Migraine is a common, but incapacitating, neurological disease that affects approximately 39 million people in the United States alone. A typical migraine headache is usually one sided and involves a severe throbbing recurring pain, lasting 4 to 72 hours. About 90% of migraine sufferers have a family history of migraine. Migraine is most common between the ages of 25 and 55. Accompanying complaints are nausea and vomiting, and a heightened sensitivity to bright lights and noise. Although the exact cause of migraine remains unknown, the most widespread theory is that it is a disorder of the serotonergic control system. Genetic factors may also contribute. Fluctuating hormone levels show a relation to migraine in several ways: three quarters of adult migraine patients are female while migraine affects approximately equal numbers of boys and girls before puberty, and migraine is known to disappear during pregnancy in a substantial number of sufferers.
The treatment of migraine begins with simple pain killers for headache and anti-emetics for nausea, and avoidance of triggers if present. Specific anti-migraine drugs can be used to treat migraine. If the condition is severe and frequent enough, preventative drugs might be considered. Patients themselves often start off with acetaminophen, aspirin, ibuprofen or other simple analgesics that are useful for tension headaches. It is one of doctors’ practical diagnoses of migraine head pain when patients say typical OTC drugs “won’t touch it”. Anti-emetics by mouth may help relieve symptoms of nausea and help prevent vomiting which can diminish the effectiveness of orally taken analgesia.
If over the counter medications do not work, the next step for many doctors is to prescribe Fioricet or Fiorinal, which is a combination of butalbital (a barbiturate) and aspirin with caffeine. While the risk of addiction is low, butalbital can be habit-forming if used daily. Narcotic pain killers (for example, codeine, morphine, or other opiates) provide variable relief, but their side effects include the possibility of causing rebound headaches or analgesic overuse headache.
Preventive treatment of migraines can be an important component of migraine management. Such treatment can take many forms, including everything from taking certain drugs or nutritional supplements, to lifestyle alterations such as increased exercise and avoidance of migraine triggers. The goals of preventive therapy are to reduce the frequency, painfulness and duration of migraines.
Preventive medication has to be taken on a daily basis, usually for a few weeks, before the effectiveness can be determined. Supervision by a neurologist is advisable.