Migraine is a unilateral (that is, one-sided; occasionally bilateral), intense and throbbing headache, lasting a few hours to several days. It is usually accompanied by nausea and vomiting, and photophobia (intolerance to light). In some patients aura may be present, that is, flashing of brightly coloured lights in a zigzag fashion, loss of vision in one part of visual field, auditory hallucinations, or abnormal smells and tastes.
It may be the case that you have warning or premonitory symptoms of an impending attack of migraine, like fatigue, euphoria or depression, craving for sweets. Although the cause for migraine is not known, there are a variety of trigger factors like certain foods, stress, caffeine, alcohol, or certain odours. Let us see how you can deal with migraines.
Dealing With Migraine
There are two ways of dealing with migraine: (1) Treatment of symptoms, (2) Prevention of future attacks. These two need to be combined for effective management of migraine. There are also a host of lifestyle changes and alternative therapies that can be tried, as given below.
Treatment Of Symptoms
Since the main symptom is pain, analgesics or pain relievers form the mainstay of treatment. However, this often needs to be combined with medication for nausea and vomiting.
There are several over-the-counter pain relievers available in the market which can be effective, particularly in mild cases. The common analgesics that can be tried are acetaminophen, ibuprofen, aspirin, indomethacin. Combinations of these medicines are also available along with caffeine.
Triptans are the drugs of choice in the majority of patients, as they relieve not only the pain, but also nausea and photophobia. There are several triptans available like sumatriptan, rizatriptan, naratriptan, zolmitriptan, eletriptan etc. Naproxen and sumatriptan combination has been shown to be more effective than single therapies. Triptans are not advisable if you are at risk for heart attack or stroke.
Combination of ergotamine with caffeine is available, but is not as effective as triptans. Corticosteroids like prednisolone and dexamethasone reduce inflammation and hence pain, so they can be tried, but their long-term use is not advisable as they have serious side effects. Narcotic analgesics like codeine, though useful, should not be taken routinely because of the risk of dependence.
For Nausea And Vomiting
Treatment for nausea and vomiting is pretty straightforward and effective. You can try either metoclopramide or prochlorperazine. Triptans too have a role in this, as already mentioned.
Prevention Of Future Attacks
Those having repeated attacks should also pay attention to the preventive aspects. There are several medications that can reduce the duration, severity and frequency of attacks of migraine, but they need to be taken under the supervision of a doctor. In addition to this, you should also try to avoid the known triggers.
These are beta blockers like propranolol, calcium channel blockers like verapamil, tricyclic antidepressants like amitryptiline and nortryptiline, and anticonvulsants like valproate, topiramate and gabapentin, antihistamine like cyproheptadine. Propranolol and amitryptiline are the drugs that have been used most often in the past for this purpose. Botulinum toxin is also finding favour these days. Choose the one that best fits your needs in consultation with your doctor.
Avoidance Of Known Triggers
Keep a migraine diary to zero in on what symptoms are preceding or triggering your attacks of migraine. Once you have found that out, try to avoid them. For instance, some of the usual triggers are caffeine, smoking, alcohol consumption, certain cheeses, chocolate, stress, and sleep disturbances. In the case of women, medications containing estrogen like oral contraceptives are best avoided, so ask your doctor for an alternative.
Lifestyle Changes And Alternative Therapies
Take the time to relax. Try yoga and meditation, or progressive muscle relaxation. These can be learnt easily these days, either through books and videos or personal instruction.
Other ways of relaxing are through indulging in your favourite hobbies like listening to music or reading. Avoid stress at all costs. Get enough restful sleep at night. If you sense an attack coming, go to a quiet and dark room, and apply ice pack on the back portion of neck. Also, massage any painful areas on your head.
Aerobic exercise done on a regular basis has been shown to reduce tension and prevent migraine. Choose the activity that you enjoy the most, such as walking, cycling or swimming.
There is evidence that the following alternative therapies can be helpful in migraine both for relieving pain and reducing the frequency of attacks: herbs like butterbur or feverfew (avoid if you are pregnant), vitamins like vitamin B2 (riboflavin), minerals like magnesium, acupuncture, biofeedback, and even chiropractic treatment.