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Migraine headaches - Highlights

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of migraine.

Highlights:

New Migraine Drug Approved

In April 2008, the FDA approved a new prescription drug (Treximet) for treatment of migraine headache attacks. Treximet is a pill that contains a combination of the triptan drug sumatriptan (Imitrex) and the anti-inflammatory pain reliever naproxen (Aleve, Naprosyn). Some studies have indicated that a combination of sumatriptan and naproxen works better for migraine pain relief than either drug alone.

Migraine Triggers

Migraines can be triggered by many everyday things. Different people respond to different triggers, so it is important to track your migraine patterns to help avoid migraine attacks. Common migraine triggers include:

Emotional stress
Intense physical exertion
Abrupt weather changes
Bright or flickering lights
High altitude
Travel motion
Lack of sleep
Skipping meals
Odors
Certain types of foods and beverages (aged cheese, chocolate, red wine, beer, coffee, and many others)
Food additives or preservatives (nitrates, nitrates, monosodium glutamate)

Migraine Treatment Approaches

Migraines need a two-pronged approach: Treatment and prevention. Treatment uses medications that provide quick pain relief when attacks occur. These drugs include pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs), triptans such as sumatriptan (Imitrex), and ergotamine drugs.

Preventive strategies begin with non-drug approaches (behavioral therapies, lifestyle changes). If headache attacks continue to occur on a weekly basis, your doctor may recommend you try preventive medication. Drugs currently approved for migraine prevention include the beta-blocker drugs propanolol (Inderal) and timolol (Blacadrene), and the anti-seizure drugs divalproex (Depakote) and topiramate (Topamax).

Resources

www.headaches.org -- National Headache Foundation
www.achenet.org -- American Headache Society
www.aan.com -- American Academy of Neurology
www.ninds.nih.gov -- National Institute of Neurological Disorders and Stroke
www.clinicaltrials.gov -- Find clinical trials

References

Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM. Does this patient with headache have a migraine or need neuroimaging? JAMA. 2006 Sep 13;296(10):1274-83.

Ebell, MH.Diagnosis of migraine headache. Am Fam Physician. 2006;74(12):2087-8.

Goadsby PJ. Recent advances in the diagnosis and management of migraine. BMJ. 2006 Jan 7;332(7532):25-9.

Lewis D, Ashwal S, Hershey A, Hirtz D, Yonker M, Silberstein S, et al. Practice parameter: pharmacological treatment of migraine headache in children and adolescents: report of the American Academy of Neurology Quality Standards Subcommittee and the Practice Committee of the Child Neurology Society. Neurology. 2004 Dec 28;63(12):2215-24.

Lewis DW, Winner P, Hershey AD, Wasiewski WW; Adolescent Migraine Steering Committee. Efficacy of zolmitriptan nasal spray in adolescent migraine. Pediatrics. 2007 Aug;120(2):390-6.

Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF; AMPP Advisory Group. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007 Jan 30;68(5):343-9.

Monastero R, Camarda C, Pipia C, Camarda R. Prognosis of migraine headaches in adolescents: a 10-year follow-up study. Neurology. 2006 Oct 24;67(8):1353-6.

Nestoriuc Y, Martin A. Efficacy of biofeedback for migraine: a meta-analysis. Pain. 2007 Mar;128(1-2):111-27. Epub 2006 Nov 2.

Pringsheim T, Davenport WJ, Dodick D. Acute treatment and prevention of menstrually related migraine headache: evidence-based review. Neurology. 2008 Apr 22;70(17):1555-63.

Sierpina V, Astin J, Giordano J. Mind-body therapies for headache. Am Fam Physician. 2007 Nov 15;76(10):1518-22.

Silberstein S, Tfelt-Hansen P, Dodick DW, Limmroth V, Lipton RB, Pascual J, et al. Guidelines for controlled trials of prophylactic treatment of chronic migraine in adults. Cephalalgia. 2008 May;28(5):484-95. Epub 2008 Feb 20.

Wilson, JF. In the clinic. Migraine. Ann Intern Med. 2007;147(9):ITC11-1-ITC11-16.

Reviewed last on: 9/9/2008
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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