What I Wish My Patients Knew About Treating Migraines
There are many things that are important for patients to know about migraines.
By understanding key concepts about migraines, you can better help your doctor find the right treatment for your migraines.
Get the Right Diagnosis
Every bad headache is not the same as a migraine, and should not be treated as such. That’s why it’s so important to get a diagnosis from your doctor. The mnemonic “POUND” has been used to aid in migraine diagnosis. The majority of people who have a migraine will have at least four of the following five symptoms:
- Pulsing headache
- One day duration
- Unilateral, or one-sided, location
- Nausea or vomiting
- Disabling intensity
You can help your doctor diagnose your migraines by keeping a headache diary. Migraines usually have a trigger, and identifying it is beneficial for developing an effective treatment plan. A good headache diary should include date, time, duration, intensity, triggers, preceding symptoms, treatment used and response to that treatment.
Find Effective Treatment
More than one medication may be needed to control migraines. There are some medications that will immediately get rid of the headache, and that may be the only remedy necessary to control your migraines. However, others may need a monthly injection or a pill that they take daily to help prevent migraines, and in the event one does occur, they will still have to take another medication to get rid of it.
Triptans are a type of a medication that is used in moderate to severe migraines or if you have a migraine “attack.” You may have to take more than one brand of triptan to get rid of a migraine headache. Many patients express frustration when the first triptan they try is not effective, and they may feel as if their migraines will never resolve. However, the doctor may switch the brand of triptan and if that is not effective, other therapies may be considered.
There are other ways to manage migraines that may not necessarily require one to take medication by mouth. Botox has been found to decrease the frequency of headaches in individuals with chronic migraines. CGRP blockers like erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality) are the newest class of migraine prevention drugs, and they block a molecule thought to instigate and intensify migraines. A monthly or quarterly self-injection of one of these drugs can reduce migraine frequency by half for some people. Studies have shown that acupuncture is beneficial in migraine prevention, as well. Triptans that can be taken nasally have proven effective in children and adolescents, but those treatments are not generally recommended by drug manufacturers or FDA-approved for use in the pediatric population. Cognitive behavioral therapy (plus the use of a preventive medication) is a good means of treatment in this population.
Migraines affect everyone differently, so it’s important to understand the nuances of your headaches. The more you know, the more likely it is that you and your doctor will find treatments that offer you relief.