Chronic Migraine Treatments

These therapies may help stave off migraines and relieve symptoms when they occur.

Experiencing chronic migraines that disrupt your daily life can be an overwhelming and debilitating ordeal. Fortunately, there are various treatment options available to help manage this condition. Chronic migraine treatment can broadly be categorized into three main approaches: preventive treatments, acute (or abortive) treatments, and complementary treatments. To effectively manage chronic migraines, a combination of these approaches is often recommended.

Preventive Medications

Preventive medications, as the name suggests, are drugs taken on a regular schedule, whether daily or through monthly injections, with the primary aim of reducing the frequency and severity of migraine attacks. Here are some common preventive medications:

1. Blood Pressure Medications: Beta-blockers, typically administered at lower doses than for hypertension, have proven to be highly effective in migraine prevention. These medications can interrupt the cortical spreading depression process in the brain, a phenomenon associated with migraines.

2. Antidepressants: Amitriptyline is a commonly used antidepressant for migraine prevention, although it may not be suitable for everyone due to side effects like nightmares, dry mouth, and sleepiness. Venlafaxine is another antidepressant option considered effective in migraine prevention.

3. Anti-seizure Drugs: Medications like topiramate and gabapentin, which are anticonvulsants, may be prescribed to prevent migraines. These drugs help calm hyperexcitable nerves that are thought to contribute to migraine development.

4. Botox Injections: Botox injections are specifically approved for individuals with chronic migraines. These injections reduce sensory input in the face and neck and may also have anti-inflammatory properties.

5. Calcitonin Gene-related Peptide (CGRP) Inhibitors: CGRP is a chemical messenger implicated in migraine attacks. There are two classes of CGRP blockers:

• Monoclonal antibodies: Medications like Aimovig, Ajovy, and Emgality block the effects of CGRP and are administered through injections every month or quarter. They are well-tolerated, with minimal side effects.
  
• CGRP receptor antagonists: These oral medications halt the inflammation associated with migraines. Nurtec ODT is a CGRP receptor antagonist approved for both prevention and acute treatment of migraines.

Medications for Acute Migraine Relief

When a migraine attack strikes, it’s essential to have medications that can provide quick relief. These acute treatments are meant to be taken at the very onset of a migraine to minimize its duration and severity:

1. Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Over-the-counter NSAIDs like aspirin, ibuprofen, and acetaminophen are convenient options for mild headaches. However, they may irritate the stomach and lead to digestive issues.

2. Triptans: Triptans, such as Imitrex (sumatriptan) and Maxalt (rizatriptan), are recommended for acute migraine relief. They work by stimulating serotonin, reducing inflammation, and constricting blood vessels. Triptans are most effective when taken early in a migraine attack.

3. Dihydroergotamine: Available as a nasal spray or injection, dihydroergotamine is especially effective for migraines expected to last longer than 24 hours. It constricts blood vessels and prevents certain substances in the brain from causing swelling.

4. CGRP Receptor Antagonists: Ubrelvy (ubrogepant) is a CGRP receptor antagonist approved for acute migraine treatment. It has been shown to reduce pain, nausea, and light sensitivity within two hours.

5. Ditans: For individuals who don’t respond well to triptans, ditans like Reyvow (lasmiditan) may be an alternative. They target specific serotonin receptors associated with headache pain.

6. Anti-nausea Medications: These medications not only address nausea, a common migraine symptom, but may also help alleviate the migraine itself. Options include metoclopramide and prochlorperazine.

Complementary and Alternative Treatments

While pharmaceutical options are crucial for migraine management, complementary treatments can play a valuable role, particularly for long-term support and stress reduction:

1. Magnesium: Magnesium supplements have shown promise, particularly for migraines with aura and menstrual-related migraines. Magnesium is considered safe, even during pregnancy.

2. B Vitamins: High doses of riboflavin (B-2) have been found to reduce migraine frequency by about two episodes per month. Combining riboflavin with other vitamins and minerals may also reduce pain severity.

3. Coenzyme Q10 (CoQ10): CoQ10 supplementation may not significantly reduce migraine severity but could offer other benefits. It may decrease migraine duration and frequency.

4. Dietary Supplements: While supplements are often recommended, they lack substantial research backing. Caution is advised, and it’s crucial to consult healthcare providers or pharmacists before starting any supplements.

5. Remote Electrical Neurostimulation (REN): Wearable REN devices like Nerivio deliver electrical pulses to arm nerves. These signals may activate the body’s pain control mechanisms and reduce migraine pain.

6. Mindfulness, Biofeedback, and Stress Management: Techniques like cognitive-behavioral therapy, mindfulness, and biofeedback can help individuals manage stress and cope with migraine-related challenges.

Incorporating complementary treatments into your migraine management plan may require patience and active engagement. Results may not be immediate, but they can contribute to long-term relief and improved quality of life.

Conclusion

Chronic migraines can be overwhelming, but with a comprehensive treatment approach that includes preventive medications, acute relief options, and complementary treatments, many individuals can effectively manage their condition. It’s crucial to maintain an open dialogue with your healthcare provider to explore the most suitable treatment strategies tailored to your specific needs and circumstances. Managing migraines requires a personalized approach, and with the right guidance, you can regain control over your life and reduce the impact of migraines on your daily activities.