Understand & Resolve Your Migraines!

Migraine is generally a severe one-sided headache often associated with nausea and/or light sensitivity.  It occurs episodically; is a result of a nerve dysfunction in the brain that results in a cascade effect; often runs in families; is more likely in women; and affects about 30 million people in the U.S.  Some migraine sufferers experience a “prodrome,” or strange sensation that arrives before the onset of a migraine.

If you think you may suffer from migraines or any recurrent headache, you should see me or your Family Physician.  If OTC pain relievers aren’t working for you, then supplements, nutrition, and migraine medicine can be much more effective.

Triggers

Most migraine sufferers have specific things that can trigger a migraine.  You need to figure out what leads to your migraines and try to avoid them.  Common migraine triggers are:

Alcohol (especially red wine),   Aspartame (found in many sugar-free foods),   Caffeine withdrawal ;   Chocolate;   Monosodium glutamate (MSG found in many processed foods);   Nitrates & sulfites (found in processed meats);   Tyramine (found in aged cheeses, chocolate, nuts, sour cream, and yogurt);   Second-hand smoke;    Perfume;   Irregular eating patterns (especially skipped meals);   Dehydration;   Insomnia;   and Hormone changes

Nondrug Options

Riboflavin (Vitamin B2) – 25-400mg/day to reduce migraine frequency

Magnesium – 250 to 500mg daily (and helps w constipation too!)

Coenzyme Q10 – 100mg three times a day (don’t take if you are on coumadin)

Acupuncture – can help in prevention and treatment

Feverfew herb – usually taken every day to prevent migraines

Butterbur herb – taken daily to prevent migraines (a patented one, Petadolex, claims to have extracted potential liver toxin pyrrolizidine)

Melatonin for cluster headaches – 3mg nightly

Biofeedback, meditation, exercise, diet changes (such as avoiding gluten), and even Vicks rubbed on the forehead can be helpful for some migraine sufferers.

Migraine Medicines

The best time to take any migraine medicine is at the earliest sign of a migraine.

Over-the-counter (OTC) Medicines – Excedrin, Ibuprofen, Aleve

Triptans (Imitrex now generic, Amerge, Frova, Axert, Relpax, Maxalt, Zomig)

The development of these about 20 years ago revolutionized migraine treatment.  These usually reverse the chemical changes in the brain to stop the migraine if taken soon enough. (They can cause transient jitteriness, other side effects, and rarely elevated blood pressure or heart attack.)

Ergots – like Cafergot (ergotamine with caffeine)

Rx pain medicines occasionally are needed – like Ultram (tramedol), Hydrocodone

Preventative Medicines

Topamax (now in generic) – very effective taken daily (often transient side effect of tingling and numbness, and nice side effect for many of mild weight loss)

Beta-blockers (like propranolol or atenolol);   Calcium channel blocker Verapamil;   Benicar blood pressure medicine;   Elavil or Pamelor or even Prozac (anti-depressant type medicines); Seizure-type medicines like Depakote

Menstrual Migraines

Migraines are about twice as likely to happen in the first few days of a woman’s  period than the whole rest of her cycle.  Knowing this can help women prevent migraines by being especially careful of triggers and get enough sleep.  Also regular dosing of NSAIDS (non-steroidal anti-inflammatory medicines) can help prevent migraines during this time (Advil or Motrin ibuprofen, Aleve, Ponstel, Cataflam, and others).  Magnesium and Riboflavin daily can be especially effective for some women as can being on oral contraceptives. 

Sex Headaches

This type of headache happens just before or during an orgasm (can be explosive or dull throbbing).  They can be caused by a few different things, but one from a brain aneurysm is life-threatening.  Therefore, if you suffer sex headaches, you must see your doctor or neurologist and have a full workup including brain MRI angiography.  Once this is done and negative, often Ibuprofen or Naproxen taken 30 minutes before sex can help or an anti-seizure medicine (like Lamictal or Depakote).

Avoid these common mistakes

by Headache sufferers – overlooking headache pain too long, and abusing your body by smoking, drinking too much, or engaging in other harmful behaviors

by Doctors – trying to manage your patients’ pain by giving too much medicine that actually can worsen headaches

As your doctor, I promise to keep learning, and teaching, and helping you!

Dr. Lisa