Hormones Matter TM

Migraine Treatment and Management Strategies

July 16, 2012  |  Chrisalbeth Guillermo, MPH, OMS-II

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Migraines have been a hot topic in the news, affecting an estimated 29.5 million Americans. They tend to run in the family, they are more common among women than men, and migraineurs will do anything to find relief. In addition to the intense, debilitating headache, migraines come with a variety of associated symptoms: nausea, vertigo, pain in the jaw or neck, eye pain, hallucinations, or even whole body paralysis. Migraines can be triggered by bright light, alcohol, stress, sleep deprivation, skipping a meal, too much or too little caffeine… You name it.

What some may not know is that migraine has also been linked to mood disorders, hormone changes across the menstrual cycle, and seizures. Indeed, individuals who suffer from migraines with aura have an increased risk of major depression and suicide attempt. Rises in both migraine and seizure frequency before and during menstruation have been associated with the changes in reproductive hormones that follow ovulation. Researchers now hypothesize that the electrochemical activity that causes migraine attacks may trigger epileptic seizures at a higher threshold of activity, as evidenced by the low proportion of migraine patients with seizures versus the significantly higher proportion of epilepsy patients with migraines.

Hence, treatment options include the same pharmacotherapies indicated for these disorders, ranging from non-steroidal anti-inflammatory drugs (NSAIDs) and hormonal birth control to anti-depressants and anti-convulsants. Unfortunately, there are still women who find little or no relief, known as refractory migraine, from prescription or over-the counter medication. However, combined therapies that directly impact migraine symptoms in addition to their health conditions have been effective. In some cases, addressing the migraine alone may actually lead to improvements in more severe symptoms of the primary diagnosis.

Over the counter remedies provide some relief, but with the January recall of these drugs, migraine sufferers have been scrounging for any leftover stock of Excedrin Migraine on Ebay and Amazon for exorbitant prices. However, professionals warn that purchasing from such websites can be dangerous, as product safety is no longer a guarantee. Much to the dismay of many patients, the use of a generic equivalent is not an option, as they may experience adverse reactions to inactive ingredients in the generic product. Others who find no relief otherwise must simply settle for buying the same active ingredients–acetaminophen, aspirin, and caffeine–as separate pills and take them simultaneously.

One remarkable breakthrough to come out of migraine research has been the FDA approval of Botox as a preventive treatment for chronic migraine. Interestingly, doctors have been recommending Botox to patients with recurring headaches for years, but as an off-label use. The theory behind its success is that the drug acts as a nerve block, relaxing the tissue around the forehead and dampening pain signals. Although approved, some researchers are questioning its efficacy, due to studies showing no difference in the occurrence of tension headaches and being no more successful than other headache treatments.

Alternative therapies that do not involve pharmaceuticals are also available. Be on the lookout for a follow-up to this article for those of you looking to minimize the amount of drugs you take!