As many as 20% of women and 10% of men in the U.S. have migraine. Yet despite how common these painful, throbbing headaches are, treatment often remains a challenge.
Migraine headaches are complex and still not completely understood. Certain nerves cells and brain chemicals play a role. When blood vessels in your brain get inflamed and swollen, it sets many other changes in motion. In addition to that throbbing pain in your head, you could have problems with your vision, feel very sensitive to noise and light, have diarrhea, or throw up.
Every person with migraine has different symptoms. Everyone’s triggers are different too, although some common ones include lack of sleep, certain foods, and stress.
As doctors learn more about migraine and what parts of the brain are involved, they’re finding better ways to prevent these headaches.
How Is Migraine Treated?
Right now, there are two methods.
Acute treatments: These drugs stop a headache after it starts. A group of drugs called ergots are the oldest treatments for migraine.
Triptans, a class of newer drugs, work the same way as ergots but are more powerful. They affect the release of certain brain chemicals and block pain pathways in your brain.
CGRP (calcium gene-related peptide) receptor antagonists are the more recent drugs approved to treat migraine. They also work to block a protein that triggers pain and inflammation.
Still, these drugs aren’t for everyone. If you have uncontrolled high blood pressure, coronary artery disease, a history of strokes, and other heart problems, you won't be able to take some of them. There may also be risks if you’re pregnant. Your doctor will discuss them with you.
If you have frequent attacks, your doctor may prescribe a drug to reduce the number of migraines you have. It could also help any acute drugs you take work better.
Drugs used to help prevent migraines include:
- Antidepressants: amitriptyline and venlafaxine (Effexor)
- Anti-seizure drugs: gabapentrin (Gralise, Horizant, Neurontin), topiramate (Qudexy XR, Topamax, Topamax Sprinkle, Trokendi XR), valproate (Depakote, Depakene, Stavzor)
- Beta-blockers: metoprolol (Lopressor, Toprol XL), nadolol (Corgard), propranolol (Inderal LA, Inderal XL, InnoPran XL), timolol
- CGRP Inhibitors: erenumab (Aimovig), eptinezumab (Vyepti), fremanezumab (Ajovy), and galcanezumab-gnlm (Emgality)
Although they can offer help, some of these medications were made to treat other health problems. Their effect on migraines was discovered by chance. Some work better for some people than for others, and side effects are common.
There are also several devices which may help prevent migraines:
- Transcranial magnetic stimulation (TMS): During this treatment, you'll hold a small device called SpringTMS to the back of your head. It sends a split-second pulse which interrupts abnormal electrical activity caused by migraine, thus aborts the migraine.
- Transcutaneous supraorbital nerve stimulation (TSNS): Cefaly uses transcutaneous supraorbital nerve stimulation and is worn as a headband on the forehead and turned on daily for 20 minutes to prevent migraine from developing.
- Noninvasive vagus nerve stimulator (nVS): gammaCore is a nVS and works by being placed over the vagus nerve in the neck. It releases a mild electrical stimulation to the nerve's fibers to relieve pain.
What Does the Future Hold?
Doctors keep looking for drugs that do a better job of stopping migraines before they even start. More CGRP inhibitors are in the pipeline and researchers continue to look at other ways to prevent and treat migraines safely and effectively.
Although new drugs are on the way to prevent migraines, research continues to show that natural, drug-free techniques help, too. After all, stress is the most common trigger. Studies show that people who learn to better deal with their worries actually start to have fewer migraines.
You can try:
Biofeedback: This type of therapy teaches you to be aware of how your body reacts to stress, whether that’s tense muscles, a fast heart rate, or cold, clammy hands. A trained professional teaches you how to change that response and calm down.
Studies show that people who use biofeedback have 55% fewer migraines. This therapy may work even better when you also take medicine that prevents headaches.
Progressive muscle relaxation (PMR): This relaxation technique helps stop your body’s response to stress before it triggers a migraine. A therapist will show you to tightly contract, then fully release, each of your muscles. He’ll also teach you to deepen and slow your breathing.
Cognitive behavioral therapy (CBT): A psychologist can help you learn how your thoughts and habits affect your migraines. She’ll also teach you to change the way your body reacts to the pain you feel during an attack.