Although No Cure Exists, Effective Treatment Is Available for Migraine

Jerry Swanson, M.D., Neurology, Mayo Clinic

At this time, no cure exists for migraine headaches. But that doesn't mean you have to just suffer through them.

Although there isn't one pill doctors can prescribe or a surgery we can recommend to cure migraine, effective treatment is available.

For many people, a combination of medication and lifestyle changes decreases the frequency and severity of migraine attacks and reduces the disruption migraine has on daily life.

Some people think of a migraine as just a very painful headache. Migraine headaches are associated with moderate to severe -- often throbbing pain that gets worse with routine physical activity, such as climbing stairs. But additional symptoms, including nausea, vomiting and sensitivity to light and sound, set migraine apart from other headaches.

For some, a migraine attack is preceded by an aura -- seeing blind spots or bright flashes of light -- or a feeling of tingling or numbness on the skin. These symptoms usually last less than an hour. Most migraine headaches are episodic, meaning that people who have them have many headaches over many years, but each attack is distinct and separate from the others.

Even though a complete cure isn't available, there are plenty of medications that can control migraine attacks. Medications used to combat migraine fall into two broad categories: acute pain-relieving medications and preventive medications.

Acute pain-relieving medications are taken during a migraine attack to stop symptoms that have already begun. For a mild migraine, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin, may be enough to relieve symptoms. For severe migraine headaches, your doctor may prescribe a triptan, a type of medication that can relieve pain, nausea and sensitivity to light and sound. There are currently seven triptans available in the U.S. All are available as tablets; one is available as an injection (sumatriptan); and two are available as nasal sprays (sumatriptan and zolmitriptan).

Ergots are another type of pain-relieving medication for migraine.

These medications are usually less effective than triptans. One type of ergot that can be quite effective is dihydroergotamine, but it must be taken as an injection or a nasal spray. If your migraine attacks are accompanied by nausea, your doctor may recommend an anti-nausea medication in addition to other medications.

Preventive medications are taken regularly, not just when you have a headache.

These medications can reduce the frequency, severity and length of migraine attacks and may increase the effectiveness of acute pain-relieving medications. Your doctor may prescribe preventive medications if you have two or more debilitating headaches a month, or if you need to use pain-relieving medications more than twice a week. Preventive medications may also be appropriate if acute pain-relieving medications don't ease your symptoms.

A variety of medications have been found to help prevent migraine headaches, although most were developed to treat other health conditions.

They include beta blockers, such as propranolol; calcium channel blockers, such as verapamil; anti-seizure medications (topiramate and divalproex sodium); and tricyclic antidepressants, such as amitriptyline. Some studies have indicated that botulinum toxin type A (Botox) injections into the scalp muscles and often neck muscles may also prevent migraine headaches.

When used in combination with medication, self-care steps can help ease migraine symptoms.

Some people find that muscle relaxation exercises -- meditation, progressive muscle relaxation, and yoga, for example -- decrease the pain of a migraine.

A gentle head and neck massage may also be soothing. A hot pack or heating pad can relax tense muscles and increase blood flow. Ice packs can have a numbing effect that dulls the pain. You may find that resting in a dark, quiet room when you feel symptoms starting can decrease the severity and length of a migraine. Exercising regularly and getting enough sleep seem to help prevent migraine headaches.

If you don't already do so, consider keeping a headache diary.

After a migraine passes, write down when and how your headache began and what might have set it off; where the pain was located and how severe it was; what type of treatment you used and how well it worked.

This diary can help identify factors that may be triggering your migraine attacks.

It also can be useful to review your headache diary as you and your doctor evaluate the effectiveness of your migraine treatment and customize that treatment so it works best for you.

-- Jerry Swanson, M.D., Neurology, Mayo Clinic, Rochester, Minn.

Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care. E-mail a question to medicaledge@mayo.edu , or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207.

For more information, visit www.mayoclinic.org.)

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Although No Cure Exists, Effective Treatment Is Available for Migraine