Management of Migraine

A migraine can be described as having severe throbbing or pulsatile headache (usually on one side of the head) which is often by accompanied with nausea, vomiting and sensitivity to bright light or loud sounds. The headache (usually one sided) lasts between 4 to 72 hours and can affect the patient’s daily life as well as work. It is important to see a doctor to have a COMPLETE PHYSICAL ASSESSMENT of your symptoms and to EXCLUDE the following conditions (which may give SIMILAR SYMPTOMS as migraine) such as brain tumour, brain aneurysm or haemorrhagic stroke.

Migraine Treatment

Around 25% of people with migraine find it difficult to control their condition even with medications.  Migraine is difficult to manage because of the following reasons;

• The severity can vary from mild ache to debilitating pain
• The duration of migraine can last from just a few hours to several days
• There may be no warning signs of an impending attack (migraine attack is unpredictable)
• The trigger factors to each attack may differ each time and varies between individuals

The treatment rationale for all migraine is 3-fold;

• Immediate pain relief
• Prevention (or reduction of the severity) of future migraine attacks
• Treatment of the nausea and vomiting (if these symptoms are severe)

1. Immediate pain relief medication is known as abortive or acute treatment aim to provide pain relief to the unpleasant migraine symptoms which are pain, nausea and light sensitivity. These medications however, do not prevent migraine.  These medication should be taken short term and stopped when the symptoms have gone.  The treatment options include;

• Paracetamol or NSAIDs (also known as Non-Steroidal Anti-Inflammatory Drugs such as Ibuprofen, Naproxen, Flurbiprofen. Etodolac, Indomethacin, Mefenamic acid, Meloxicam, Piroxicam and Diclofenac). (The side effects include dyspepsia, gastritis or risk of bleeding)
• Selective Serotonin Receptor Agonists (also known as SSRA) such as Sumatriptan (Imigran) (The side effects include flushing, tightness in the throat or chest, feeling warm or cold, drowsiness, tiredness, weakness, dizziness, upset stomach, diarrhoea or muscle cramps)
• Calcitonin Gene-Related Peptides antagonists (also known as anti-CRGP) such as Rimegepant (Nurtec). (The side effects include dry mouth, nausea or sleepiness)

2. Preventive medication is usually taken on a longer term basis to either prevent future attacks or if there are future attacks, the symptoms would be milder and not be so severe.  These medication should considered when the patient is having frequent attacks which is affecting their work or daily activities. A simple rule is that if you have ‘more than 15 headaches a month for more than 3 consecutive months’, you may be a good candidate for preventive medication. The treatment options include;

• Blood pressure medications such as beta-blockers (Propranolol) may be useful in preventing migraines with aura
• Anti-depressant medication (such as Amitriptyline). (The side effects and risks include blurred vision, dry mouth, constipation, nausea, tiredness, difficulty passing urine, sexual dysfunction and headache)
• Anti-Epilepsy medications (such as Sodium Valproate and Topiramate).  (The side effects and risks include nausea, dizziness, tiredness or drowsiness)
• Calcitonin gene-related peptides antagonists such as Rimegepant (Nurtec). (The side effects and risks include dry mouth, nausea or sleepiness)

3. Anti-nausea Medication such as Chlorpromazine, Metoclopramide or Prochlorperazine may be prescribed together with the pain medications if nausea and vomiting symptoms are severe.

Do discuss with your Doctor or a Neurologist your Treatment Options for your Migraine Symptoms

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Disclaimer. TELEME blog posts contains general information about health conditions and treatments. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. The information is not advice and should not be treated as such. 

If you think you may be suffering from any medical condition, you should seek immediate medical attention from your doctor or other professional healthcare providers. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.