HEADACHES AND HORMONES
How Migraine is Treated
Treatment of migraine has improved dramatically due to new medications and better use of older ones. However you need a physician who is familiar with these advances. But first you have to mention it. Studies show many with migraine do not even tell their doctors!
There are two aspects of migraine treatment: those that prevent the headache and those that take it away. Many women with migraine need both.
Preventive treatment for migraine: Preventive treatment consists of taking a medication daily to prevent the headaches from starting in the first place. The main classes of medications used for prevention are beta-blockers such as propranolol (Inderal®), atenolol (Tenormin®) and nadolol (Corgard®). These are taken daily and can cut the frequency and severity of migraine attacks in half. My preference is for calcium channel blockers — such as verapamil (Calan SR®) or amlodipine (Norvasc®) and others — because they seem to have fewer side effects. Many migraine sufferers do quite well with beta-blockers however. It is sometimes necessary to try several medications in these classes before you find one that works for you. Occasionally, other medications such as the anti-convulsant carbamazepine (Tegretol®) are used for migraine prevention.
If your migraines are very infrequent there is no reason to take medication every day to prevent a headache every few months. But if you are one of the unlucky ones who gets them every week or two, preventive treatment may make a big difference in your life. Anyone who has ever had a migraine would rather not have them at all than get the headache then wait for medication to take it away. Not all doctors are familiar with preventive treatment for migraine. It is worth searching for one who is, he or she might be a specialist in female hormone problems or a neurologist with a special interest in headache.
Medication to stop the attack: This is an area which has advanced considerably in recent years.
Acetaminophen (Tylenol® and others) or NSAIDs such as ibuprofen (Advil®) or naproxin (Alleve®) may work for mild migraine.
There are now several prescription medications, called triptan, that have a direct effect on the blood vessel changes that cause the pain. The first fully effective drug was sumatriptan (Imitrex®). This is available in oral, injectable, and nasal spray forms. The nasal spray acts almost as quickly as the injection and faster than the tablets, and consequently is often the first choice. Other newly introduced medications for stopping attacks are dihydroergotamine nasal spray (Migranal®) and zolmitriptan (Zomig®) rizatriptan (Maxalt®) which are tablets. These last for a few hours. For migraine sufferers whose headaches usually last longer, an alternative is naratriptan (Amerge®) which lasts longer. Naratriptan is very useful for menstrual migraine when the attack often lasts for two or three days but an individualized regimen must be worked out. Because these medications work by causing blood vessels in the brain to constrict, it is important not to take them more often than recommended. Patients must be very sure they fully understand their doctors’ instructions before using these medications and should not make changes without medical advice.
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