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Migraine headache treatments

A migraine is a severe headache, usually involving a throbbing pain at the front of the head or on one side.  The pain may be accompanied by nausea and light sensitivity.

Around 15% of adults in the UK experience migraines. A bad migraine can mean a person needs bed rest for up to several days until it passes.

How are migraines diagnosed?

There is no specific test to diagnose a migraine headache. Instead, doctors will look for a pattern of headaches, symptoms and possible triggers.

It may help to keep a headache diary in which you record information about symptoms leading up to a headache, symptoms of the actual headache and possible triggers that may have provoked the episode.

Your doctor will want to take a careful history to determine any patterns to your headaches, and to learn whether such headaches run in your family. The doctor will also perform a careful physical examination to make sure you don't have any other symptoms or signs that point to another problem as the source of your headaches.

What are the treatments for migraines?

There are two main approaches to migraine treatment. The first is stopping (aborting) an acute attack, if possible, or at least controlling the pain and nausea. The second approach is preventing future attacks.

Conventional medicine for migraines

In acute (abortive) therapy for migraines, it's important to take medication as early as possible in the course of the headache. So if you have an aura or other prodrome (early symptom before headache onset), take the medicine then. Many medicines can help, but the leading ones are called triptans. They include sumatriptan (tablets, injection and nasal spray) , zolmitriptan, rizatriptan and others. People respond differently, and one of these medicines may work better for you than others.

Ergotamine preparations are another class of medication that can be used to abort a migraine. The most popular one is ergotamine tartrate. NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen may also abort a migraine attack. Often doctors recommend taking antinausea (antiemetic) medicines such as domperidone or metoclopramide.

One of the best ways to prevent migraine attacks is to recognise factors that may trigger them, such as particular foods, stress, irregular meals, lack of sleep, bright lights or, in women, the menstrual cycle or contraceptive pill. Keeping a diary of your symptoms may help you to identify triggers so that you can learn to avoid them.

Prophylactic treatment (preventative therapy) is usually recommended if you have more than two or three migraines per month or suffer severe symptoms despite treatment during the attacks. Medication intended to ward off a migraine episode so that it never develops fully include:

  • Tricyclic antidepressants such as amitriptyline.
  • Beta-blocking agents (also used to treat high blood pressure) such as propranolol, metoprolol, timolol and nadolol.
  • Pizotifen, an antihistamine and serotonin antagonist.
  • Antiseizure medications including sodium valproate, valproic acid, topiramate and gabapentin.
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