Northwest Herald

From Mercyhealth: Reducing the effects of migraines and improving your quality of life

A migraine is a primary headache disorder characterized by recurrent moderate-to-severe headaches, often accompanied by nausea, vomiting and/or sensitivity to light and sound.

A migraine is the result of a complex brain network disorder involving the cortex, hypothalamus, thalamus and brainstem in genetically predisposed individuals.

According to the American Headache Society, the overall prevalence of a migraine over a three-month period in the U.S. adult population is 15.3%, affecting approximately 20.7% of females and 9.7% of males. The global lifetime prevalence of migraines is estimated at 14%.

The human brain has several key areas that constantly talk to each other, especially when it senses pain. When something triggers a migraine, this complex communication system goes into overdrive. This involves a specific network of nerves and blood vessels in the head becoming very active. At the same time, a slow wave of altered electrical activity spreads across a part of the brain, temporarily changing how brain cells work. The result of all this is what we call migraine: a headache that’s usually on one side, feels throbbing, can be quite painful and sometimes comes with visual disturbances or other sensations beforehand.

Migraines can cause disabling effects on a person’s life, including migraine-associated disability, quality of life and functional disability affecting family, work and other life functions.

Migraine patients need to be assessed by a doctor who can readily exclude other serious conditions, such as intra-cranial bleed or tumor or Chiari malformation or systemic conditions like giant cell arteritis or phaeochromocytoma, to name a few. They can also make sure no complications such as a stroke have occurred.

There has been significant improvement in the treatment and prevention of this malady. With successful treatment, patients can realistically expect to have reduced migraine-related disability.

Acute treatment

Over-the-counter options like acetaminophen, aspirin, ibuprofen or naproxen are recommended for short-term relief. For moderate-to-severe migraines, triptans such as sumatriptan and zolmitriptan are suggested, often in combination with nonsteroidal anti-inflammatory drugs (NSAIDs). Metoclopramide and prochlorperazine can be used to manage nausea and vomiting associated with migraines.

If the above fails, providers can offer rimegepant or ubrogepant for the short-term treatment of a migraine. We inform patients about the risk of developing a medication overuse headache when starting acute treatment.

Preventive treatment

Metoprolol, propranolol, valproate and topiramate are recommended for preventing episodic migraines. Amitriptyline and venlafaxine are considered second-choice options for migraine prophylaxis.

Calcitonin-gene related peptide is a protein that plays a key role in migraines by causing blood vessels to widen and increase inflammation leading to headache pain. The gepants or monoclonal antibodies block the activity of CGRP and help prevent or reduce migraines. They are suggested for patients not responding to other treatments.

A provider can initiate candesartan or telmisartan for the prevention of episodic migraine.

Oral magnesium can be used for migraine prophylaxis. However, there was no clear benefit in using coenzyme Q10, feverfew, melatonin, omega-3, vitamin B2, or vitamin B6 for the prevention of headache.

In adult patients who’ve previously failed two to four classes of conventional oral treatments for migraine prevention, atogepant was found to be effective in controlling headaches.

Non-pharmacologic interventions

Aerobic exercise or progressive strength training is recommended for migraine prevention. Biofeedback, cognitive-behavioral therapy, yoga and mindfulness-based therapies are considered, though evidence is limited.

Dr. Tahir Mahmood is an internal medicine physician at Mercyhealth Woodstock. To schedule an appointment, call 815-337-7100.