Management of Headache and Headache Medications

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Although the term "migraine" is often used to describe any severe headache , a migraine headache is the result of specific physiologic changes that occur within the brain, and lead to the characteristic pain and associated symptoms of a migraine. Migraines usually are associated with sensitivity to sound, light, and smells. A migraine attack may be accompanied by nausea or vomiting. This type of headache often involves only one side of the head, but in some cases, patients may have pain bilaterally or on both sides.

Aids to management of headache disorders in primary care (2nd edition)

The pain is often described as throbbing or pounding and it may be made worse with physical exertion. Not all headaches represent migraines, and migraine is not the only condition that can cause severe and debilitating headaches. For example, cluster headaches are very severe headaches that affect one side of the head in a recurrent manner occurring in a "cluster" over time. The pain is sometimes described as "drilling," and can be worse than migraine pain in some cases.

Cluster headaches are less common than migraine. Tension headaches are a more common cause of headache. These occur due to contraction of the muscles of the scalp , face, and neck. What is migraine with aura? In some cases, people with migraines have specific warning symptoms, or an aura, prior to the onset of their headache. These warning signs can range from flashing lights or a blind spot in one eye to numbness or weakness involving one side of the body. The migraine aura may last for several minutes, and then resolves as the head pain begins or may last until the headache resolves.

For patients who have never had an aura, it can be frightening and can mimic the symptoms of a stroke. Migraine and stroke may occur at the same time, but a causal link has not been established. When an ischemic stroke occurs during a migraine attack it is called a "migrainous infarction. Rarely, people with specific migraine symptoms may be related to a higher risk of stroke. Migraines may be a risk factor for stroke, in that strokes occur more frequently in people who have had migraines, but the strokes do not necessarily occur during migraine attacks.

What are the signs and symptoms of migraine headaches? The most common symptoms of migraine are:. A tension headache is described as being bilateral and the pain is not pulsating, but feels like pressure or tightness.

Headache Treatment Options and Remedies

While severity can be mild-to-moderate, the headache is not disabling and there is no worsening of the pain with routine physical activity; additionally, there is no associated nausea, vomiting, photophobia, or phonophobia. What causes migraine headaches? The specific cause of migraines is not known, but there may be fluctuations in certain neurotransmitters, chemicals that send messages between brain cells. These changes may predispose some people to develop migraine headaches.

What foods and other things trigger migraines? Many factors have been identified as migraine triggers. Not every individual who has migraine attacks will experience one when exposed to these triggers. If a person is unsure what specific triggers might cause a migraine, maintaining a headache diary can be beneficial to identify those individual factors that lead to migraine. How can you tell if it is a migraine or a different type of headache? No specific physical findings are found when patients are experiencing a routine migraine headache. If an abnormality is identified on physical examination, there should be suspicion of other possible causes for the headache.

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According to the International Classification of Headache Disorders 3 ICHD criteria for migraine without aura, a patient must have had at least five headache attacks fulfilling the following criteria:. Imaging the brain with an MRI and CT scans or performing a brain wave test electroencephalogram [ EEG ] is not necessary if the patient's physical examination is normal.

What are the treatments guidelines for migraine headaches? Migraine headache treatment can vary due to several factors. Usually, the treatment for migraines depends upon how frequently they occur, the type of medicine prescribed to prevent triggers and attacks or provide pain relief, and how long they last. Medications for acute and chronic migraines. The treatment of an acute migraine headache may vary from over-the-counter OTC medicines, like acetaminophen Tylenol and others , ibuprofen Advil , Motrin , etc.

Narcotics for pain. Narcotic pain medications are not necessarily appropriate for the treatment of migraine headaches and are associated with the phenomenon of rebound headache, where the headache returns -- sometimes more intensely -- when the narcotics wear off. In all cases of migraine, the use of acute pain therapies must be watched closely so that a patient does not develop medication overuse headache.

Too frequent use of many of the medications used to treat migraine headache can lead to increased headache occurrence, or even daily headaches. This type of headache phenomenon is known as medication overuse headache. Migraine prevention medications.

Headache Treatment

If an individual experiences frequent headaches, or if the headaches routinely last for several days, then preventive medications may be indicated. These may be prescribed on a daily basis in an effort to decrease the frequency, severity, and duration of migraine headaches. There are many different medications which have been shown to be effective in this role, including:. The specific migraine headache treatment that is selected for a patient is dependent on many other factors, including age, sex, blood pressure, and other pre-existing medical conditions.

Other patients may find that use of one of the new calcitonin gene-related peptide CGRP receptor antagonists, including erenumab Aimovig , fremanezumab Ajovy , or galcanezumab Emgality is beneficial to decrease their migraine frequency. These medications are injected monthly or quarterly every 3 months to treat migraine. What natural home remedies and lifestyle changes relieve migraines? Keep track of when migraines occur by using a headache diary or log to track pain levels, triggers, and symptoms.

In addition, patients should keep track of the migraine types they experience an individual can experience more than one type of migraine. This can help identify patterns that precede a migraine, as well as help identify factors that contribute to the development of the headache. Once these contributing factors are known, lifestyle modifications can lessen their impact. These modifications may include:. Some people find that exercises that promote muscle relaxation can help manage the pain of migraines.

Examples of types of mind-body exercises that can help encourage relaxation are:. There is no specific diet for people with migraines that will help relieve symptoms. However, certain foods can be triggers for migraines in susceptible people.

These foods include:. Understanding the particular triggers of your migraines and avoiding them may help some sufferers decrease the frequency of attacks.

Headache Treatments : How to Stop Migraine Headaches

What is the treatment for migraines during pregnancy? Can you take medication? Many women find their headaches stabilize or even resolve during pregnancy. This may be related to more consistent hormone levels that occur during pregnancy. To decrease the risk of birth defects , certain medications used to prevent migraines may need to be discontinued prior to a pregnancy. There are limited studies of drugs used to treat migraines during pregnancy. Acetaminophen is relatively safe when used in recommended doses. If a you are pregnant and are experiencing frequent headaches, your doctor or other health care professional may provide treatment alternatives.

Many migraine medicines, including the triptans, are not well studied in pregnancy, so the doctor needs to weigh the potential benefits to the patient against the risks to the fetus before prescribing these medications. What is the treatment for migraines in children? Migraines may occur in children. These drugs cause constriction of blood vessels and bring about a general interruption in the chain of chemical events that lead to a migraine.

Triptans include:. While specific triptans differ in their ability to prevent a recurrence of migraine headache , they are generally equally effective in their ability to provide relief. Triptans are more migraine-specific than the earlier ergotamines.


Another migraine drug used to abort the pain of a migraine is a combination product containing the vasoconstrictor isometheptene mucate, the sedative dichloralphenazone, and the analgesic acetaminophen Midrin. The FDA has classified isometheptene mucate as "possibly" effective for migraines, pending further review.

Antihistamines are also used to ease migraine symptoms. These drugs counteract the effect of histamine , a substance that dilates blood vessels and causes an inflammatory response in the body -- the same kinds of response seen during a migraine attack. Antihistamines are broadly grouped into sedating and non-sedating types.

An example of a sedating type is diphenhydramine ; an example of the non-sedating type is loratadine Claritin. Which medications are used for preventing migraines?