Preventive therapies and treatments to manage severe migraine attacks range from common over-the-counter painkillers to complementary medicine approaches, such as acupuncture.
Migraines are severe headache attacks that can last for between 4 and 72 hours. They are often accompanied by severe nausea and vomiting, acute sensitivity to light and sounds, and, in some cases, by temporary cognitive impairment and allodynia, which is when normal touch is felt as painful.
Individuals can start experiencing migraines from childhood, and their prevalence increases well into adulthood, until age 35 to 39. Migraines are up to three times more common in women than they are in men, and the attacks also last longer in women.
Multiple studies link chronic migraine with a decreased quality of life and disrupted activity levels. What, then, are the options of prevention and treatment available to people who face migraines? Here is a list of the five most cited approaches.
1. Prescription and over-the-counter drugs
A range of over-the-counter (OTC) and prescription drugs are used to manage migraines. These include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). These are common OTC drugs and include aspirin (acetylsalicylic acid), ibuprofen, diclofenac, and naproxen. They are by far the most widely used type of medication in the case of migraines, partly because they are readily available and inexpensive, but also because they are effective in both mild and moderate attacks.
- Triptans. These are serotonin receptor agonists, which, as their name suggests, selectively activate serotonin receptors. Low levels of serotonin are sometimes believed to be one of the causes behind migraine attacks. Triptans are occasionally prescribed to regulate that imbalance, but they are not effective in all cases.
- Ergotamine. This is a chemical that can provide immediate pain relief. The drug is usually prescribed only to people who experience migraines infrequently, or whose attacks go on for a long time. Ergotamine is a vasoconstrictor, meaning that it causes blood vessels to become narrower. As such, it can have unpleasant cardiovascular side effects, so it is not recommended to people who experience migraines often.
- Antiemetics. Since severe nausea and vomiting affect most people who experience migraines, antiemetic agents, or drugs that counter the sensation of nausea, are often prescribed.
NSAIDs, such as the widely available OTC drug ibuprofen, are the most common port of call for handling migraine attacks.
Specialists advise that medication taken to relieve migraine "should be taken as early as possible after the onset of [an attack]" to maximize effectiveness.
Preventive drugs are also sometimes prescribed to people who experience migraines, though these are generally symptomatic and are better adapted to coexisting conditions, rather than to migraine itself.
These may include, on a case-by case basis, antihypertensives (which are drugs that target high blood pressure), anticonvulsants (which is medication normally used in the treatment of epilepsy), and antidepressants. However, most of these treatments can also produce adverse effects, so they tend to have a poor adherence rate.
2. Dietary supplements
Supplements are often used for migraine prevention, especially since they are more easily available and do not have as many side effects as traditional medication.
Some of the supplements that have been found to help with migraines are:
Certain dietary supplements, such as vitamin B-2, are sometimes said to ease the painfulness of migraines.
- Coenzyme Q10. It seems that coenzyme Q10, when taken alongside other preventive medication, is effective in reducing both the severity and the frequency of migraine attacks.
- Riboflavin, or vitamin B-2. Recent research suggests that this dietary supplement can act as a neuroprotective agent, safeguarding brain function and structure, and it can be effective in reducing the painfulness of migraine headaches.
- Magnesium. This is a mineral that plays a key role in many processes that take place in the body, including metabolism and the regulation of blood pressure. Some studies suggest that various kinds of magnesium supplementation are beneficial in reducing migraine intensity and frequency, though not all researchers agree.
- Melatonin. This is a hormone that regulates states of sleep and wakefulness in animals, and guards against oxidative stress - which is a process that can lead to cell damage and death - in plants. Some research suggests that it can be effective in migraine prevention and can be more beneficial than other preventive drugs as it has fewer side effects.
- Butterbur. This refers to extracts from the root of the butterbur plant (Petasites hybridus), which is common in Europe and some parts of North America and Asia. A number of studies suggest that butterbur is effective in preventing migraine, but some specialists urge that this dietary supplement should be treated with caution.
3. 'Neuromodulation' therapy
"Neuromodulation" therapy works by stimulating the brain or spinal chord to promote or suppress various functions of the central nervous system. Sometimes, the stimuli are delivered using implanted devices.
This kind of therapy is more often used to treat chronic illnesses that inflict severe pain or seizures.
Two types of neuromodulation therapy are now approved by the United States Food and Drug Administration (FDA). Single-pulse transcranial magnetic stimulation (sTMS) involves stimulating the brain through magnetic impulses generated by a device placed over the person's head. The FDA have approved sTMS in the treatment of acute migraine.
Transcutaneous supraorbital nerve stimulation (t-SNS) acts in a similar way, with a device placed on the forehead generating magnetic impulses that stimulate the supraorbital nerve, which allows the impulses to travel through the forehead to the scalp, eyes, and sinus. The FDA have approved t-SNS as a preventive treatment for migraine.
Some studies suggest that practicing meditation can decrease the frequency of attacks and improve individuals' resilience to pain.
Meditation is increasingly explored as a way of relieving stress and pain, as Medical News Today have reported. Research suggests that meditation - spiritual meditation, in particular - can improve tolerance to pain in the case of migraines.
The study worked with participants who were dealing with migraine in their day-to-day lives. They were randomly assigned to practice one of four meditation types or relaxation techniques: spiritual meditation, internally focused secular meditation, externally focused secular meditation, or progressive muscle relaxation.
It was found that the people involved in spiritual meditation experienced migraine attacks less frequently and had a strengthened pain tolerance threshold.
MNT have also previously reported on studies that suggested that acupuncture could be an effective alternative treatment for chronic pain. A recent article published in JAMA found that acupuncture could reduce both the frequency and intensity of migraines without aura, which are migraines not accompanied by visual disturbances or temporary cognitive impairment.
This seems to support previous research with similar findings, which recommended acupuncture as a first port of call for people dealing with migraine who want to explore nonpharmaceutical approaches.
Do you experience migraines frequently? If so, how do they affect your lifestyle, and what are some approaches you take to cope with them? Do you follow traditional or nontraditional therapy to treat or prevent attacks? Let us know what your coping strategies are, and if there are any therapies you would like to know more about.