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Managing Migraine October 2012 Lia Schmitz, Pharmacist at Island Drug in Clinton This is Lia Schmitz, I'm one of the pharmacists at Island Drug in Clinton. Migraines are more than simply a bad headache. They are a primary headache disorder caused by a deep brain mechanism that produces inflammatory chemicals which lead to a complex interaction of vascular and neuronal factors. In any given year, an average of 10% of adults worldwide suffer a migraine. It appears to affect people of any color or creed, women twice as often as men. A migraine can be distinguished from other types of headache in that it is often unilateral (effecting one side of the head), nauseating, and throbbing; it lasts many hours, and causes sound and light sensitivity. Migraines can Page 1 of 4 The above article is general information that is in no way intended to treat, diagnose, or cure any medical condition. Further it is not intended, nor recommended, that this information be used without the supervision of your medical provider. occur along with tension-type headaches, precipitate them, or be triggered by them. Because a migraines evolves differently from a tension or other type of headache, it is important to get a formal diagnosis of migraine before designing treatment strategies. The first step to managing migraines is to note when they occur in order to identify triggers. Common triggers include stress, fatigue, oversleeping, fasting, missing a meal, changes in altitude, certain foods, caffeine, alcohol, or menses. Common food culprits include fresh yeast baked goods, processed meats or fish, monosodium glutamate, aspartame, cheese, and chocolate. Journaling migraine occurrences and surrounding events is a good strategy and will aid a doctor in diagnosing the headache. Once migraine symptoms start, an over-the-counter pain reliever taken immediately can abort a mild to moderate migraine. Even after a migraine has progressed, an analgesic can relieve some of the pain. Good options are ibuprofen, acetaminophen, aspirin, naproxen, or ketoprofen. There are also a number of combination products available, most of which contain these pain relievers, plus sometimes caffeine. Different combinations work well for different people, so give one a try, and next time try a different one if it didn't relieve the pain. Page 2 of 4 The above article is general information that is in no way intended to treat, diagnose, or cure any medical condition. Further it is not intended, nor recommended, that this information be used without the supervision of your medical provider. Feel free to ask your pharmacist for product selection guidance. Periods of rest and sleep help a great deal, and possibly applying a cold pack to the head for minutes at a time. Complete pain relief is unlikely, the goal is to prevent and lower the pain down to a functional level. Carefully follow the package directions for dosing and contraindications. If you are unsure if a medicine is appropriate for you to take for migraine, please ask your pharmacist for advice. Migraines frequency can sometimes be lessened by taking a preventative medicine every day. Some herbal options are available and include the following: Butterbur, which needs a dose of at least 50 mg/day, it can cause belching and should be avoided during pregnancy. Feverfew, which does not have clearly defined dosing recommendations and has been known to cause rebound headaches if stopped abruptly. Peppermint oil used on the skin, which also should be used with caution during pregnancy. If migraines occur three or more times per week, or impact your life on a regular basis, it's time to go to the doctor. Professional medical advice is needed for treatments this frequent. Additionally, there are prescription treatments for both migraine pain relief and migraine prevention which are statistically more effective than the over the Page 3 of 4 The above article is general information that is in no way intended to treat, diagnose, or cure any medical condition. Further it is not intended, nor recommended, that this information be used without the supervision of your medical provider. counter options. Commonly used prescription pain relievers are referred to as 'triptans and include sumatriptan, rizatriptan, almotriptan, and others. Commonly used preventative therapies include amitriptyline, propranolol, and related medications. Once preventative therapy is started, full effect may take up to 8 weeks. It is important to know when a headache condition should be assessed by a doctor. Please seek professional medical advice if you have severe worst-headache-of-your-life type pain, a headache which lasts for 10 days, you have a fever, you are pregnant or have liver disease, or if the headache is caused by some other specific physical disorder. World Health Organization [Internet]. c October 2012. Health Topics: Headache disorders [cited 2012 October 16]. Available from: http://www.who.int/topics/headache_disorders/en/index.html Remington TL. Headache. In: Berardi RR, et al. Handbook of nonprescription drugs. 15th edition. Washington DC: American Pharmaceutical Association; 2006. Page 4 of 4 The above article is general information that is in no way intended to treat, diagnose, or cure any medical condition. Further it is not intended, nor recommended, that this information be used without the supervision of your medical provider.