“Many migraineurs suffer needlessly,” says Seymour Diamond, MD, director of the Diamond Headache Clinic and executive chairperson of the National Headache Foundation. A study conducted by the foundation in 1999 surveying migraine incidence and treatments over the preceding decade found little change in the way people treat their headaches.

Ironically, during that same period, researchers made enormous strides in treating this debilitating headache that affects about 13 percent of the population.

“Possibly the greatest discoveries of the last 40 years have occurred in this ten-year period,” Dr. Diamond says. Why aren’t doctors and patients taking advantage of these research strides? “Two things are happening: patients aren’t going to their doctor, and the doctors aren’t prescribing the newer medications.” The survey found that the only medications that increased in rate of prescriptions during the decade were pain relievers. “People are still treating migraine in an old-fashioned way.”

Dr. Diamond blames the discrepancy between research and practice in the field, in part, on patients not seeking medical attention because they believe they must live with the pain. But the managed care system also shares the blame. “I think that managed care would rather promote an inexpensive pain-relieving drug than give them what I call a reversal drug, a drug that actually reverses what’s happening when a person gets a migraine attack.”

“There have been a lot of arguments recently about consumer advertising of [prescription] drugs, but I think it should be done,” he says. Such ads encourage patients to explore other care options and persuade doctors to learn more about the advances about which their patients are asking.

As many as 30 percent of migraineurs also suffer from tension, drug-rebound and other headaches. A complete physical and tracking of headache patterns with a headache diary are essential to identifying triggers of the pain. Here is an overview of medications and non-drug therapies used in treating migraines.

Non-Medication Methods for Preventing Migraines
A number of methods for reducing headaches do not involve pharmaceuticals. These include:

  * Diet Avoiding any dietary triggers is essential. Keeping a regular meal schedule is also important, even on weekends and holidays. Missing meals can be a trigger for some migraine sufferers. Some doctors recommend a diet low in tyramine-containing foods. These include chocolate, alcoholic beverages, processed meats, cultured dairy products, monosodium glutamate (MSG) and peanuts, for example.
  * Exercise As a stress reliever and general promoter of health, exercise is encouraged.
  * Sleep Keep a regular sleep schedule. Get enough sleep but avoid oversleeping.
  * Stress Reduction Stress is a risk factor for most headaches. Biofeedback and relaxation methods such as breathing techniques can reduce the effects of stress on headaches.

Medications for Treating Existing Migraines
Over-the-counter medications are the first line of defense for mild migraine, but advances in prescription drugs for interrupting serious migraine pain have changed the face of migraine treatment. Migraine medications include:

  * OTC Treatments Many mild migraines can be treated successfully with over-the-counter medications, particularly those combining acetaminophen, aspirin and caffeine, such as Excedrin Extra Strength, the first OTC medication approved specifically for migraine treatment.
    Naproxen (e.g., Aleve) is somewhat more effective than aspirin or ibuprofen (e.g., Advil). High doses of these nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen or naproxen, combined with metoclopramide (Reglan) to reduce nausea and vomiting, have been effective in several studies. Long-term use of NSAIDs can lead to gastrointestinal problems, including gastrointestinal bleeding.
  * Triptans These raise the level of serotonin in the brain, reducing the dilation of blood vessels, the source of the pain. Sumatriptan, the first drug developed for migraine, has been joined by several other triptans available in oral form and nasal sprays. Particularly when taken at the first sign of headache, these can be effective in as little as 15 minutes, and offer relief to most migraine sufferers. Side effects: nausea, dizziness, muscle weakness. Not recommended for women who are pregnant or for people with uncontrolled diabetes or cardiovascular conditions.
  * Ergotamine These drugs contract smooth muscles, including those in blood vessels, reducing the dilation of the blood vessels, which cause the headache pain. Dihydroergotamine (DHE), administered as a nasal spray, injection, as a suppository or orally, is particularly effective. It can be toxic at high levels. Pregnant women, those over 60, and those with chronic health problems should avoid these.
  * Lidocaine Nasal drops of this local anesthetic have been found to be effective in stopping or reducing headaches within a few minutes. In fact, in one study, it was effective in more than half the sufferers. Relapses are common, but the temporary relief can act as a bridge while other drugs take effect.

Medications for Preventing Migraines
Those who suffer from chronic severe and disabling migraines (more than two or three each month) may benefit from these preventive medications. Each has significant side-effects and should be used under a doctor’s supervision. These include:

  * NSAIDs Regular use of low-dose aspirin may reduce the occurrence of migraine, according to one study. Prescription-strength doses have also been found to reduce the frequency of headaches. Long-term use can lead to serious gastrointestinal problems, including bleeding of the stomach lining.
  * Beta Blockers Usually prescribed for cardiovascular disease, these medications can also reduce the frequency and severity of severe migraine.
  * Anticonvulsants Valproate and related drugs, used to treat epilepsy and bipolar disease, have recently been approved for the prevention of migraines.
  * Antidepressants Tricyclic antidpressants (amitriptyline (Elavil, Endep) and protriptyline (Vivactil) and selective serotonin-reuptake inhibitors or SSRIs (Prozac, Zoloft and Paxil) reduced the number and severity of migraine attacks by half in up to half of the patients in one study. The tricyclics are particularly effective for people who suffer from combined migraine and tension headaches.
  * Calcium Channel Blockers Also typically prescribed for heart patients, calcium blockers have been shown in clinical studies to be effective in preventing migraine. They may work by blocking the release of neurotransmitters (chemicals in the brain that stimulate nerve cells) involved in causing pain.