brain, spinal cord, and nerve disorders
Migraines
Treatment of Migraine
Behavioral interventions, yoga, or relaxation techniques Medications to stop a migraine as it starts or keep it from progressing Medications to control pain and nausea Medications to prevent migraines Migraines cannot be cured, but they can be controlled. Doctors encourage people to keep a headache diary. In it, people write down the number and timing of attacks, possible triggers, and their response to treatment. With this information, triggers may be identified and eliminated when possible. Then, people can participate in their treatment by avoiding triggers, and doctors can better plan and adjust treatment. Doctors also recommend using behavioral interventions (such as relaxation, biofeedback, and stress management) to control migraine attacks, especially when stress is a trigger or when people are taking too many medications to control the migraines. Relaxation techniques can help control stress, ease muscle tension, and alter brain wave activity. Yoga can reduce the intensity and frequency of migraines. Yoga combines physical poses that strengthen and stretch muscles with deep breathing, meditation, and relaxation. Some medications stop (abort) a migraine as it is starting or keep it from progressing. Some are taken to control the pain. Others are taken to prevent migraines. For mild to moderate migraines, pain relievers ( Treatment of Pain ) can help control the pain. Often, nonsteroidal anti-inflammatory drugs (NSAIDs) or When migraines are or become severe, medications that can abort the migraine are used. They are taken as soon as people sense a migraine is starting. They include the following: Triptans(5-hydroxytryptamine [5-HT], or serotonin, agonists) are usually used. Triptans prevent nerves from releasing substances that can trigger migraines. Triptans are most effective when taken as soon as the migraine begins. They may be taken by mouth or by nasal spray or be injected under the skin (subcutaneously). Ditansare a class of medications that can abort headaches. They work like triptans but may have fewer side effects that involve the heart (such as changes in blood pressure or heart rate).Lasmiditan, taken by mouth, is currently the only ditan being used. No more than one dose oflasmiditanshould be taken in 24 hours. Gepantsare another class of medications that can abort headaches. Gepants block a protein in the blood that triggers migraine. These medications (rimegepantandubrogepant) are taken by mouth. Dihydroergotamineis given intravenously, subcutaneously, and by nasal spray to stop severe, persistent migraines. It is usually given with a medication used to relieve nausea (antiemetic medication), such asprochlorperazine, given intravenously. Certain antiemetic medications(such asprochlorperazineormetoclopramide) may be used to relieve mild to moderate migraines.Prochlorperazine, taken by mouth or given as a suppository, is also used to stop migraines when people cannot tolerate triptans ordihydroergotamine. Because triptans anddihydroergotaminemay cause blood vessels to narrow (constrict), they are not recommended for people who have angina, coronary artery disease, or uncontrolled high blood pressure. If older people or people with risk factors for coronary artery disease need to take these medications, they must be monitored closely. However, people with one of these disorders can takelasmiditan,rimegepant, orubrogepant. If migraines are usually accompanied by nausea, taking an antiemetic with a triptan when symptoms begin is effective. Antiemetics (such asprochlorperazineormetoclopramide), taken alone, may also stop mild or moderate migraines from progressing. When other treatments are ineffective in people with severe migraines, opioid analgesics may be used as a last resort. When migraines are severe, fluids given intravenously can help relieve headache and make people feel better, especially if people are dehydrated from vomiting. Other medications are used to prevent migraine and can decrease the frequency and severity of symptoms. They include the following: Antiseizure medications Beta-blockers Calcium channel blockers Monoclonal antibodies (erenumab,fremanezumab, andgalcanezumab) Tricyclic antidepressants OnabotulinumtoxinA(which is injected into the scalp, forehead, and neck) or monoclonal antibodies can be used to treat chronic migraines. Missing or reducing a dose of a medication used to prevent migraines or taking it late may trigger or worsen a migraine. Devices that stimulate certain nerves, held to certain parts of the body, can help treat migraine attacks, as well as prevent them. One such device, held to the forehead, can reduce the frequency of migraines. Another device, held to the back of the skull, can relieve migraines as they start. A device that uses an armband to stimulate nerves in the skin can relieve migraine pain. These devices have no significant side effects. 