What is a migraine headache?
Who gets migraines?
- Approximately 15% of women and 6% of men suffer from migraines each
year. In addition, migraines tend to run in families with some
suggestions that there exists at least some genetic component.
What causes migraines?
- Many patients have "triggers" which may be a contributing factor
in the formation of migraine. However, these triggers are not the
cause of migraines. Here is a table adapted from Pryse-Phillips'
article "Guidelines for Nonpharmacologic Management of Migraines."
| Triggers |
Examples |
| Emotional Stress |
|
| Changes in Behavior |
Missing a meal, hypoglycemia, changes in sleep pattern |
| Environmental Factors |
Bright or flickering lights, loud noise, weather changes,
strong odors, allergens |
| Foods and Beverages |
Chocolate, cheese, cured meats, caffeine, alcoholic (esp.
red wine) |
| Chemicals |
Aspartame, MSG, benzene, insecticides, nitrites |
| Drugs |
Atenolol, caffeine, cimetidine, danazol, diclofenac, H2
receptor blockers, hydralazine, indomethacin, nifedipine, nitrofurantoin,
nitroglycerin, oral contraceptives, reserpine |
What is standard or traditional therapy?
- The usual remedy for migraine headaches is prescription medication.
In acute settings, drugs like sumatriptan (Imitrex) are the mainstay of
treatment. However, there are several others that are used:
Nonsteroidal Anti-Inflammatories (acetaminophen, aspirin, ibuprofen),
ergotamines, other triptans, dopamine antagonists, and even narcotics.
These medications come in a variety of forms ranging from nasal sprays, to
shots, to pills. There are also medications for the prophylaxis of
migraine headaches, these include: beta blockers (propranolol), anticonvulsants
(valproic acid), tricyclic antidepressants (amitryptilline), calcium channel
blockers (verapamil), sertonergic medicines (methysergide), and monoamine
oxidase inhibitors (phenelzine).
What are other standard non-pharmacologic approaches?
- The Old Standards/"Old Wive's Tales":
- Apply cold over the temples
- Apply massaging pressure over the temples
- Hide in a quiet, dark room and attempt to fall asleep
- Relaxation therapy
- Hypnosis
- Cognitive Behavioral Therapy
- Transcutaneous Electrical Stimulation
Why seek alternative treatments?
There are a number of reasons why patients and physicians are looking for
different approaches to treatment migraines.
- Traditional pharmacologic management is varies in its success rates
between 50-70%.
- Patients are fearful of medication side effects and interactions with
their other medications.
- Winner Study showed in his study comparing sumatriptan (Imitrex) and
dihyrdroergotamine mesylate that these medications worked in an acute setting to
relieve migraines 85% and 75% of the time respectively. Unfortunately, 45%
and 18% respectively had a rebound migraine within 24 hours.
- Billions of dollars are spent annually for lost productivity and treatment
related only to migraines.
- Migraines are rare, as a type of headache, but the most frequent type to
be diagnosed when a headache is the reason to see a physician.
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