Headache

Migraine Headaches

Signs and Symptoms
Diagnosis
Treatment

Treatment

Migraines can be triggered by certain factors. By identifying and avoiding these “trigger factors,” you can help manage your headache. People who suffer from migraines tend to be sensitive to stress. Since the stresses of everyday life cannot be avoided, practicing stress-relieving techniques, such as yoga, transcendental meditation, hypnosis and biofeedback may be helpful.

Keeping a headache diary that tracks the date, time and onset of your headache, a list of medications you were using, and any other external factors, can also help you and your clinician track patterns and plan treatment.

Trigger Factors

Trigger factors include:

Sleep — Too much or too little sleep can trigger a migraine in some people.

Hormones — Many women with migraine headaches have attacks linked to their menstrual cycles. Oftentimes women will have one of their worst migraine attacks just prior to their menstrual bleeding or in the first day or two of their period.

Fluctuating estrogen may play a role. Menstrual migraines can be more debilitating, difficult to treat and longer lasting than other migraines. This condition may worsen in early pregnancy, but then improve in later pregnancy. Migraines typically subside as women age. About 80 percent of migraine-suffering women will see their attacks almost completely subside after menopause is finished. However, oral contraceptives or estrogen-replacement therapy can provoke or worsen migraines in some women.

Stress and Anxiety — Emotional stress or daily pressure can trigger a migraine attack in some people. Managing stress can help alleviate migraines. For example, it might help to complete large jobs in small increments over time instead of all at once. Learning to relax and "let go" of events beyond your control also may help. Exercise and meditation can modestly improve migraine pain.

Environmental Factors — Migraine headaches can be triggered by environmental conditions including weather or temperature changes, glaring or fluorescent lights, computer screens, strong odors and high altitude.

Diet — Certain foods can trigger migraines in some people, although this is rarely the only cause of the headache. Alcohol, especially red wine; the sugar substitute aspartame; caffeine; monosodium glutamate (MSG), a food seasoning; foods that contain tyramine, such as aged cheeses; and preserved meats with nitrates and nitrites may cause migraines.

Medications

Typically, pain relievers such as aspirin, acetaminophen and ibuprofen are recommended as initial treatments. If they don't relieve the pain, your doctor may prescribe other drugs or drug combinations. Your doctor will work with you to determine which drugs are best for you, based on the severity of your attacks. Drugs, however, don't cure the condition. As you age, though, your migraines may subside. Studies show that migraine attacks peak between the age of 35 and 45 and then begin to decline.

Some medications used to treat other conditions — such as beta-blockers for hypertension and tricyclic for depression — are effective in treating migraines. The benefits and dosages of these drugs when used for migraines, however, are different than those in the treatment of other conditions.

Tricyclic Antidepressants — Antidepressant drugs have analgesic or pain-relief qualities. Although you may not be depressed, your doctor may prescribe drugs such as amitriptyline or doxepin to help reduce the frequency and severity of your headaches.

Beta-blockers — A drug such as propranolol may be combined with an antidepressant, such as amitriptyline, to prevent chronic daily headaches.

Anti-seizure medications — Most recently a number of medicines used in epilepsy (seizures) have been found to be very effective in migraine and may be used to prevent attacks.

Combination therapy — Symptoms of migraine headaches are caused by multiple mechanisms. A new fixed-dose tablet combining the medications sumatriptan and naproxen targets more than one of these mechanisms. Some doctors have been clinically combining the two drugs for some time. However, results of two recent studies assessing the efficacy and safety of the combination drug suggest that it provides more effective headache relief compared to either drug alone. It was also well tolerated, with minor side effects including dizziness, paresthesias and somnolence.

Many drugs for acute migraine attacks work best when taken as soon as you feel a migraine coming on. It is important to note that you must not take these medications more often or in higher doses than your doctor recommends.

If you experience frequent attacks, medication to prevent migraines may be prescribed so that headaches will strike less often and last for shorter periods of time. Be sure to continue taking your preventive medications even while being treated for an acute attack.

If your doctor prescribes you medication, be sure to ask:

• How often the medication should be taken
• If the medication should be taken with meals or on an empty stomach
• What to do if pain or other symptoms persist

Reviewed by health care specialists at UCSF Medical Center.
Last updated December 17, 2008