Migraine Headache Treatments and Prevention

Many people around the world suffer from migraine headaches. These headaches can often lead to a large amount of pain which can be debilitating for some people.

Migraines are affecting a huge percentage of people and the causes are usually determined on an individual basis. People often use acupuncture to reduce the severity of the migraine headaches and reduce the frequency that they occur. These alternative therapies can also be used to reduce the side effects of migraines such as sickness, stress, muscle tension and fatigue.

No matter what types of medication you take for migraine headaches they can produce unwanted side effects and symptoms. And unfortunately, they can also increase the intensity of the very pain they were intended to relieve.

There are many migraine headache triggers that will cause migraines and the first step toward eliminating this painful disorder is to determine what these triggers are and then eliminate them. Throbbing head pain is caused when the blood vessels surrounding the brain dilate. Placing a cold compress on the back of the neck can help minimize the flow of blood to the brain, thus relieving the throbbing pain.

There are other effective home remedies that can help reduce pain. Massaging tight muscles can aid in relaxation and the best spots for massage are the muscles of the neck, shoulders, face, and head. Be sure to use the pads of your fingers or thumbs and rub your muscles gently, but firmly. Another migraine treatment that has shown good results is taking niacin, also known as vitamin B3. If taken in sufficient amounts it can cause a person’s body to flush, or turn red. Before beginning a proper treatment for migraine headaches relief, it isn’t uncommon for sufferers to wind up in an emergency room because of the unendurable pain. Constrictions of blood vessels that supply the brain with blood are the likely root cause of migraines.

Migraines are a medical condition that impairs millions of people each year. While migraines differ in severity, common symptoms include altered perceptions, severe headaches, and nausea. Preventative migraine headache treatment options are used to prevent – or reduce – the number of migraines a person suffers from. Treatment usually is in the form of a medication or patch. Trigger management migraine treatments are aimed at identifying what causes migraines. Triggers can include a change of weather, air pressure, bright lights, glare, fluorescent light, fumes, and foods.

General pain management for migraine headache treatment can be used to treat non-life threatening migraines. Treatment options include the use of narcotic analgesics, non-steroidal anti-inflammatory drugs, and simple analgesics. As someone who has the unfortunate task of dealing with migraines you will surely be seeking some kind of migraine headache treatment to relieve yourself of the agony and pain that migraines come bearing when they do attack.

This option as it suggests should offer you more pleasant results compared to medicine. There are a number of techniques that have been researched by many migraine sufferers like applying heat or cold to the affected area and many more.

Fioricet is supplied in hard-gelatin capsule form for oral administration.

Each capsule contains the following active ingredients:

Butalbital, USP……………………50 mg
Acetaminophen, USP…………….300 mg
Caffeine, USP……………………..40 mg

Inactive Ingredients: sodium lauryl sulfate, talc, microcrystalline cellulose, stearic acid, FD&C red # 40, titanium dioxide, FD&C blue # 1,FD&C yellow # 6, gelatin.

Butalbital (5-allyl-5-isobutylbarbituric acid), is a short to intermediate-acting barbiturate. It has the following structural formula:

Butalbital SF

Acetaminophen (4´-hydroxyacetanilide), is a non-opiate, non-salicylate analgesic and antipyretic. It has the following structural formula:

Acetaminophen SF

Caffeine (1,3,7-trimethylxanthine), is a central nervous system stimulant. It has the following structural formula:

Caffeine SF

Not all migraine cases are the same. One way to distinguish them is to determine whether or not you experience an aura.

So-called “complicated” migraine attacks begin with an aura. These can be visual distortions such as dots, wavy lines, or zig zags. Some people experience numbness or tingling across one side of the body. If they accompany headaches, auras usually appear about an hour earlier. If they do not, these auras are called “ocular migraines.”

About a quarter of people diagnosed with migraine (“migraineurs”) have this type. For those who do not, their condition is known by professionals as “common migraine.” Even without aura, you may experience light sensitivity, nausea, and other symptoms.

Gabapentin for the Prophylaxis of Episodic Migraine in Adults

Am Fam Physician. 2014 May 1;89(9):714-715.

Author disclosure: No relevant financial affiliations.

Clinical Question

Does gabapentin (Neurontin) help prevent episodic migraine?

Evidence-Based Answer

Gabapentin does not decrease the frequency of migraine headaches and is not recommended for prophylactic therapy. (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Worldwide, migraine has a lifetime prevalence of 18% in women and 10% in men.1 Therapeutic options are usually divided into prophylactic and abortive. Avoidance of triggers may be beneficial. Effective prophylaxis can range from acupuncture to medications such as propranolol, topiramate (Topamax), and valproic acid (Depakene), all of which have shown consistent positive benefit in systematic reviews.25

Previously published systematic reviews by these same authors gave cautious support for the use of gabapentin for migraine prophylaxis based on poor-quality evidence. However, new data from not-yet-published industry-sponsored trials of gabapentin for migraine have come to light during litigation against the drug manufacturer. These data have led the authors to change their conclusion based on the results of five studies involving 1,009 patients.

Four trials with a total of 351 patients compared gabapentin in a dosage of 900 to 2,400 mg per day with placebo. The meta-analysis found no significant reduction in the frequency of migraine headache (mean difference in the number of headaches = −0.44; 95% confidence interval, −1.43 to 0.56). Pooled results of two studies with 235 patients comparing the proportion of responders (at least 50% improvement in frequency of headaches) between those treated with up to 2,400 mg of gabapentin vs. placebo failed to show a difference (odds ratio = 1.59; 95% confidence interval, 0.57 to 4.46). One study analyzed prophylactic use of the prodrug gabapentin enacarbil (Horizant) titrated up to 3,000 mg daily and failed to find any benefit.

Patients taking gabapentin often reported adverse effects, most commonly dizziness (number needed to harm [NNH] = 7), drowsiness (NNH = 9), and abnormal thinking (NNH = 20).

According to the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society, prophylaxis should be offered to anyone whose daily activities are severely impaired, or when acute drug treatment is inadequate. The antiepileptic drugs topiramate and valproic acid are considered first-line prophylactic agents. However, the guidelines state that the evidence is inadequate to recommend the use of gabapentin for migraine prevention.6 Because gabapentin is not effective and commonly causes adverse effects, family physicians should consider alternatives when offering prophylaxis for migraine headache.

Author disclosure: No relevant financial affiliations.

How are migraines treated?

Migraine headaches are chronic. They can’t be cured, but they can be managed and possibly improved. There are two main treatment approaches that use medications: abortive and preventive.

  • Abortive medications are most effective when you use them at the first sign of a migraine. Take them while the pain is mild. By possibly stopping the headache process, abortive medications help stop or decrease your migraine symptoms, including pain, nausea, light sensitivity, etc. Some abortive medications work by constricting your blood vessels, bringing them back to normal and relieving the throbbing pain.
  • Preventive (prophylactic) medications may be prescribed when your headaches are severe, occur more than four times a month and are significantly interfering with your normal activities. Preventive medications reduce the frequency and severity of the headaches. Medications are generally taken on a regular, daily basis to help prevent migraines.

What medications are used to relieve migraine pain?

Over-the-counter medications are effective for some people with mild to moderate migraines. The main ingredients in pain relieving medications are ibuprofen, aspirin, acetaminophen, naproxen and caffeine.

Three over-the-counter products approved by the Food and Drug Administration for migraine headaches are:

  • Excedrin® Migraine.
  • Advil® Migraine.
  • Motrin® Migraine Pain.

Be cautious when taking over-the-counter pain relieving medications. Sometimes overusing them can cause analgesic-rebound headaches or a dependency problem. If you’re taking any over-the-counter pain medications more than two to three times a week, report that to your healthcare provider. They may suggest prescription medications that may be more effective.

Prescription drugs for migraine headaches include:

Triptan class of drugs (these are abortives):

  • Sumatriptan.
  • Zolmitriptan.
  • Naratriptan.

Calcium channel blockers:

  • Verapamil.

Calcitonin gene-related (CGRP) monoclonal antibodies:

  • Erenumab.
  • Fremanezumab.
  • Galcanezumab.
  • Eptinezumab.

Beta blockers:

  • Atenolol.
  • Propranolol.
  • Nadolol.

Butalbital:

Antidepressants:

Antiseizure drugs:

Other:

  • Steroids.
  • Phenothiazines.
  • Corticosteroids.

Your healthcare provider might recommend vitamins, minerals, or herbs, including:

Drugs to relieve migraine pain come in a variety of formulations including pills, tablets, injections, suppositories and nasal sprays. You and your healthcare provider will discuss the specific medication, combination of medications and formulations to best meet your unique headache pain.

Drugs to relieve nausea are also prescribed, if needed.

All medications should be used under the direction of a headache specialist or healthcare provider familiar with migraine therapy. As with any medication, it’s important to carefully follow the label instructions and your healthcare provider’s advice.

Alternative migraine management methods, also known as home remedies, include:

  • Resting in a dark, quiet, cool room.
  • Applying a cold compress or washcloth to your forehead or behind your neck. (Some people prefer heat.)
  • Massaging your scalp.
  • Yoga.
  • Applying pressure to your temples in a circular motion.
  • Keeping yourself in a calm state. Meditating.
  • Biofeedback.

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