Migraine Relief Guide
The pain caused by a serious case of migraine can be devastating and make it impossible to work. Likely, all you will be able to have on your mind is finding a place to rest and close your eyes. It follows then, that finding migraine relief and prevention is extremely important.
What separates migraines from headaches is that migraines are more frequent, in other words, migraines are chronic headaches.
In a typical example, the migraine will be connected with other symptoms such as nausea, vomiting, and extreme sensitivity to light and sound. Likewise, it is not uncommon to experience that symptoms or signs, like flashes of light, blind spots, or tingling in your arms / legs, precede the migraine. These symptoms or signs are referred to as auras.
While there typically is no way to completely cure migraines, a combination of the right medications, home remedies, and lifestyle improvements, can lead to drastic improvements in the condition.
If you suffer from migraines, it is important to talk to your doctor and agree on a comprehensive course of treatment, taking into consideration the three factors mentioned above.
What are the symptoms of a migraine?
Most often, migraines start in childhood, adolescence, or the beginning of adulthood.
A case of migraine will typically be accompanied by:
- Pain ranging from significant to very severe. The pain can be isolated at one side of the head, but might also affect both sides
- The pain might be a pulsating or throbbing sensation
- The condition gets worse with physical activity
- The condition is so severe it makes regular activities difficult to carry out
- Nausea, possible with vomiting
- Heightened sensitivity to light and sound
A migraine will usually last from four to 72 hours if nothing is done to treat it. It varies from each person how frequent the “attacks” occur. Some have migraines several times a month, for others it happens a lot less.
Migraines are often divided into two categories, so-called common migraines and classic migraines. The distinction lies in whether the headaches are preceded or accompanied by auras, classic migraines are, while common migraines are not. As mentioned, auras can be seeing flashes of lights or a sensation of pins and needles in arm(s) or leg(s).
Even if you do not have auras, you may experience these feelings several hours, or a day, preceding your migraine:
- Feeling of elation
- Feeling intense energy
- A craving for sweets
- Feeling thirsty
- Feeling drowsy
- Feeling irritable
- Feeling depressed
What Signs Indicate that it is Time to See a Doctor?
Too often migraines go untreated. If you suspect that you have migraines, it is important to consult your doctor, so you can get started on the treatment best suited for you. The best, safest start to migraine relief is to talk to your doctor.
It can be helpful to keep a record of the headaches and how you responded to them, this will make it easier to find the best plan of treatment.
What Signs Indicate that You Should Seek Immediate Help?
Certain migraine-like symptoms can indicate another, serious medical issue. If you experience any of the following, seek medical help immediately:
- A sudden, very severe headache, feeling like a thunderclap
- Headache accompanied by fever, stiff neck, rash, mental confusion, seizures, double vision, weakness, numbness or trouble speaking
- Headache following an injury to the head
- Chronic headache that is more severe when it follows coughing, exertion, straining or sudden movement
- If you are above 50 years old and experience new headache pains
What Causes Migraines?
What causes migraines is not fully understood. It seems clear though, that both genetics and environmental factors are important.
A change in the trigeminal nerve, which is an important pain pathway, might lead to migraines.
Other causes possibly involved are brain chemicals in imbalance. The most significant being a chemical that contributes to regulating pains in the nervous system, known as Serotonin. It is a fact that Serotonin levels drop during migraines. It is thought that this drop might trigger the release of neuropeptides, these will go to the outer covering of the brain and cause headache.
While the precise cause of the condition is not fully understood, certain triggers for people suffering from migraine are known.
Changes in estrogen levels have been shown to trigger “attacks” in women with diagnosed migraine. This means that the frequency of headaches often increase right before and during periods, where estrogen levels drastically decrease. Others experience migraines during pregnancy and/or menopause.
Certain foods are capable of triggering migraines. These include alcohol, cheeses, chocolate, caffeine, and salty foods. It is important to eat regular meals, as skipping meals or fasting can trigger migraines.
It is well-known that high stress levels are a frequent trigger of migraines.
Bright lights, sun glare and loud sounds also trigger headaches. As does certain smells, both pleasant ones, like perfume, and unpleasant ones, like gasoline or secondhand smoke.
Irregular sleeping patterns are also an offender. Avoid missing sleep, as well as oversleeping. In the same vain, jet lag can also trigger headaches.
Extreme physical strain and exertion can provoke “attacks”.
Several medications are known to aggravate the condition.
What Makes a Person More Prone to Migraines?
Certain things exist that will increase the risks of getting migraines. These include family history, age and gender.
It is common for people who suffer from migraines to have a family history of this condition. You will be at a much higher risk, if one or even both your parents are afflicted with migraines.
Age is another important factor, you will be much more likely to get migraines if you are younger than 40. The statistics show that half of all people with migraines began having them before they reached 20. It also shows that the most afflicted age group is people between 30 and 39 years old.
Gender matters too, as women’s likelihood to have migraines are three times higher than men’s. Interestingly, headaches have a tendency to affect boys to a higher degree than girls before puberty, but by puberty, and later, girls are a lot more affected.
What Are Complications Connected to Migraines?
There is a very real risk that efforts to relieve your pain can lead to additional problems. These include:
Nonsteroidal anti-inflammatory drugs, such as ibuprofen and aspirin, are meant to relieve migraine pain, but can cause abdominal pain, bleeding and ulcers. The risk is particularly high, if they are used for long periods of time and/or in large doses.
Additionally, using over-the-counter, or even prescription, headache medication in excess of 9 days a month or in too high quantities, might result in a severe complication referred to as rebound headaches. Rebound headaches happen as excessive use of medication actually begin to trigger headaches and stop relieving pain. It can result in a vicious cycle, where the additional headaches caused by the medication, makes you use even more of it.
A potentially life- threatening situation, known as serotonin syndrome, can occur as a drug interaction if you use certain medications intended for migraine, called triptans, together with certain antidepressants, named selective serotonin reuptake inhibitors, or serotonin and norepinephrine reuptake inhibitors. These include common drugs such as Zoloft, Prozac and Paxil. Serotonin syndrome, while rare, is important to be aware of because of its potentially bleak consequences.
Which Self-care Measures Might be Helpful for Migraine Relief?
Certain lifestyle changes can make a difference in the severity and frequency of your migraines.
Muscle relaxation, meditation, and yoga, do not require equipment and can be helpful in relieving stress and helping you to relax. They can be learned in classes or by books, video or audio at home. Another idea is to spend minimum half-hour every day doing something relaxing, such as listening to music, taking a hot bath, reading, or whatever you find the most comforting.
Develop healthy sleeping habits. This entails going to sleep and waking up at regular times, sleeping uninterrupted, and sleeping an appropriate amount of hours. An average adult needs about six to eight hours every night, do not sleep significantly less or more.
If you feel a headache approaching, try to rest and relax in a dark, quiet place. You can also try to place an ice pack, wrapped in a cloth, on the back of your neck and you can carefully apply pressure to aching spots on your scalp.
Even after seeing your doctor, it can be helpful to keep a headache diary. As the diary expands, it will help you discover what triggers migraines and what relieves them.
How Can Migraines Best be Prevented?
Certain lifestyle changes can reduce frequency and severity of migraines, this is the case whether or not you take preventive medications.
Certain foods have a tendency of triggering migraines in some, if you have experienced this in the past, do your best to avoid these foods. The same goes for problematic scents.
In general, establish a healthy lifestyle.
Regular sleep patterns and regular meals are beneficial. Trying to control stress is also important, since this is a well known cause of migraines.
Regular exercise reduces tension and stress. Choose a aerobic exercise you enjoy, for example walking, swimming, or cycling. Since sudden, extreme exercise can cause headaches, you should warm up slowly and never push yourself too hard.
Obesity is also suspected of being a factor in migraines, so keep your weight at a healthy level.
For women who suffer from migraines where estrogen seems to be a trigger, try to avoid using or reduce the amount used of medications containing estrogen. This includes birth control pills and hormone replacement therapy. Consult your doctor to find the best alternatives and/or dosages for you.
What Is Useful to Do as Preparation for a Doctor’s Appointment?
Most likely the first doctor you will see is your primary care provider. Depending on the state of your condition, you might thereafter be referred to a specialist, for example a neurologist.
Appointments can be short; therefore good preparation is needed to cover as much territory as possible. Following are some helpful tips to get prepared for an appointment, allowing you to get your migraine relief underway, as effectively as possible.
Make a list of the symptoms you have experienced, making sure also to include those that might not be related to the migraine.
Make a list of important personal information, major stresses, and recent changes in your life.
List all medications (including vitamins and supplements) that you are using. Take particular care in listing all medications used to relieve your headaches, as well as the doses of the medications.
It is a good idea to bring a friend, family member, or significant other, as it is sometimes difficult to remember all information provided during an appointment. If you miss or forget anything, a person who accompanies you might remember. Plus, having support is always beneficial, for example to reduce stress.
Writing a list of questions to ask the doctor is helpful, since you might otherwise forget in the “heat” of the appointment. Even better is to list your questions starting with the most important and ending with the least important.
Some fundamental questions regarding migraines are:
- What might be triggering the migraines?
- What are other possible causes for the symptoms?
- Do I need any tests?
- Are the migraines temporary or chronic?
- What is the best way to go from here?
- Are there any alternatives to the primary course of action suggested?
- How can I improve my lifestyle and diet?
- How can I best manage my migraine in connection with my additional health conditions?
- Does any generic alternative to the medicine you are prescribing exist?
- Can I get your recommendations in written form or as a brochure?
The fact that you make a list of questions, should not stop you from asking additional questions that might arise during the appointment.
What Can be Expected from the Doctor?
Being prepared to answer the questions your doctor is likely to ask, is another way to use the time most effectively.
Your doctor might ask questions such as:
- When was the first time you experienced symptoms?
- Have your symptoms been chronic or more occasional?
- What is the severity of your symptoms?
- Does anything improve the symptoms?
- Does anything make the symptoms worse?
What Can be Done While Waiting for an Appointment?
As mentioned, keeping a diary regarding your headache will help your doctor pinpoint what causes, worsens, and improves your migraines. Important points to note are, when your “attacks” start, for how long they last, and what provides effective migraine relief. If you use any headache medications, be sure to note what effect they have. Write down what meals you had, and at what times, in the 24 hours preceding any attack. Did you experience unusual stress? How did you feel and what were you doing when the migraine struck?
Since stress often triggers migraines, it is important to do your best to avoid stressful situations; it can also be very beneficial to use stress-reduction techniques, such as meditation.
Sleep is very important, you should get good, uninterrupted sleep, without oversleeping. It is recommended to get between six to eight hours of sleep every night.
How will Testing and the Diagnosis be Carried Out?
Provided you have a family history of migraine and the symptoms match a typical case, your doctor will most likely diagnose the condition on nothing further than medical history and a physical exam.
However, if any of the danger signs listed earlier occurs, such as unusual, severe or sudden headaches, a variety of additional tests might be conducted, in order to exclude other possible causes.
An imaging procedure, known as Computerized Tomography, can provide cross-sectional view of the brain. This is done by using a series of computer-directed X-rays. A C.T. can help the doctors discover possible tumors, infections and other medical problems that might be triggering the headaches.
A procedure known as Magnetic Resonance Imaging, uses radio waves in combination with a powerful magnet, thereby producing extremely detailed cross-sectional images of your brain. MRI scans will enable the doctors to diagnose medical conditions such as tumors, strokes, aneurysms, and neurological diseases. It is likewise used in examining the blood vessels supplying the brain.
In case your doctor suspects a condition other than migraine is causing headaches, he or she might perform a spinal tap (also known as a lumbar puncture). This is done by a thin needle inserted between two vertebrae in your lower back, which will extract a dose of cerebrospinal fluid for further analysis.
How can Migraine be Treated?
While no absolute cure exists, a long list of drugs exists, that in fact has been specifically designed to relieve migraines. Additionally, certain drugs designed to treat other conditions may also be helpful in relieving and/or preventing migraines.
Medications used in the treatment of migraines, can be categorized into two groups:
Medications designed to relieve pain. Treatment using these drugs are often referred to as acute or abortive treatment. They should be taken during migraine “attacks” and will help relieve the symptoms already present.
Medication designed to prevent further “attacks”. These should be taken regularly, for example on a daily basis, and will help reduce the severity and/or frequency of the headaches.
Choosing the best strategy for you depends on a number of factors. How often does the “attacks” occur? How severe are they? Do you have other medical conditions? How impaired does your migraine leave you?
Finding the best course of treatment should be done in cooperation with your doctor.
How Will the Best Results using Pain Relieving Medications be Achieved?
It is important to take the pain relieving medications as soon as the signs or symptoms of a migraine show.
If possible, it might help to rest in a dark room after taking them:
Nonsteroidal anti-inflammatory drugs, for example ibuprofen or aspirin, might relieve mild migraines to a certain degree. Some drugs are marketed specifically for migraine, using a combination of acetaminophen, aspirin and caffeine. These might likewise relieve moderate migraines, but they are still not effective by themselves when it comes to severe migraines. As mentioned, excessive use of these medications can result in stomach aches, ulcers, gastrointestinal bleeding and even rebound headaches.
Patients suffering from severe migraine often choose the drugs known as triptans. Their strength lies in their ability to effectively relieve the pain, nausea and sensitivity to light and sound, common in severe migraines. Triptans has possible side effects such as nausea, dizziness and muscle weakness. People at risk for strokes and heart attacks should not use them. In 2008 a tablet combining Sumatriptan and Naproxen Sodium, called Treximet, was made available, it has been shown to be more effective in relieving migraine symptoms than the separate medications on their own.
Ergotamine is a much more inexpensive alternative, but, sadly, it is also less effective than triptans. It is most effective for people whose migraines last more than 48 hours. Dihydroergotamine is derived from ergot, and seems both more effective and with fewer side effects.
Since migraines often are accompanied by nausea, medication to relieve this is appropriate. It is most often combined with other medications. Examples of these drugs are metoclopramide and prochlorperazine.
Medications, known as Butalbital combinations, combine the sedative qualities of butalbital with aspirin or acetaminophen. They are occasionally used in the treatment of migraine. Some combinations further include caffeine or codeine, however these carry a substantial risk of rebound headaches. Therefor they should be used with caution and infrequently.
As a last resort, medications containing narcotics, such as codeine, are occasionally used in migraine relief for people unable to take triptans or ergot. They are addictive, hence they are only used as a desperate, last resort.
How Will the Best Results using Preventive Medications be Achieved?
Most doctors agree that medication used to prevent migraine “attacks” are used too little. It is estimated, that about half of those who suffer from migraines would benefit by taking preventative medication, however only 1 in 10 actually use it.
If you suffer more than one severe attack a month, if medications supposed to relieve pain no longer helps, or if prolonged auras, numbness, and weakness accompany your migraines, you might benefit from preventive therapy.
The benefits of preventive medications mainly consist in reducing the frequency, severity and length of migraine “attacks”, additionally it might also be able to increase the effectiveness of pain relieving medications. Preventive medication might be taken daily or sometimes only as predictable triggers, e.g. menstruation, approaches.
It is rare that preventive medications completely eliminate migraines and some have potentially serious side effects. If preventative medicine provides good results and you have been free of migraines for about a year, it might be recommended to slowly reduce the dosage to observe if your migraines come back.
Beta blockers can be used as preventive migraine relief. They are regarded as first-line treatment agents. Calcium channel blockers may also be able to reduce migraines and to relieve symptoms stemming from auras. Additionally, antihypertensive medications lisinopril and candesartan can be used to reduce the length and severity of migraine “attacks”. Why these drugs work is not fully understood. Possible side effects include dizziness, drowsiness, and lightheadedness.
Some antidepressants are suited to prevent certain types of headaches, one of them being migraines. The most effective of these are tricyclic antidepressants, e.g. amitriptyline, nortriptyline, and protriptyline. Like beta-blockers, antidepressants are considered among first-line treatments. They work by affecting the level of brain chemicals, such as serotonin. Having a depression is not necessary to benefit from these medications.
Anti-seizure drugs, e.g. divalproex, topiramate, and gabapentin, appear helpful in reducing the frequency of migraines. Potential side effects, especially at high doses, include nausea, vomiting, diarrhea, cramps, hair loss, and dizziness.
An antihistamine, called Cyproheptadine, is used as a preventive treatment. It works since it specifically affects serotonin levels. It is most often used as a preventive measure for children.
What Alternative Medicine Might be Helpful?
Several non-traditional therapies might be beneficial in relieving chronic headache pain.
In acupuncture many thin, disposable needles are inserted into areas of your skin at defined points. Research has found acupuncture to be helpful in relieving headache pain.
Biofeedback seems very effective in relieving migraine pain. It is relaxation technique that uses special equipment and aims to teach how to monitor and control physical responses connected to stress, e.g. muscle tension.
Massage might reduce the frequency of migraines. It is also known to be effective in improving sleep, which adds additional benefits to preventing migraines.
Some evidence indicates that the herbs feverfew and butterbur can help prevent or reduce the severity of migraines. They should not be used while pregnant. High doses of riboflavin may also prevent “attacks” by improving on small imperfections in the brain cells. Coenzyme Q10 supplements might be helpful to some. Though studies does not all agree, oral magnesium sulfate supplements might make headaches more infrequent for some people. Magnesium can also be taken intravenously, which seems to help some people, especially people with magnesium deficiencies, during acute headaches.
Before starting any of these treatment, ask your doctor if they are appropriate for you.
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