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Migraine headaches

Description

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


Prevention

There are several ways to prevent migraine attacks. A healthy diet (See Lifestyle Changes in this report), the right amount of sleep, and non-drug approaches, such as biofeedback, should be tried first for prevention.

Behavioral Treatments

Behavioral techniques that reduce stress and empower the patient may help some people with migraines. Studies report between 35 - 50% reduction in migraine and tension-type headaches with these approaches. They generally include:

Behavioral methods may help counteract the tendency for muscle contraction and uneven blood flow associated with some headaches. They may be particularly beneficial for children, adolescents, and pregnant and nursing women, and anyone who cannot take most migraine medications.

Biofeedback. Studies have demonstrated some effectiveness from biofeedback for migraine headaches. Biofeedback training teaches the patient to monitor and modify physical responses, such as muscle tension, using special instruments for feedback.

Cognitive Behavioral Therapy. Behavioral therapy may be useful alone but is particularly beneficial for patients who are on preventive drug treatments. It typically uses the headache diary to track activities and headaches. The patient then works with the therapist to change or add behaviors or medications that will reduce the frequency and severity of attacks.

Acupuncture and Relaxation Therapy

Alternative non-drug therapies used for headache management and prevention include hypnosis, meditation, visualization and guided imagery, acupuncture, acupressure, yoga, and other relaxation exercises. There is no clear evidence that any of these techniques have specific value for migraines.

Some studies report the following:

Avoiding Oral Contraceptives

Hormonal drugs, such as oral contraceptives (OCs) or hormone replacement therapy, have a mixed effect on women with migraines. Oral contraceptives (OCs) have been associated with worse headaches in 18 - 50% of women and have also been linked to a higher risk for stroke in women with classic migraines (with auras). Young women should avoid or stop oral contraception if they have classic migraines, migraines that worsen or change character after OCs, if they have close relatives with stroke or heart disease, or if they smoke.

Some evidence suggests, however, that OCs may help prevent true menstrual migraines (which do not have auras). In such cases, their benefits may outweigh the low risk of a serious adverse event. Keeping a migraine record for at least three menstrual cycles can help confirm whether a woman actually has a true menstrual migraine.


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