General Health Treatment of Migraine Self-help Keep a diary of your migraines. Record your symptoms, how bad they get, how long they last and what medication you use, if any. This can help you to spot things that may trigger or make your migraines worse. It’s best to rest in a quiet, darkened room and sleep if you can. You may want to try using a cold compress, such as an ice pack or ice wrapped in a towel to ease your headache. Don’t apply ice directly as it can damage your skin. A hot compress may also help. You may want to try applying pressure to the pulse points on the side of your forehead or neck. Medicines Acute Therapy Different types of medicine are used to treat migraines, depending on your symptoms and the severity of your migraines. If you use any type of painkiller too frequently, it may become less effective and cause further headaches called ‘medication overuse headaches’. This can happen if you regularly use painkillers for 10 to 15 days a month, for more than three months. Over-the-Counter Medicines You may find that over-the-counter painkillers (such as aspirin, paracetamol and ibuprofen) help to relieve the symptoms of your migraines. Your body absorbs soluble painkillers that you dissolve in water quicker than nonsoluble ones so they may be more effective. You could also try a combination painkiller (paracetamol) and antinausea medicine (metoclopramide). This can help relieve pain and may stop you vomiting and feeling sick. Make sure you don’t take additional paracetamol with this combination product because too much paracetamol can harm your liver. Always read the accompanying consumer medicines information leaflet and if you have any questions, ask your pharmacist or GP for advice. Triptans If over-the-counter painkillers don’t help to ease your migraines, your GP may prescribe other medicines called triptans (also known as 5HT agonists). These work well in about two-thirds of people and you may need to try more than one before you find which medicine works best for you. Triptans stop the effects of serotonin, which is thought to cause migraines. They are more effective if you take them when the headache is beginning to develop. Triptans are available as tablets, dissolvable wafers, nasal sprays or injections. Triptans are not recommended in people who: • Have uncontrolled high blood pressure • Have had a stroke • Have had a heart attack • Are taking certain medicines – for example ergotamines, lithium or some antidepressant medicines Check with your GP if you are pregnant or breastfeeding. Common side effects of using triptans may include dizziness, feeling sick, vomiting, tiredness or sensations of tingling, heat, heaviness or pressure in any part of the body. Other Prescription Medicines If you can’t take triptans or over-the-counter painkillers don’t work for you, your GP may prescribe non-steroidal anti-inflammatory drugs or a combination of anti-nausea medicine and painkillers. Do not treat more than two headaches per week Treat early and treat well Preventive treatment You need regular preventive medicines if: • Your migraines are frequent • Affecting your quality of life • You are consuming too many painkillers • You are experiencing prolonged attacks with aura See your GP and he will discuss the suitable option for you. Alternate/Additional Treatments Although the cause of migraines is unclear, stress and anxiety are thought to make migraines worse. Relaxation techniques such as yoga, meditation, muscle stretches and controlled breathing exercises can be useful in the management of stress and anxiety. Another option is a talking treatment called cognitive behavioural therapy (CBT). A trained therapist can help you challenge negative thoughts, feelings and behaviour to help reduce stress and anxiety that may cause or make your migraines worse. You may wish to try acupuncture to help relieve some of your symptoms, but there is little evidence to show that it’s effective for migraines. Before trying it, speak to your GP and check that your acupuncturist belongs to a recognised professional body. Chronic Migraine The International Headache Society defines chronic migraine as more than 15 headache days per month over a three-month period of which more than eight are migrainous, in the absence of medication over-use. The incessant nature of chronic daily headaches makes them among the most disabling headaches. Aggressive initial treatment and steady, long-term management may reduce pain and lead to fewer chronic daily headaches. While there is no known cure, treatment for chronic migraine includes both prescription and over the counter painkillers as well as migraine specific drugs such as Triptans. A combination of lifestyle changes and understanding the migraine triggers is also important. The role of the neurologist is becoming increasingly important in managing migraine. Investigations into chronic migraine may be required as well as a tailored treatment plan to try to minimise the frequency and severity of attacks. Chronic migraine is sometimes progressive. It is therefore important to keep a record of how many days per month migraine disrupts daily life. If this is more than half the month, a neurologist might be able to offer a wider range of treatments to help reduce symptoms. A new treatment for patients experiencing more than 15 headache days per month is botox injections. The benefits of botox can last up to three months and has changed the lives of many chronic migraine sufferers. It is advisable seek a referral to a neurologist from your GP as this treatment should only be performed by a neurologist. It has been shown that many chronic migraine patients over-use headache medications. This can create further complications, so it is important to seek advice from a GP or neurologist if headache medications are used daily. Pindara Magazine 20 Autumn - Winter | 2014
Pindara Private Hospital Magazine - Issue Two
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