them, your symptoms before and during them, and anything that seems to trigger them. These patterns can help her decide if what you are experiencing are migraine.

She’ll also want to know whether migraine headaches run in your family. Plus, she’ll do a careful physical exam to make sure you don't have any other symptoms that point to another health problem as the source of your headaches.

What Are the Treatments for Migraine Headaches?

There are two main ways to treat them. The first is to stop a migraine, if possible, or at least to control your symptoms, like pain and nausea. The second way is to prevent future attacks.

Stopping Migraine Pain

To stop the pain, it's important to take medication at the first sign a migraine is coming. 

Many drugs can help, but the leading ones are called triptans. They come in different forms including dissolvable pills, regular pills, nasal sprays, and injections. They include rizatriptan (Maxalt), sumatriptan (Imitrex), zolmitriptan (Zomig), and others. Some of these drugs may work better for you than others. It may take some time before you and your doctor can find the right one.

Ergot alkaloids are another type of drug that can stop a migraine. The most popular one is dihydroergotamine (DHE). You can take it as a nasal spray or a shot. NSAIDs (nonsteroidal anti-inflammatory drugs), such as ketoprofen or ibuprofen, may also stop a migraine attack. Often, doctors recommend taking anti-nausea drugs, too.

Your doctor may suggest the eNeura Transcranial Magnetic Stimulator (TMS), a prescription device you place on the back of the head at the start of a migraine with aura. It releases a pulse of magnetic energy to part of the brain, which may stop or lessen pain.

Aside from taking medicine, you’ll want to be as comfortable as possible until your migraine stops. Try lying down in a dark, quiet room and trying to sleep. Put a cold pack on your head. If nausea or vomiting keeps you from taking medicine or your symptoms don't improve, you may need to go to a hospital for treatment.

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Preventive Treatments

Doctors usually recommend these if you have more than two or three migraines a month. Medications that aim to head off a migraine episode, so that it never fully starts, include:

Although triptans can usually treat a migraine once it starts, one of them, frovatriptan (Frova), also may prevent menstrual-related migraine headaches. 

Another prevention tool is one that may surprise you: Botox. Along with treating wrinkles, studies have shown that it helps some people with chronic migraine headaches. In 2010, the FDA approved Botox for the preventive treatment of chronic migraine headaches -- those that occurat least 15 days per month, with the headache lasting 4 hours daily or longer. Scientists think that the drug keeps the body from releasing chemicals involved in sending pain signals.

When you take medication to prevent migraine headaches, keep these tips in mind:

  • Your doctor will likely start you on a low dose and gradually increase it over time. It may take several months to find the best dose with the fewest side effects.
  • Don't suddenly stop taking preventive medications. That could trigger a severe rebound headache. Instead, you’ll need to slowly taper them off under your doctor's direction.
  • Preventive migraine medications probably won't completely get rid of your headaches. You'll still need to take other medications when you have a migraine.

Cefaly is a portable headband-like device sends electrical pulses through the skin of the forehead. They stimulate a nerve that’s linked with migraine headaches. You use it once a day for 20 minutes, and when it's on you'll feel a tingling or massaging sensation.

The eNeura device is also a portable, non-invasive transcranial magnetic stimulation device. It has proven to effectively prevent, reduce, or stop pain associated with migraine with aura. 

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Alternative and Mind/Body Medicine

Electromyographic (EMG) biofeedback training helps you learn to recognize tension as it builds up in your muscles, and teaches you to relax the ones that can lead to migraine pain, including those in your face, head, neck, shoulders, and back.

You can also use relaxation techniques on their own or along with biofeedback. They include progressive relaxation, guided imagery, and different types of meditation. They may help you handle the stresses in your life that can trigger migraine headaches and help you get through a migraine attack.

Herbs and Supplements

Some people with migraine headaches have too little magnesium in their bodies. Taking a supplement or increasing the amount of magnesium in their diets may help.

People have taken feverfew, a flower in the daisy family, for decades to help relieve migraine symptoms. But there’s not much scientific evidence that it really works. While feverfew is probably not harmful, don't take it if you're pregnant or taking blood thinners, because it thins the blood. It can also have some serious side effects, including allergic reactions, mouth ulcers, anxiety, an upset stomach, and it may actually cause headaches.

Lifestyle Tips

Along with preventive treatments, your habits can go a long way to help you have fewer, less-severe migraine headaches. Some changes that may help:

  • Set a consistent  sleep  schedule. Go to bed and get up about the same time every day, including weekends and holidays. Changes to your sleep routine, or getting too much or too little sleep, can trigger a headache.
  • Exercise . You may be tempted to avoid it, afraid it might trigger a migraine. And, although physically overdoing it can trigger a headache for some people, research suggests that regular, moderate exercise may help many people have fewer, less-severe headaches. Regular exercise also helps control stress.
  • Eat regular meals. A drop in blood sugar can trigger a migraine, so eat on a schedule to keep yours level. Also drink plenty of water to avoid dehydration, another trigger.
  • Limit stress. Take time each day to relax with something you enjoy. Listen to calming music, take a short walk, meditate, or do yoga.
WebMD Medical Reference Reviewed by Lawrence C. Newman, MD on August 17, 2017

Sources

SOURCES: 

Young, W. Migraines and Other Headaches, Demos Medical publishing, 2004. 

Blumenfeld, A. Dermatology Clinic, April 2004. 

Sheftell F. Journal of the American Academy of Nurse Practitioners, August 2005.

News release, NuPathe Inc.

News release, FDA.

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