Treatment:

There is no specific cure for migraine headaches. The goal is to prevent symptoms by avoiding or changing your triggers.

A good way to identify triggers is to keep a headache diary. Write down:

• When your headaches occur
• How severe they are
• What you've eaten
• How much sleep you had
• Other symptoms
• Other possible factors (women should note where they are in their menstrual cycle)

For example, the diary may reveal that your headaches tend to occur more often on days when you wake up earlier than usual. Changing your sleep schedule may result in fewer migraine attacks.

When you do get migraine symptoms, try to treat them right away. The headache may be less severe. When migraine symptoms begin:

• Drink water to avoid dehydration, especially if you have vomited
• Rest in a quiet, darkened room
• Place a cool cloth on your head

Many different medications are available for people with migraines. Medicines are used to:

• Reduce the number of attacks
• Stop the migraine once early symptoms occur
• Treat the pain and other symptoms

REDUCING ATTACKS

If you have frequent migraines, your doctor may prescribe medicine to reduce the number of attacks. Such medicine needs to be taken every day in order to be effective. Such medications may include:

• Antidepressants such as amitriptyline
• Blood pressure medicines such as betablockers (propanolol) or calcium channel blockers (verapamil)
• Seizure medication such as valproic acid and topiramate
• Serotonin reuptake inhibitors (SSRIs) such as venlafaxine

STOPPING AN ATTACK

Other medicines are taken at the first sign of a migraine attack. Over-the-counter pain medications such as acetaminophen, ibuprofen, or aspirin are often helpful, especially when your migraine is mild. (Be aware, however, that overuse or misuse of such pain medications may result in rebound headaches.) If these don't help, ask your doctor about prescription medications.

Your doctor can select from several different types of medications, including:

• Triptans -- the most frequently prescribed medicines for stopping migraine attacks -- such as almotriptan (Axert), frovatriptan (Frova), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig)
• Ergots such as dihydroergotamine or ergotamine with caffeine (Cafergot)
• Isometheptene (Midrin)

These medications come different forms. Patients who have nausea and vomiting with their migraines may be prescribed a nasal spray or injection instead of pills.

Some migraine medicines narrow your blood vessels and should not be used if you are at risk for heart attacks or have heart disease, unless otherwise instructed by your healthcare provider. Ergots should not be taken if you are pregnant or planning to become pregnant, because they can cause serious side effects to an unborn baby.

TREATING SYMPTOMS

Other medications are primarily given to treat the symptoms of migraine. Used alone or in combinations, these drugs can reduce your pain, nausea, or emotional distress. Medications in this group include:

• Nausea medicines such as prochlorperazine
• Over-the-counter pain relieves such as acetaminophen (Tylenol)
• Sedatives such as butalbital
• Narcotic pain relievers such as meperidine
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen

If you wish to consider an alternative, feverfew is a popular herb for migraines. Several studies, but not all, support using feverfew for treating migraines. If you are interested in trying feverfew, make sure your doctor approves. Also, know that herbal remedies sold in drugstores and health food stores are not regulated. Work with a trained herbalist when selecting herbs.

Support Groups:

American Council for Headache Education - www.achenet.org

The National Migraine Association - www.migraines.org

National Headache Foundation - www.headaches.org

Expectations (prognosis):

Every person responds differently to treatment. Some people have rare headaches that require little to no treatment. Others require the use of several medications or even occasional hospitalization.

Complications:

Migraine headaches generally represent no significant threat to your overall health. However, they can be a long-term (chronic) problem and may interfere with your day-to-day life.

Calling your health care provider:

Call 911 if:

• You are experiencing "the worst headache of your life"
• You have speech, vision, or movement problems or loss of balance, especially if you have not had these symptoms with a migraine before
• Your headaches are more severe when lying down
• The headache starts very suddenly

Such headaches may be the result of stroke, bleeding in the brain, aneurysm, or other serious condition and require the immediate attention of a health care provider.

Depending on the history of the headache, a CT scan or MRI may be done to rule out any of the above conditions.

Also, call your doctor if:

• Your headache patterns or pain change
• Treatments than once worked are no longer helpful
• You have side effects from medication, including irregular heartbeat, pale or blue skin, extreme sleepiness, persistent cough, depression, fatigue, nausea, vomiting, diarrhea, constipation, stomach pain, cramps, dry mouth, or extreme thirst
• You are pregnant or could become pregnant -- some medications should not be taken when pregnant