Migraine Prophylaxis: Treatment, Procedure, Cost and Side Effects

Migraine is described as a complex disorder of recurrent headaches. Most often, it is either unilateral or in association with sensory or visual indications which is collectively called an aura (arises before head pain but occurs before or after a migraine). Migraine most commonly occurs in women and also has a strong genetic element. There are a few signs and symptoms in accordance with migraines. The first one is pulsatile headaches or throbbing, with moderate pain that intensifies and becomes severe with either movement or physical activity. The second one is localized or unilateral pain in the ocular and frontotemporal area, the pain can be felt around the head or neck. Headaches lasting for 4-72 hours, is also a symptom. Other symptoms include light-headedness, sensitivity to sound and light and progressive pain built up.

Selection of laboratory or imaging studies to fend off conditions apart from migraine headache is usually determined by individual presentation such as C-reactive protein levels and erythrocyte sedimentation rate. A patient with a history of normal neurologic examination and migraine headaches doesn’t need to get neuroimaging. Acute treatment of a migraine attack aims to reverse or stop the progression of a headache. Its effect is the most within the first 15 minutes of the onset of pain to mild pain. Abortive medications for this condition include analgesics, antiemetics, combination products, NSAIDs (nonsteroidal anti-inflammatory drugs). Preventive or prophylactic measures are associated to the usage of abortive medications twice a week or even more. On the other hand, prophylactic medications involve antiepileptic drugs, calcium channel blockers, serotonin antagonists, selective serotonin reuptake inhibitors (SSRIs), botulinum toxin, tricyclic antidepressants and NSAIDs.

An antidepressant named amitriptyline is the first-line agent for migraine prophylaxis and is the only one providing consistent evidence as an effective measure. There is a study of amitriptyline therapy (50-100 mg/daily) compared to placebo over a period of 4 weeks in 162 people having migraines. The results displayed an odd ratio of 2.4 (95% Cl, 1.1 – 5.4) in patients who underwent a 50% improvement in migraine index. The results were as such that on comparing amitriptyline with propranolol we found that propranolol was more beneficial for migraine patients having a single type migraine, whereas amitriptyline was more effective for patients with tension features or a mixed type migraine.

There is sufficient evidence to support the usage of naproxen (Naprosyn) and naproxen sodium (Anaprox) in case of migraine prevention. For menstrual prevention of migraines the doctor recommends to start a course of anti-inflammatory drugs a week before menstruation and continue the course for the first few days of the period. Patients with comorbid osteoarthritis are recommended NSAIDs typically. However, keep in mind to take precautions for chronic NSAIDs as it can lead to adverse effects in accordance with renal dysfunction and gastrointestinal problems (3 to 45 percent in trials). Be careful about the high dose of aspirin as well.

A person who has had 5 headache attacks lasting 4-72 hours which was either untreated or unsuccessfully treated, a headache on a unilateral location, pulsating quality, moderate or severe intensity of the pain, aggravation by avoiding a routine physical activity (eg, climbing stairs, walking), are the eligibility criteria for receiving the treatment.

People with stable headaches which go off before 4 hours are not eligible to receive the treatment for migraine. Pregnant women facing harmful side effects from certain medications must be excluded.

The side effects of migraine treatment include sleepiness, extreme fatigue, nausea, racing heartbeat, and difficulty in thinking.

Excessive use of computers and mobile phones must be avoided at all cost. After the intake of medications, take a nap for 3-4 hours or put your head down while looking at the floor. Cigarette smoking can increase the risk of developing migraines. It is advisable to stay away from it. Warm compresses on your head your will provide immense relief and will fend off irritation. A diet enriched with omega-3 fatty acid supplement will help your condition. Some of the lifestyles changes include listening to calming music, meditation, yoga, acupuncture, getting massages, a talk therapy and taking short walks.

It takes approximately 4-72 hours to recover from a migraine attack. This period includes extreme headache, nausea, vomiting and intense sensitivity to sound and light.

The price of the treatment ranges from Rs. 500 to Rs. 2,000.

The results of prophylactic migraine treatment are not permanent as it only provides preventive measures and not long-term benefits. It only subdues the onset of a migraine.

The alternative treatment methods for migraine include acupuncture, stress management, head massages, herbs, aroma therapy and specific dietary changes which may prevent your frequent migraine headaches.