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Migraines can be triggered by many everyday things. Different people respond to different triggers, so it is important to track your migraine patterns to help you avoid things that set off your migraine attacks. Common migraine triggers include:
Migraine Treatment Approaches
Migraines need a two-pronged approach: Treatment and prevention. Treatment uses medications that provide quick pain relief when attacks occur. These drugs include pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen (Tylenol, generic), triptans such as sumatriptan (Imitrex, generic), and ergotamine drugs.
Preventive strategies begin with non-drug approaches, including behavioral therapies and lifestyle changes. If headache attacks continue to occur at least once a week, or if your attacks do not respond well to treatment, your doctor may recommend you try preventive medication.
Migraine Prevention Guidelines
In 2012, the American Academy of Neurology (AAN) updated its guidelines for prevention of migraine in adults. The main treatments recommended by the AAN for migraine prevention are:
Antidepressants [amitriptyline (Elavil, generic) or venlafaxine (Effexor, generic)] are also considered for migraine prevention. OnabotulinumtoxinA (Botox) injections are approved for prevention of chronic migraine.
Five Migraine “Don’t’s”
In 2013, the American Headache Society issued a list for doctors and patients of five migraine tests and procedure that are unnecessary, and potentially harmful. The AHS recommends:
In 2013, the FDA advised that pregnant women should not take valproate products (valproate sodium, divalproex sodium, and valproic acid) for migraine prevention. There is evidence that these drugs can decrease IQ scores in children born to mothers who took the drug during pregnancy. The FDA is updating the prescribing lablels for these medications to emphasize that the risks of use in pregnant women clearly outweigh any benefits.
In 2013, the FDA approved a new form of sumatriptan for treatment of migraine pain and nausea. Zecurity is a battery-powered skin patch that is placed on the thigh or upper arm during a migraine attack. Pressing a button activates the patch to deliver the drug through the skin.
Migraine headaches are a type of neurovascular headaches, a category that also includes cluster headaches. Doctors believe that neurovascular headaches are caused by an interaction between blood vessel and nerve abnormalities. Migraine headaches are the second most common type of primary headache after tension-type headaches. A primary headache is a headache that is not caused by another disease or condition.
Migraine headaches typically have throbbing disabling pain on one side of the head, which sometimes spreads to affect the entire head. In fact, migraine comes from the Greek word hemikrania, meaning “half of the head.”
Migraines are classified as occurring either:
Auras are sensory disturbances that occur before a migraine attack that can cause changes in vision, with or without other neurologic symptoms. [For more information on auras, see Symptoms section of this report.]
Migraines typically occur as isolated episodic attacks, which can happen once a year or several times within one week. In some cases, patients eventually experience on-going and chronic migraine (previously called transformed migraine). Chronic migraines typically begin as episodic headaches when patients are in their teens or 20s, and then increase in frequency over time. A headache is considered chronic when it occurs on at least 15 days in a month, and often on a daily or near-daily basis.
The majority of chronic migraines are caused by overuse of analgesic migraine medications, both prescription pain reliever drugs and over-the-counter medications. Medication overuse headaches are also called rebound headaches. Obesity and caffeine overuse are other factors that may increase the risk of episodic migraine transforming to chronic migraine.
Chronic migraines may resemble tension-type headaches and it is sometimes difficult to differentiate between them. The two types of headaches can co-exist. It is not uncommon for patients with migraine headaches to also have tension-type headaches.
Menstrual Migraines. Migraines are often tied to a woman's menstrual cycle, typically in the first days preceding or beginning menstruation. Estrogen and progesterone fluctuations may play a role. About half of women with migraines report an association with menstruation. Compared to migraines that occur at other times of the month, menstrual migraines tend to be more severe, last longer, and not have auras. Triptan drugs can provide relief and may also help prevent these types of migraines.
Basilar Migraine. Considered a subtype of migraine with aura, this migraine starts in the basilar artery, which forms at the base of the skull. It occurs mainly in young people. Symptoms may include vertigo (a sensation of dizziness), ringing in the ears, slurred speech, unsteadiness, possibly loss of consciousness, and severe headaches.
Abdominal Migraine. This migraine tends to occur in children who have a family history of migraine. Periodic migraine attacks are accompanied by abdominal pain, and often nausea and vomiting.
Ophthalmoplegic Migraine. This very rare headache tends to occur in younger adults. The pain centers around one eye and is usually less intense than in a standard migraine. It may be accompanied by vomiting, double vision, a droopy eyelid, and paralysis of eye muscles. Attacks can last from hours to months. A computed tomography (CT) or magnetic resonance imaging (MRI) scan may be needed to rule out bleeding from an aneurysm (a weakened blood vessel) in the brain.
Retinal Migraine. Symptoms of retinal migraine are short-term blind spots or total blindness in one eye that lasts less than an hour. A headache may precede or occur with the eye symptoms. Sometimes retinal migraines develop without headache. Other eye and neurologic disorders must be ruled out.
Vestibular Migraine. These attacks produce episodic dizziness, which can develop alone or with headache and other typical migraine symptoms. Ringing in the ears (tinnitus) and ear fullness are common.
Familial Hemiplegic Migraine. This is a very rare inherited genetic migraine disease. It can cause temporary paralysis on one side of the body, vision problems, and vertigo. These symptoms occur about 10 - 90 minutes before the headache.
Status Migrainosus. This is a serious and rare migraine. It is so severe and lasts so long that it requires hospitalization.
The exact causes of migraine headaches are unknown. Doctors think that migraines may start with an underlying central nervous system disorder. When triggered by various stimuli, this disorder may set off a chain of neurologic and biochemical events, some of which subsequently affect the brain's blood vessel (vascular) system.
There is certainly a strong genetic component to migraines. Several different genes are probably involved.
Many brain chemicals (neurotransmitters) and nerve pathway disrupters appear to play a role in causing migraines. They include the neurotransmitter serotonin, magnesium deficiencies, and abnormalities in the channels within cells that transport electrical ions such as calcium.
Many types of events and conditions can alter conditions in the brain and trigger migraines. They include:
About 75% of all migraine sufferers are women. During childhood, boys and girls are equally affected. After puberty, migraines are more common in girls. Migraine most commonly affects women between the ages of 20 - 45.
Fluctuations of female hormones, such as estrogen and progesterone, appear to increase the risk for migraines and their severity in some women. About half of women with migraines report headaches associated with their menstrual cycle. For some women, migraines also tend to be worse during the first trimester of pregnancy, but improve during the last trimester.
Migraine headaches typically affect people between the ages of 25 - 55. However, migraine also affects about 5 - 10% of all children. Many children with migraine eventually stop having attacks when they reach adulthood or transition to less severe tension-type headaches. Children with a family history of migraine may be more likely to continue having migraines.
Migraines tend to run in families. About 70 - 80% of patients with migraine have a family history of the condition.
People with migraine may have a history of depression, anxiety, stroke, epilepsy, irritable bowel syndrome, or high blood pressure. These conditions do not necessarily increase the risk for migraine, but they are associated with it.
A migraine attack may involve up to four symptom phases: prodrome phase, auras, the attack, and the postdrome phase. These phases may not occur in every patient or every headache.
The prodrome phase is a group of vague symptoms that may precede a migraine attack by several hours, or even a day or two. Prodrome symptoms may include:
Auras are sensory disturbances that occur before the migraine attack in 1 in 5 patients. Visually, auras are referred to as being positive or negative:
Other neurologic symptoms may occur at the same time as the aura, although they are less common. They may include:
If left untreated, attacks usually last from 4 - 72 hours. A typical migraine attack produces the following symptoms:
Less common symptoms include tearing and redness in one eye, swelling of the eyelid, and nasal congestion, including runny nose. (Such symptoms are more common in certain other headaches, notably cluster headaches.)
After a migraine attack, there is usually a postdrome phase, in which patients may feel exhausted and mentally foggy for a while.
For many people, migraines eventually go into remission and sometimes disappear completely, particularly as they age. Estrogen decline after menopause may be responsible for remission in some older women.
Risk for Stroke and Heart Disease. Migraine or severe headache is a risk factor for stroke in both men and women, especially before age 50. Research indicates that migraine may also increase the risk for other types of heart problems.
Migraine with aura appears to carry a higher risk for stroke than migraine without aura, especially for women. Because of this, it is very important that women with migraine avoid other stroke risks such as smoking and possibly birth control pills. Some studies suggest that people who have migraine with aura are more likely than people without migraine to have cardiovascular risk factors (such as high cholesterol and high blood pressure) that increase the risk for stroke.
Emotional Disorders and Quality of Life. Migraines have a significant negative impact on quality of life, family relations, and work productivity. Studies indicate that people with migraines have poorer social interactions and emotional health than patients with many chronic medical illnesses, including asthma, diabetes, and arthritis. Many people who have migraines also suffer from anxiety (particularly panic disorders) and depression.
A National Headache Foundation-sponsored survey of migraine sufferers reported that:
Anyone, including children, with recurring or persistent headaches should consult a doctor. There are no blood tests or imaging techniques that can be used to diagnose migraine headaches. A diagnosis will be made on the basis of medical history and physical exam, and, if necessary, tests may be necessary to rule out other diseases or conditions that may be causing the headaches.
A diagnosis of migraine is usually made on the basis of repeated attacks (at least 5) that meet the following criteria:
The patient should try to recall what seems to bring on the headache and anything that relieves it. Keeping a headache diary is a useful way to identify triggers that bring on headaches, as well as to track the duration and frequency of headache attacks. Some tips include:
1 = Mild, barely noticeable
2 = Noticeable, but does not interfere with work/activities
3 = Distracts from work/activities
4 = Makes work/activities very difficult
5 = Incapacitating
Tell your doctor any other conditions that might be associated with headache, including:
The doctor will also need a general medical and family history of headaches or diseases, such as epilepsy, that may increase their risk. Migraine tends to run in families.
The doctor will examine the head and neck and will usually perform a neurologic examination, which includes a series of simple exercises to test strength, reflexes, coordination, and sensation. The doctor may ask questions to test short-term memory and related aspects of mental function.
Differentiating Between Migraines and Tension Headaches. Migraine and tension-type headaches have some similar characteristics, but also some important differences:
Differentiating Between Migraines and Sinus Headaches. Many primary headaches, including migraine, are misdiagnosed as sinus headaches, causing patients to be treated inappropriately with antibiotics. Many patients who think they have sinus headaches may actually have had a migraine. It is also possible for patients to have migraines with sinus symptoms such as congestion and facial pressure.
Sinus headaches occur in the front of the face, with pain or pressure around the eyes, across the cheeks, or over the forehead. They are usually accompanied by fever, runny nose or congestion, and fatigue. In sinus headaches, the nasal discharge is thick green or yellow. Nasal discharge in migraines is clear and watery.
A real sinus headache is a sign of an acute sinus infection (sinusitis), which responds to treatment with decongestants and may sometimes require antibiotics. If sinus headaches seem to recur, the patient is likely experiencing migraines.
The doctor may order a magnetic resonance imaging (MRI) scan to check for abnormalities that may be causing the headaches. For patients who have migraine headaches that are stable, imaging tests are usually not necessary unless the patient experiences new and serious symptoms. Symptoms that may suggest neurologic problems that warrant a MRI include:
For imaging tests, MRIs are preferred over computed tomography (CT) scans because they do not expose patients to radiation.
Headaches indicating a serious underlying problem, such as cerebrovascular disorder or malignant hypertension, are uncommon. (A headache without other neurologic symptoms is not a common symptom of a brain tumor.) People with existing chronic headaches may, however, miss a more serious condition by believing it to be one of their usual headaches. Such patients should call a doctor promptly if the quality of a headache or accompanying symptoms has changed. Everyone should call a doctor for any of the following symptoms:
Migraine treatment involves both treating acute attacks when they occur and developing preventive strategies for reducing the frequency and severity of attacks.
There are many medications for treating a migraine attack. Still, many patients are treated with unapproved drugs, including opoids and barbiturates that can be potentially addictive or dangerous.
The main types of medications for treating a migraine attack are:
It is best to treat a migraine attack as soon as symptoms first occur. Doctors generally recommend:
Try to guard against medication overuse, which can cause a rebound effect. Nearly all pain relief drugs used for migraine can cause rebound headache, and patients should not take any of these drugs more than 2 days per week. This is especially true for OTC medications that contain caffeine. If you find that you need to use acute migraine treatment more frequently, talk to your doctor about preventive medications.
Preventive strategies for migraine include both drug treatment and behavioral therapy or lifestyle adjustments.
Patients should consider using preventive migraine drugs if they have:
The main preventive drug treatments for migraine are:
OnabotulinumtoxinA (Botox) injection is also approved for prevention of migraine but it appears to work best for chronic (not episodic) migraine.
Butterbur (Petasites hybridus) is an herbal remedy that may be effective for migraine prevention. It is recommended by the American Academy of Neurology.
A preventive medication strategy needs to be carefully tailored to an individual patient, taking into account the patient's medical history and co-existing medical conditions. These drugs can have serious side effects.
A preventive medication is usually started at a low dose, and then gradually increased. It may take 2 - 3 months for a drug to achieve its full effect. Preventive treatment may be needed for 6 - 12 months or longer. Most patients take preventive medications on a daily basis, but some patients may use these drugs intermittently (for example, for preventing menstrual migraine).
Patients can also help prevent migraines by identifying and avoiding potential triggers, such as specific foods. Relaxation therapy and stress reduction techniques may also help. (See Lifestyle section in this report.)
Migraine Treatment for Children. Most children with migraines may need only mild pain relievers and home remedies (such as ginger tea) to treat their headaches. The American Academy of Neurology's practice guidelines for children and adolescents recommend the following drug treatments:
Migraine Prevention for Children. Non-drug methods, including biofeedback and muscle relaxation techniques, may be helpful. If these methods fail, then preventive medications may be used, although evidence is weak on the effectiveness of standard migraine preventive drugs in children.
If medication overuse causes rebound migraines to develop, the patient will need to stop taking the drug. (If caffeine is the trigger, a person may only need to reduce coffee or tea intake.) The patient usually has the option of stopping abruptly or gradually and should expect the following course:
Many different medications are used to treat migraines. Some migraines respond to non-prescription pain relievers such as ibuprofen, acetaminophen, naproxen, or aspirin. Among prescription drugs, triptans and ergotamine are the only types of medications approved by the U.S. Food and Drug Administration (FDA) for migraine treatment.
Other types of drugs, including opioids and barbiturates, are sometimes prescribed off-label for migraine treatment. Opioids and barbiturates have not been approved by the FDA for migraine relief, and they can be addictive.
All FDA-approved migraine treatments are approved only for adults. No migraine products have officially been approved for use in children.
Some patients with mild migraines respond well to over-the-counter (OTC) painkillers, particularly if they take a full dose of the medicine at the very first sign of an attack. OTC pain relievers, also called analgesics, include:
There are also prescription-only NSAIDs such as diclofenac (Cataflam, generic).
NSAID Side Effects. High dosages and long-term use of NSAIDs can increase the risk for heart attack, stroke, kidney problems, and stomach bleeding. Aspirin does not increase the risk for heart problems, but it can cause other NSAID-related side effects. Frequent or daily use of NSAIDs may worsen migraines and lead to the development of medication overuse headache. The American Headache Society advises against using OTC medications for headache more than twice a week.
Triptans (also referred to as serotonin agonists) were the first drugs specifically developed for migraine treatment. They are the most important migraine drugs currently available. They help maintain serotonin levels in the brain. Serotonin is one of the major brain chemicals involved in migraines.
Triptans are recommended as first-line drugs for adult patients with moderate-to-severe migraines when NSAIDs are not effective. Triptans have the following benefits:
Sumatriptan. Sumatriptan (Imitrex, generic) has the longest track record and is the most studied of all triptans. Sumatriptan is effective for many patients, but for some people headache recurs within 24 hours after taking the drug.
Sumatriptan is available as a fast-dissolving pill, nasal spray, injection, orskin patch. Injected sumatriptan works the fastest of all the triptans and is the most effective, but it can cause pain at the injection site. The nasal spray form is absorbed more quickly than the oral form. Some patients report relief as soon as 15 minutes after administration. The spray tends to work less well when a person has nasal congestion from cold or allergy. It may also leave a bad taste.
The newest form of sumatriptan (Zecurity) is a single-use battery-powered skin patch that is applied to the upper arm or thigh when a migraine attack occurs. Pressing a button activates the patch to deliver the drug during a 4-hour period. The patch is approved to treat both migraine pain and nausea.
Other Triptans. Newer triptans include almotriptan (Axert), zolmitriptan (Zomig), naratriptan (Amerge, generic), rizatriptan (Maxalt), frovatriptan (Frova), and eletriptan (Relpax). Treximet combines in one pill both sumatriptan and the anti-inflammatory pain reliever naproxen (Aleve, generic). Frovatriptan is also recommended for prevention of menstrual migraine; naratriptan and zolmitriptan may also possibly be effective for menstrual migraine.
Although triptans, (like all migraine medications), are approved only for adults, researchers are investigating zolmitriptan for treating migraines in adolescents.
Side Effects. Side effects of triptans may include:
Complications of Triptans. The following are potentially serious problems.
The following people should avoid triptans or take them with caution and only under a doctor's supervision:
Drugs containing ergotamine (commonly called ergots) constrict smooth muscles, including those in blood vessels, and are useful for migraine. They were the first anti-migraine drugs available. Ergotamine is available by prescription in the following preparations:
Ergotamine does not work as well as triptans but may still be helpful for patients with status migrainous or those with frequent recurring headaches.
Side Effects. Side effects of ergotamine include:
The following are potentially serious problems:
The following patients should avoid ergots:
Ergotamine can interact with other medications, such as antifungal drugs and some antibiotics. All ergotamine products approved by the FDA contain a "black box" warning in the prescription label explaining these drug interactions. The FDA-approved ergotamine products are:
If migraine pain is very severe and does not respond to other drugs, some doctors recommend painkillers containing opioids. Opioid drugs include morphine, codeine, meperidine (Demerol, generic), and oxycodone (Oxycontin)]. Butorphanol is an opioid in nasal spray form that may be useful as a rescue treatment when others fail.
Opioids are not approved for migraine treatment and should not be used as first-line therapy. Nevertheless, opioid products are prescribed to many patients with migraine, sometimes with dangerous results. For example, following reports of several drug-related deaths, the FDA warned that the cancer pain pill fentanyl (Fentora, generic) should not be used to treat patients with migraine or others conditions for which the drug is not specifically approved.
Side Effects. Side effects for all opioids include drowsiness, impaired judgment, nausea, and constipation. There is a risk for addiction, and these drugs can become ineffective with long-term use for chronic migraines. They may also increase the risk of making episodic migraines become chronic and heightening sensitivity to pain. Doctors should not prescribe opioids to patients at risk for drug abuse, including those with personality or psychiatric disorders.
Metoclopramide (Reglan, generic) is used in combination with other drugs to treat the nausea and vomiting that sometimes occur either as a medication side effect or migraine symptom. Metoclopramide and other anti-nausea drugs may help the intestine better absorb migraine medications. The battery-powered sumatriptan skin patch (Zecurity) is approved to treat both migraine nausea and pain.
The FDA’s approved drugs for prevention of migraine are:
Propanolol and timolol are beta-blocker drugs. Divalproex, valproate, valproic acid, and topiramate are anti-seizure drugs. Many other drugs are also being used or investigated for preventing migraines.
Beta blockers are usually prescribed to reduce high blood pressure. Some beta blockers are also useful in reducing the frequency of migraine attacks and their severity when they occur. Propranolol (Inderal, generic) and timolol (Blocadren) are approved specifically for prevention of migraine. Metoprolol (Lopressor, generic) is also recommended and atenolol (Tenormin, generic), and nadolol (Corgard, generic) may also be considered for migraine prevention.
Side Effects. Side effects may include:
If side effects occur, call your doctor. Never abruptly stop taking a beta-blocker because this can increase the risk for dangerous heart rhythms, heart attack, or other heart problems. Some evidence suggests that people with migraines who have had a stroke should avoid beta blockers.
Anti-seizure drugs, also called anticonvulsant drugs, are commonly used for treating epilepsy and bipolar disorder. Divalproex sodium (Depakote, Depakote ER, generic), valproic acid (Stavzor, Depakene, generic), and valproate sodium (Depacon, generic) are collectively referred to as valproate products and are all approved for prevention of migraine. Topiramate (Topamax, generic) is another anti-seizure drug approved for migraine prevention. Valproate products and topiramate are the only anti-seizure drugs that are approved for migraine prevention.
Side Effects. Anti-seizure medication side effects vary by drug but may include:
Valproate products should never be used by pregnant women for prevention of migraine. When taken during pregnancy, these drugs can cause decreased IQ scores in children. Topiramate can also increase the risk for birth defects, particularly cleft palate Women who are of child-bearing age and considering pregnancy should discuss with their doctors other types of migraine preventive medication.
All anti-seizure drugs can increase the risks of suicidal thoughts and behavior (suicidality). The highest risk of suicide can occur as soon as 1 week after beginning drug treatment and can continue for at least 24 weeks. Patients who take these drugs should be monitored for signs of depression, changes in behavior, or suicidality.
Amitriptyline (Elavil, Endep, generic), a tricyclic antidepressant drug, has been used for many years as a first-line treatment for migraine prevention. It may work best for patients who also have depression or insomnia. Tricyclics can have significant side effects, including disturbances in heart rhythms, and can be fatal in overdose. Although other tricyclic antidepressants may have fewer side effects than amitritpyline, they do not appear to be particularly effective for migraine prevention.
Venlafaxine (Effexor, generic) is another antidepressant recommended for migraine prevention. It is a serotonin norepinephrine reuptake inhibitor (SNRI). Serotonin-reuptake inhibitors (SSRIs), such as fluoxetine (Prozac, generic), do not appear to be effective for migraine prevention.
OnabtulinumtoxinA (Botox) is approved for preventing chronic migraine in adults. Botox is given by multiple injections to the head and neck area about every 12 weeks. These injections may help to dull future headache symptoms. Botox appears to work best for chronic migraines. It has not been shown to work for migraines that occur less frequently than 14 days a month or for other types of headaches (such as tension headaches). The most common side effects are neck pain and headache.
Other types of medications and treatments are being used or investigated for prevention of migraines.
Triptans. Frovatriptan is effective for prevention of menstrual migraines. Naratriptan (Amerge, generic) and zolmitriptan (Zomig) may also be helpful.
NSAIDs. Certain over-the-counter and prescription nonsteroidal anti-inflammatory drugs (NSAIDs) may be helpful for migraine prevention. They include naproxen (Aleve, generic), ibuprofen (Aleve, Motrin, generic), fenoprofen (Nalpron), and ketoprofen (Nexcede, generic). However, daily use of NSAIDs can cause stomach problems and may also lead to a condition called medication overuse headache.
ACE Inhibitors. Commonly used for treating high blood pressure, angiotensin converting enzyme (ACE) inhibitors such as lisinopril (Prinivil, generic) block the production of the protein angiotensin, which constricts blood vessels and may be involved in migraine.
Angiotensin-Receptor Blockers. Angiotensin-receptor blockers (ARBs), such as candesartan (Atacand), are another type of high blood pressure medications being studied for migraine prevention.
Histamine. Subcutaneous (under the skin) injections of histamine may be helpful for migraine prevention.
Neurostimulation Devices. Researchers are investigating a transcranial magnetic stimulation (TMS) device to help stop migraines before they occur. The hair dryer-size device is held to the back of the head and delivers quick magnetic pulses. The device is used when a patient experiences the first signs of a migraine. Other types of nerve stimulation devices are also under investigation.
Nasal Devices. New types of nasal sprays and powders are being researched. Some of them use capsaicin, the chemical found in cayenne peppers, to help relieve pain.
Herbs and Dietary Supplements. Certain herbs and dietary supplements may be helpful for migraine prevention. See Non-Drug Treatments and Lifestyle Changes section of this report.
There are several ways to prevent migraine attacks. You should first try a healthy diet, the right amount of sleep, and non-drug approaches (such as biofeedback) for prevention.
Behavioral techniques that reduce stress and empower the patient may help some people with migraines. They generally include:
Behavioral methods may help counteract the tendency for muscle contraction and uneven blood flow associated with some headaches. They may be particularly beneficial for children, adolescents, pregnant and nursing women, and anyone who cannot take most migraine medications. Studies generally find that these techniques work best when used in combination with medications.
Biofeedback. Many studies have demonstrated that biofeedback is effective for reducing migraine headache frequency. Biofeedback training teaches the patient to monitor and modify physical responses, such as muscle tension, using special instruments for feedback.
Relaxation Therapy. Relaxation therapy techniques include relaxation response, progressive muscle relaxation, visualization, and deep breathing. Muscle relaxation techniques are simple and easy to learn, and can be effective. Some patients may also find that relaxation techniques combined with applying a cold compress to the forehead may help provide some pain relief during attacks. Some commercially available products use a pad containing a gel that cools the skin for several hours.
Cognitive Behavioral Therapy. Cognitive-behavioral therapy (CBT) teaches patients how to recognize and cope with stressors in their life. It can help patients understand how their thoughts and behavior patterns may affect their symptoms, and how to change the way the body responds to anticipated pain. CBT may be included with stress management techniques. Research indicates that CBT is most effective when combined with relaxation training or biofeedback.
Acupuncture is a Chinese medicine technique that uses thin needles to stimulate specific points aligned with energy pathways in the body. Studies have showed mixed results on the benefits of acupuncture for preventing migraine.
Making a few minor changes in your lifestyle can make your migraines more bearable. Improving sleep habits is important for everyone, and especially those with headaches. What you eat also has a huge impact on migraines, so dietary changes can be extremely beneficial, too.
Avoid Food Triggers. Avoiding foods that trigger migraine is an important preventive measure. Common food triggers include monosodium glutamate (MSG), processed lunch meats that contain nitrates, dried fruits that contain sulfites, aged cheese, alcohol and red wine, chocolate, and caffeine. However, people’s responses to triggers differ. Keeping a headache diary that tracks diet and headache onset can help identify individual food triggers.
Eat Regularly. Eating regularly is important to prevent low blood sugar. People with migraines who fast periodically for religious reasons might consider taking preventive medications.
Stay Physically Active. Exercise is certainly helpful for relieving stress. An analysis of several studies reported that aerobic exercise in particular might help prevent migraines. It is important, however, to warm up gradually before beginning a session, since sudden, vigorous exercise might actually precipitate or aggravate a migraine attack.
Limit Estrogen-Containing Medications. Medications that contain estrogen, such as oral contraceptives and hormone replacement therapy, may trigger migraines or make them worse. Talk to your doctor about whether you should stop taking these types of medications or reduce the dosage.
Manufacturers of herbal remedies and dietary supplements do not need Food and Drug Administration approval to sell their products. Just like a drug, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. There have been several reported cases of serious and even lethal side effects from herbal products. Patients should always check with their doctors before using any herbal remedies or dietary supplements.
In 2012, the American Academy of Neurology (AAN) updated its guidelines on migraine prevention to include complementary treatments. Based on reviews of clinical studies, the AAN recommends:
Although not specifically recommended by the AAN, other herbal and dietary supplements associated with migraine prevention include:
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