Exploring the Frontiers of Migraine Treatments: Recent Advances and Options
New treatment options are helping us provide better migraine symptom relief and prevention. These include preventive medicines, which are taken daily to reduce the severity and frequency of future headaches. These can include seizure medications, blood pressure drugs, antidepressants and calcitonin gene-related peptide (CGRP) antagonists.
Other treatments include acupuncture and relaxation techniques such as biofeedback. These help to control stress, which is a common trigger for migraines.
Migraine can cause a lot of pain, but you can also feel depressed and anxious as well. Those feelings can increase the frequency and intensity of your migraine attacks. The good news is that you can treat these symptoms with antidepressants that are specifically prescribed for migraines. These drugs can help reduce your anxiety and depression, and prevent future migraines.
Most antidepressants work by altering a type of chemical called a neurotransmitter. Neurotransmitters are messengers that carry messages between cells in the brain. Changes in serotonin, a chemical produced by the body, have been linked to both depression and migraine. Medications that affect the level of serotonin in the body can also reduce headaches.
Doctors usually start with the SSRIs, or selective serotonin reuptake inhibitors, because they have the fewest side effects. If those don’t help, they may try the SNRIs or tricyclic antidepressants. These older medications have more side effects, but they are also proven effective for migraine prevention. The most widely used drug in this category is amitriptyline, which has been tested in three large randomized controlled trials.
Antidepressants can be taken on their own or in combination with other medicines used to treat migraines. In particular, they can be taken with triptans, which are a mainstay of migraine treatment. If you’re planning to take triptans, talk to your doctor about whether or not the antidepressant will interfere.
You should also be careful about taking antidepressants if you have other health problems, such as heart disease or high blood pressure. You should also avoid them if you’re pregnant or breastfeeding. The best way to diagnose migraine is for your doctor to see you in person and ask you questions about your past and present headaches. You’ll need to describe your headaches in detail, including the frequency and duration of each one, and when it occurs. Your doctor will then examine you and may order tests to check your blood pressure, your heart rate and other things. He or she will also ask about your family history of migraine and any other health problems you have.
Many migraine sufferers try natural treatments as a supplement to traditional medications. They are generally considered safe, but it’s best to speak with your doctor before trying any new treatment. Some natural remedies can interfere with some prescription drugs, and a doctor can help determine which ones work well with your body.
Ginger powder, a common food ingredient, has been shown to relieve nausea and vomiting associated with migraine. Research suggests it may also help reduce the frequency of attacks. Try chewing on a piece of ginger, taking it as a pill or eating some ginger candy.
A 2010 study found that the menthol in peppermint oil eases pain for some migraine patients. Apply it to your temples or forehead at the first sign of an attack. Acupressure — pressing on specific points on your body — may relieve headache pain, too. Find acupressure point maps online or ask an acupuncturist for directions to the right pressure points on your head and neck.
Regular exercise may also help prevent migraines, because it releases chemicals that block pain signals in the brain. However, some exercises may trigger a migraine, such as vigorous activity or certain types of exercise, so check with your health care provider to see what’s safe for you.
If you have a history of migraine, keep a diary of your symptoms to help identify triggers. Write down the date, time and other information, such as how you felt, what you were doing and what seemed to help or hinder your symptoms.
Omega-3 fatty acids, which are found in fish, flaxseed and walnuts, have been shown to shorten the duration of migraines. Omega-3s have anti-inflammatory and blood-clotting effects. Magnesium and riboflavin, an important B vitamin that is naturally found in foods like leafy green vegetables, nuts and eggs, can also help reduce migraines.
Some over-the-counter medications may reduce mild to moderate migraines, including aspirin, ibuprofen and naproxen. Some neurologist-prescribed migraine medicines, such as triptans or ergot alkaloids, are also effective at stopping and preventing migraines. Talk to your neurologist if you haven’t yet found a migraine medication that works for you.
Migraine is one of the most disabling conditions worldwide. It is responsible for more than 50% of all years lost due to neurological disorders and is the first cause of disability in people under the age of 50. It has a significant impact on social, physical and occupational functioning. It is also a common reason for visits to emergency departments. It is therefore important to ensure that patients are adequately managed in this setting, including preventing the overuse of opioid medications, and that nonopioid treatments are available for acute migraine headache.
Migraine prevention involves identifying and avoiding trigger factors, which are known to induce the disorder in many people with migraine. These factors may include environmental (e.g., weather and pressure changes, light, sound, odours), sleep pattern (e.g., sleeping too much or too little), diet (e.g., fasting, consuming some foods and drinks, or caffeine), neck pain, stress and anxiety, exercise, and hormone changes.
ANTIEMETICSIntravenous prochlorperazine and intramuscular or intravenous metoclopramide are effective as antiemetics in treating acute migraine headache. These medications act as dopamine receptor antagonists and decrease the release of inflammatory substances in the gut and brain, which contribute to nausea.
A number of simple analgesics have been shown to be effective in reducing the symptoms of migraine, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen. The combination of aspirin and metoclopramide has also been shown to be effective in a recent randomized controlled trial.
HERBS AND VITAMINS
Some herbs, such as feverfew and butterbur, have been shown to prevent or reduce migraines, though larger studies are needed. Some dietary supplements, such as riboflavin, coenzyme Q10, and magnesium, might also reduce the frequency of migraine attacks.
Neuromodulation techniques, such as occipital nerve stimulation, sphenopalatine ganglion stimulation, and high cervical spinal cord stimulation, might be helpful in preventing migraine. They also might be useful in managing migraines during pregnancy and lactation, if medications are not effective or are contraindicated. This approach should be tried after all other preventive and abortive medications have been tested.
The Food and Drug Administration recently approved a device that’s the first of its kind to prevent migraines. The device, shaped like a tiara and known as Cefaly, works by stimulating nerves beneath the forehead. In a clinical trial, Cefaly reduced the number of chronic migraine days per month for 38% of users. It also reduced the intensity of migraine attacks in those who had them.
Another new device is a small battery-powered handheld gadget that’s used when a person feels a migraine coming on. The FDA has cleared three devices that use a technique called neuromodulation. They use electric or magnetic stimulus to change the activity of brain cells. Some of the devices are able to stop an attack that’s already underway, while others can prevent future headaches from occurring.
In a 2021 study, patients who used the occipital neurostimulator, or ONS, for migraines experienced less than half as many migraine attacks compared to those using a placebo. Unlike the other devices, ONS involves surgically implanting a small device in the back of the neck that sends electrical impulses to the occipital nerve. The ONS device is reversible and can be turned off if needed, and doctors have reported a high rate of patient satisfaction with this treatment option.
A headset that’s a little more portable was developed in the same research center and is the latest migraine device to gain national recognition. The Relivion device is an external concurrent occipital and trigeminal neurostimulation system. In a 2022 clinical trial, Relivion helped relieve migraines in 60 percent of patients who had a migraine without aura or an aura with a headache.
Other devices have been gaining popularity among migraine sufferers, including an acupressure mat that uses thousands of spikes to apply pressure to the skin and muscles. The Shakti Mat helps with the pain and nausea of some migraines as well as the sensitivity to light that often precedes or follows them. The Allay Lamp, a hand-held device that emits green light to help alleviate the symptoms of migraine, has also gained widespread popularity.