To minimize the onset and the effects of migraines, most individuals can use alternative, non-drug (nonpharmacologic) measures. However, drugs may be necessary to incorporate into prevention and treatment options to minimize the frequency and severity of migraines and, in some causes, to treat the symptoms or terminate the attack all together.

Non-Drug Prevention

Researchers have found that trigger factors often provoke migraine attacks. These trigger factors could be a reaction to certain foods or beverages or a reaction to lifestyle or environmental factors. (Table 3) Studies have shown that avoiding these trigger factors could reduce the frequency of migraine attacks by half.¹⁵ Additionally, individuals should exercise, get plenty of sleep, form regular sleeping habits, avoid missing meals, and discontinue smoking. Individuals may also find that relaxation, and stress management help to prevent migraines.

Table 3. Common Migraine Triggers4,5,6

Foods Aged cheese Alcohol MSG Chocolate Caffeine Hot dogs Bacon Luncheon meats Avocado Fermented or pickled foods Yeast or protein extracts Onions Nuts Aspartame

Medications Antibiotics Antihypertensives H2 blockers Vasodilators

Hormonal Factors Menstruation Oral contraceptives Hormone replacement therapy

Lifestyle Factors Delaying or skipping meals Changes in sleep patterns Stress

Environmental Changes Weather changes High altitude Time zone changes, such as jet-lag

Prevention using medication (prophylactic treatment)

Although alternatives to medicine often help to reduce the frequency and severity of attacks, individuals have found that medication plays a role in preventing migraines as well. The medications that prevent migraines are put into a category called prophylactic treatment. (Table 4) Prophylactic treatment is only recommended in individuals when:

• Migraines occur twice a month, producing disability that lasts three days or longer
• Medication that treats symptoms or tries to stop an attack are not best for patients or are not working
• Pattern of migraine attacks are predictable, such as menstrual migraines

Table 4. Prophylactic Treatment for Migraine Headaches7-9

Beta-blockers (Most commonly used. Approximately 60 — 80% effective in reducing attacks by 50%.) Propranolol Atenolol Metoprolol Timolol

Calcium Channel Blockers Verapamil Diltiazem Nifedipine

Serotonin Antagonists Methysergide Cyproheptadine

Tricyclic Antidepressants Amitriptyline Nortriptyline Doxepin

Anticonvulsants Divalproex sodium Phenytoin Carbamazepine

Non-steroidal Anti-inflammatory Drugs (NSAIDs) Naproxen Meclofenamate Flurbiprofen Ibuprofen

Monoamine Oxidase Inhibitors (MAOIs) Phehelzine

Selective Serotonin-reuptake Inhibitors (SSRIs) Fluoxetine

Alpha-adrenergic Blockers Clonidine

Treatment during migraine pain (acute treatment)

Acute treatment is used to prevent progression and, hopefully, reverse migraines once they have started. The best time to start acute treatment is at the onset of headache pain. The goal of acute treatment is to get individuals to achieve closer to normal functioning.

Two types of acute treatment exist–abortive and symptomatic. Abortive therapy focuses on stopping the migraine as it progresses. Symptomatic therapy focuses on treating the symptoms that result from migraines. (Table 5)

Table 5. Abortive and Symptomatic Therapy for Migraines7-11

Abortive Migraine Medication 5-HT1 agonists, such as Prozac®, Zoloft®, Paxil®, Anfranil®, Effexor®, Desyrel®, Imitrex®, BuSpar®, Propulside®, Methysergide, Zofran®, Kytril® ergot alkaloid agents

Symptomatic Medication Simple analgesics, such as aspirin or Tylenol® Combination analgesics, such as Excedrin Migraine® (The first over-the-counter medication made specifically to relieve migraine symptoms.) Isometheptene-containing agents (NSAIDs), such as Midrin® Butalbital-containing agents (short-acting barbituates that contain simple analgesics and caffeine) Antiemetics–used to relieve nausea and vomiting Sedatives Steroids Ergot-containing substances Serotonin agonists Opioid analgesics–used for moderate-to-severe migraines in individuals who are less responsive to other therapies