NEW HOPE FOR MIGRAINE HEADACHE PAIN

 In spite of many medication on the market geared toward relieving headache pain, there are numerous those who still expertise chronic headaches.

For many Americans, the medication don't seem to be effective in reducing the amount or severity of headaches.

Often medication simply mask symptoms instead of resolving the difficulty.

For many patients during this state of affairs, a replacement supply of hope might are available the shape of an recent ancient methodology of treatment.

A very broad primarily based study recently conducted at Duke University reviewed quite thirty studies involving quite four,000 patients with headaches together with migraines, tension headaches, sinus pain and alternative forms of headache.

Here is a quote from the DukeHealth.org website:

“We combed through the literature and conducted the most comprehensive review of available data done to date using only the most rigorously-executed trials,” said Tong Joo (T.J.) Gan, MD, a Duke anesthesiologist who led the analysis.

“Acupuncture is becoming a favorable option for a variety of purposes ranging from enhancing fertility to decreasing post-operative pain because people experience significantly fewer side effects and it can be less expensive than other options,” Gan said. “This analysis reinforces that acupuncture also is a successful source of relief from chronic headaches.”

According to the Duke source, 62 percent of patients responded favorably to acupuncture versus only 45 percent for medication.  The patients receiving acupuncture also reported having other benefits such as improved feelings of well being, better sleep and more energy.

I have found that results in our clinic even exceed those quoted in the Duke Study.  It is unusual, in fact, if a patient with headaches does not respond favorably to treatment in our clinic.
Here’s a recent example:

A mother brought her teenage son to see me earlier this year. He told me that he had headaches that were severe enough that he often was unable to even carry on with normal activities. I asked how long he had experienced headaches. “Since second grade,” he replied.

He then told me that in the past few months the headaches had been getting worse and occurring three or four days per week.

I asked him and his mother what doctors they had previously consulted.  They had made several visits to various specialists and had many tests and imaging studies performed. Because no previous doctor had found a solution, the last doctor he had seen had told him that he would just have to live with the headaches and maybe he “would grow out of them.”

After so many years of failed responses to ordinary medical care, they decided to consider unconventional treatment. They consulted with me to learn whether acupuncture treatment might be an option.

He was not hopeful at first. He had tried so many treatments without results that he was expecting another ineffective try. Realizing that this treatment involved being stuck with needles on a weekly basis, he was even more hesitant.

Once he experienced the first treatment, however, and discovered the needles didn’t hurt, he grew a little more positive. After he realized a week later that he had not had as many headaches, he began to look forward to the visits.

Last week, he sat in my office and told me that he had only had one mild headache during the past month. I asked if he had experienced any minor headaches. He told me that he had not had any pain at all except for that single headache.
Every patient varies in their response to acupuncture. But if the patient is an appropriate candidate and proper treatment is given, the response is usually positive.

This patient, like millions of others, had been told incorrectly that there is no hope other than drugs that mask their symptoms. They have been told that no solution exists.

I sometimes consult with patients that I decline to accept for treatment because I do not think I have an effective solution for them.

I prefer to tell them that I do not have an answer for them, rather than declaring that there is no answer.

I always suggest that they keep searching, rather than give up.

Resolve to stay happy and stay healthy for the rest of the year!



source: murfreesboropost.com

keywords: migraine headache, headache, headache pain, pain.

Yoga - A cure for migraine

Yoga can help with the early stage of a migraine by helping you rebalance the oxygen in your body. Stretching will help draw blood supply toward muscles and away from the brain. Certain poses will help rebalance your hormones and your digestion. Stretching can also help relax muscles that are reacting to the headache, and help the sufferer let go enough to ease the secondary symptoms. Using the right breathing theme will also help rebalance the oxygen.
So do this routine when you first feel the migraine coming on - when you get the visual disturbances, or first start feeling nauseous or whatever you have come to realize are your early symptoms:
1. Chose some stretches that are fairly demanding for you and that make you feel good. You might especially like to try twists, if you can do them, or postures that help your neck and shoulders, as tension in these areas might be helping trigger your headache. Pick at least 2 stretches. This should take you about 5 minutes. (6 stretches done over 15 minutes would be ideal.)

2. As you do the poses:

• Take long slow breaths out
• Then take shallow breaths in, about 2/3 full
• Do not hold your breath after you've breathed in.
• When you breathe out take all the time in the world to breathe out and stretch more and more as you do so.
• Then, before you breathe in, pause for as long as you can comfortably do so.
• The idea here is to encourage less oxygen intake and give your body time to build up CO2 before getting more fresh air with the next breath.

I find almost instant relief using this Breathing Theme. If you stick with it for about 5 minutes, the relief can last for hours. Later in the day, or as you feel the symptoms sneaking back, take another 5 minute yoga break to do this again. 
Poses to Help Headaches
Try these only if they are appropriate for you. Not all poses can be done by everybody. See our Caveats page and the caveats that are on each posture page. Pregnant women should not do the abdominal lifts or twists. Pregnant women and women having their period should not do inverted poses.
Great during a headache. Possibly because they involve holding your breath and altering your blood pressure.
Help relieve tension in the spine and body and can re-balance digestion. Good during a headache for some people. Others find that, by including twists in their daily routine, it helps them avoid headaches or lessens their intensity.
Relieve tension in the body and rebalance hormones and digestion. Not pleasant actually during a headache, but try including them in your daily routine to help you reduce the number of or intensity of headaches.
Good overall work out that can be made as intense or as gentle as you like. Removes tension from the entire body, rebalances blood flow, and constricting the over-dilated blood vessels in the brain by sending more blood to the working muscles. Good during a headache if combined with controlled breathing: 5 - 10 rounds recommended.
Breathing Themes that Will Help Your Headaches
When dealing with a headache, it helps to pace your breathing. This can help reduce the swelling in the blood vessels in your brain and rebalance the chemistry in your body - all of which can bring relief. So try using a Yellow Level Breathing Themes when you are doing any of the poses or routines above.

You can also do those Breathing Themes by themselves, as a breathing exercise, to provide some relief.   

readmore in audioyoga.com 

Drinking water - A simple cure for migraine

Researchers claim that increasing water intake by about six cups per day can reduce the intensity and duration of migraine attacks, reports Sade Oguntola.
Many migraine patients report that certain foods are often related to the triggering of migraine attacks. Fortunately, identifying and avoiding these foods can help to significantly reduce the frequency of attacks. In addition, research has shown that migraine patients may be able to decrease the number of migraines they experience by increasing their water intake by about 6 cups per day.

Wondering if this is possible? According to a new finding published in the European Journal Of Neurology, drinking water could be a simple cure for migraines. The findings, published in the European Journal Of Neurology, suggested that people that experience migraine especially in hot weather should drink more water to prevent dehydration, which is a significant factor in the build-up to migraine attacks, this can reduce the intensity and duration of attack.

In the study, the researchers examined whether increasing water intake in migraine patients would help prevent future attacks. For the study, the 18 people that participated were divided into two groups.  The first group received a placebo medication, while the second group was instructed to drink 1.5 additional Liters of water on top of their normal intake every day.  After 12 weeks of the experimental treatment, each group had their migraine headache symptoms measured.

The results of this study found that the group who increased their water intake, reduced their total hours of headaches in a two-week period by 21 hours.  This group also had a significant decrease in the intensity of their headache pain.

Simply put, dehydration occurs as the result of excessive loss of water from the body, when we lose more water than we take in. It’s a bit more complicated than that since the body loses valuable electrolytes as well. Dehydration can be a major issue, both in and of itself and as a headache or Migraine trigger due to the lowering of blood volume. Unfortunately, a reduction in blood volume causes less blood and oxygen to the brain.

Many people mistakenly think it occurs only in hot weather and that you’re not dehydrated if you’re not thirsty. Both of these misconceptions lead to many cases of dehydration every year, some of them quite serious. However, it takes an average of 64 to 80 ounces to replace the water our bodies lose in 24 hours. Under normal circumstances, how much water the body needs depends a great deal on the volume of perspiration and urine output. In addition, the bodies’ water needs increases under circumstances such as warmer weather or climate, increased physical activity, when experiencing vomiting, diarrhea or fever.

People suffering from migraines have learned that there can be many different types of triggers that lead to a migraine attack.  Weather, lights, noise, stress, sleeping problems, alcohol, caffeine, and many others can affect migraine sufferers in different ways.  And while the exact mechanism of what causes a migraine remains unclear, “almost 40 to 50 per cent of all triggers of migraine is due to stress, sleeping problems, diet, menstrual cycle and environmental changes such as light among others,” stated Dr Mayowa Owolabi, a consultant neurologist at the University College Hospital (UCH),Ibadan, Oyo State.

Although what triggers a headache for one person may not bother someone else, Dr Owolabi stated that dehydration was not a scientifically and recognized trigger of migraine.

According to Dr Owolabi, “even though generally water deprivation is not good for anyone because the entire body system runs on water, dehydration is not a recognized and well studied as well as established precipitant of migraine attack.”

Nonetheless, dehydration is best avoided because of its implications on health. According to Dr Owolabi, “the body composition is almost 70 per cent water. All the chemical reactions that take place in the body require water as a medium to take place. As such, when there is water shortage, the whole body system would go awry. A person that does not take enough water stands the risk of kidney stones and even a kidney failure. So many things can happen. Ordinarily, an adult living in the tropics needs to take three litres of water per day if he or she does not have kidney problem.”

By what mechanisms can lack of water produce migraine triggers? For one, our nerves (which are themselves tiny water pathways) send signals to control every part of our body. If a lack of water thickens the fluid inside nerves, their signals can be distorted. Distorted signals can be migraine triggers. In addition, water normally carries toxins away from cells. Without sufficient water, toxins build up and cause inflammation to nerves. Inflamed nerves are migraine triggers.

Water is a vitally important transport system, but it also plays an active role in body chemistry. For example, the liver uses water to metabolize fats into usable energy. Without enough water, there will be a lack of energy to power various cell pumps that keep migraine triggers from overwhelming neurons in the brain and causing a migraine

However, another way that migraine can be avoided with natural substances is to eat apples. Certainly, apple is no miracle medicine, but this will help to avoid unhealthy migraine triggers such as caffeine and alcohol. Apples, just like many foods, also contain a certain amount of water that can add to your water routine without forcing yourself to drink more water unlike coffee, chocolate, and anything else that contains a significant amount of caffeine which can ease bring about these headaches.

Changes in the body such as moderate hunger, stress, changes in the balance of hormones, and changes in normal sleeping patterns can also bring on a headache. But those who drink a moderate amount of water on a daily basis can easy some of the symptoms of these altered patterns, including reducing migraine headaches.

Written by Sade Oguntola - tribune.com.ng

Is your head aching? Relax! and you will feel better

Stress is one of the main cost of tension headache, if it get out of control it can elevate the problem of mild headache to chronic headache. Various other problems such as high blood pressure, high heart rate, insomnia and headache occur and aggravate at a continuous pace, due to stress.

So,How to manage stress? There are many way to manage stress and relaxation is one of them. If we knew how to use it, it would be very useful to combat the stress, which is a trigger for migraine headache. 

• Relaxtion could reduce your blood pressure
• Relaxtion can also normalize blood vessels in brain, causing increased blood flow to brain, which help in preventing migraine headache.

 Relaxation should be aimed at:

• Reduced level of stress and anxiety
• Improvement in yourself and increase in self-awareness.
• Improved inspiration and motivation
• Enhanced mind’s potential
• Improved quality of sleep 

Here some easy ways to relax:

• Deep Breathing: This is a simple way to  relax. Just let your hair down and breathe in deeply through the nose, this will increase oxygen flow to your various organs and you will feel better.

• Meditation and Yoga: With the deep breathing, in this technique your have to speak a mantra in rhythmic order. OM is a universally accepted mantra and following it may prevent the common diseases of throat, lung and chest. Deep breathing helps in oxygen flow.

• Progessive relaxation: This technique is different from the previous techniques, in this technique, you allow your muscles alternately tense and relaxed, causing exercises of your muscles. This relaxing technique will decrease the stress level and ultimately prevent migraine headache.

The above are some relaxations , they are very simple but very useful for you. Besides, some of following common habits are also useful for preventing tension headache, such as:

• Follow regular eating and sleeping schedules (even do not change them during vacation or weekends.

• Regular physical exercises  such as walking, biking etc may help you in reducing headache.

• Don’t sit or stand for quite a long time, carry out regular stretching of muscles of hand, foots, … remember: Avoid a single posture for long time

• Applying heat or ice (what ever suitable for you may prevent tension headache.

A guide to non-Migraine Headache

■ Tension Headache

This is the most common type of headache, affecting 90 percent of American adults and occurring in more women than men. Sufferers describe the condition as a band steadily tightening around their head. There also may be pain in the back of the neck or base of their skull. Tension headaches can last 30 minutes to a week. If they occur more than 15 times a month, they’re considered chronic. The pain can be severe and distracting, but rarely affects your ability to function like a migraine does.

          Triggers and causes – Tension headaches occur when muscles in the face, neck, scalp and jaw tighten up.  The word “tension” is mis-leading because that’s not the only cause of these headaches—stress, poor posture and depression also can bring them on.  (So, don’t put off treatment under the assumption that when the tension goes away, the headache will, too!)  Another cause, ironically, can be thevery pain relievers you’re taking to stave off the headache.  If you take these drugs every day, your body can become dependent on them.  When you miss a day, your head begins to hurt—a symptom of medication withdrawal.

Treatments and prevention – Rest, ice packs, warm compresses or a hot shower can relieve an occasional tension headache. Severe headaches can be treated with aspirin, acetaminophen and muscle relaxants.  Your doctor also may prescribe therapy such as muscle relaxation and stress reduction techniques, after evaluating your lifestyle to determine the cause of your headaches.

■ Cluster Headache

Cluster headaches are relatively uncommon, but you’ll know if you have one.  A cluster headache begins with stabbing pain on one side of the head, usually starting at the eye.  Eighty-five percent of sufferers are men.  Symptoms include an intense burning or stabbing sensation, bloodshot or teary eye, runny nose, and a flushed and sweaty face. Clus-ter headaches last less than 45 minutes and can occur daily for weeks or months before subsiding.

Triggers and causes – Researchers haven’t yet determined the exact cause of cluster headaches.  They believe histamines, which dilate or expand blood vessels, trigger the condition, because of the increased levels of histamine in the blood and urine of cluster headache patients.  Alcohol also is a potential trigger, and many people who get cluster headaches are heavy smokers.

Treatment and prevention – Cluster headaches can be treated with medications (such as triptans) similar to those prescribed for migraines. Breathing 100 percent oxygen during a severe headache is helpful to some patients.

■ Sinus Headache

Sinus headaches usually are accompanied by pain or pressure in the forehead or around the eyes and cheeks, and the skin and bones around the eyes feel tender.  The pain gets worse when you bend down, quickly moving your head while exercising, or blow your nose. 

Triggers and causes – A sinus headache occurs when sinuses are con-gested. Sinuses are cavities in the head, connected to the face through small openings. The sinus lining normally produces mucus, which drains through these small openings to the nose. When you have a cold or allergy, the openings are blocked by excess mucus or swollen tissue, and this can cause an infection—and headache. When the sinuses are clear, the headache will subside.

Treatment and prevention – Aspirin, acetaminophen or ibuprofen may temporarily relieve the pain of a sinus headache.  See your doctor if headaches persist. He or she may prescribe decongestants or an antibiotic if you have a sinus infection.

Lehigh Valley

Migraine Headache Treatment

A headache may only be one symptom of the migraine process; other symptoms may include sensitivity to light or sound, nausea, vomiting, diarrhea or neurological symptoms. Migraine patients who have associated (usually occurring 20-40 minutes before the headache) neurological symptoms such as numbness, altered (not just blurred) vision or tingling are said to have migraine with aura. Most migraine patients do not have an aura, but for those who do estrogen-containing contraceptives may be contra-indicated.
Research suggests that a group of cells at the base of the brain, present in all humans, may cause migraines in some people as a result of an increased or unstable firing pattern. This in turn may promote inflammation of blood vessels in the covering of the brain and alterations in blood vessel caliber. Many medications effective in the control of migraine are now felt to work by stabilizing or reducing the firing rate of these brainstem cells or by reducing inflammation and/or blood vessel dilatation.
For some, triggers of migraine may include sun glare, alcohol, smoking and other fumes, certain foods (caffeine, cheese, chocolate, nuts, processed meats and monosodium glutamate), or some medications (most notably birth control pills). Skipping meals and “sleeping in” can both trigger migraine, for some. Trying to discern your triggers can be difficult…and rewarding.


What can you do to manage your migraine? First, do not try to ‘work through’ a migraine. The longer you let a migraine develop, the more difficult it is to reverse. Stop what you are doing, lie down in a darkened room, and take your migraine reversal medication. Thus, you should have your medication available at all times.
Migraine treatment consists of migraine reversal and, for some patients, migraine preventive medication (taken daily to prevent or reduce the frequency of migraines). Migraine reversal medication should not be routinely used more than two days per week; overuse or frequent use of reversal medications can lead to rebounding, a syndrome in which daily or near daily consumption of headache relief medication actually results in daily headaches. Examples of migraine reversal medications include acetaminophen, aspirin and caffeine mixes (e.g. Excedrin Migraine), ibuprofen (Advil), naproxen (Aleve), dihydroergotamines (DHE, Migranal), “triptans” (imitrex, maxalt, zomig, relpax and others) and Midrin.
For patients having more than two headaches per week, or whose headaches last days at a time, preventive medications may be appropriate. Migraine preventive medicines were originally developed to control other conditions such as hypertension, depression or seizures—yet have been found to have this additional property in common.
The choice and use of both the reversal and preventive medications for migraines require a partnership between the clinician and patient; without a ‘patient kept’ headache diary to track the headache frequency and pattern(s), the clinician cannot make rational medication adjustments. Each type of medication (reversal and preventive) may require a two or three month trial to fully evaluate its effectiveness.

By University of Oregon

How are migraines treated?

Migraine has no cure. But your migraines can be managed with your doctor’s help. Together, you will find ways to treat migraine symptoms when they happen, as well as ways to help make your migraines less frequent and severe. Your treatment plan may include some or all of these methods.
Medicine. There are two ways to approach the treatment of migraines with drugs: stopping a migraine in progress (called “abortive” or “acute” treatment) and prevention. Many people with migraine use both forms of treatment.
Acute treatment. Over-the-counter pain-relief drugs such as aspirin, acetaminophen, or NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen relieve mild migraine pain for some people. If these drugs don’t work for you, your doctor might want you to try a prescription drug. Two classes of drugs that doctors often try first are:

• Triptans, which work by balancing the chemicals in the brain. Examples include sumatriptan (Imitrex^®), rizatriptan (Maxalt^®), zolmitriptan (Zomig^®), almotriptan (Axert^®), eletriptan (Relpax^®), naratriptan (Amerge^®), and frovatriptan (Frova^®). Triptans can come as tablets that you swallow, tablets that dissolve on your tongue, nasal sprays, and as a shot. They should not be used if you have heart disease or high blood pressure.
• Ergot derivatives (ergotamine tartrate and dihydoergotamine), which work in the same way as triptans. They should not be used if you have heart disease or high blood pressure.

Most acute drugs for migraine work best when taken right away, when symptoms first begin. Always carry your migraine medicine with you in case of an attack. For people with extreme migraine pain, a powerful “rescue” drug might be prescribed, too. Because not everyone responds the same way to migraine drugs, you will need to work with your doctor to find the treatment that works best for you.
Prevention. Some medicines used daily can help prevent attacks. Many of these drugs were designed to treat other health conditions, such as epilepsy and depression. Some examples are:

• antidepressants, such as amitriptyline (Elavil^®) or venlafaxine (Effexor^®)
• anticonvulsants, such as divalproex sodium (Depakote^®) or topiramate (Topamax^®)
• beta-blockers, such as propranolol (Inderal^®) or timolol (Blocadren^®)
• calcium channel blockers, such as verapamil

These drugs may not prevent all migraines, but they can help a lot. Hormone therapy may help prevent attacks in women whose migraines seem to be linked to their menstrual cycle. Ask your doctor about prevention drugs if:

• your migraines do not respond to drugs for symptom relief
• your migraines are disabling or cause you to miss work, family activities, or social events
• you are using pain-relief drugs more than two times a week

Lifestyle changes. Practicing these habits can reduce the number of migraine attacks:

• Avoid or limit triggers.
• Get up and go to bed the same time every day.
• Eat healthy foods and do not skip meals.
• Engage in regular physical activity.
• Limit alcohol and caffeine intake.
• Learn ways to reduce and cope with stress.

Alternative methods. Biofeedback has been shown to help some people with migraine. It involves learning how to monitor and control your body’s responses to stress, such as lowering heart rate and easing muscle tension. Other methods, such as acupuncture and relaxation, may help relieve stress. Counseling also can help if you think your migraines may be related to depression or anxiety. Talk with your doctor about these treatment methods.

Conclusions: Migraine Headache Treatment

Migraine is often under-diagnosed and under-treated. There is no cure for migraine. Nevertheless, there are numerous measures that may help improve the life of migraine sufferers. The choice of these measures should take into account the individual aspects of each migraine sufferer. Triggering factors, nerve inflammation, blood vessel changes, and pain are each addressed aggressively. Individualizing treatment is essential for optimal outcome.

Additional resources from WebMD Boots UK on Migraines and Headaches

REFERENCES:

Dowson AJ, Lipscombe S, Sender J, Rees T, Watson D. New Guidelines for the Management of Migraine in Primary Care. Curr Med Res Opin. 2002;18(7):414-439.

Goetz CG, Pappert EJ. Textbook of Clinical Neurology. 2nd ed. Philadelphia, PA: Saunders; 2003.

Holroyd KA, Drew JB. Behavioral approaches to the treatment of migraine. Semin Neurol. 2006 Apr;26(2):199-207.

Landy S, Smith T. Treatment of primary headache: acute migraine treatment. In: Standards of care for headache diagnosis and treatment. Chicago (IL): National Headache Foundation; 2004. p. 27-39. [11 references].

National Guideline Clearinghouse. Pharmacologic management of acute attacks of migraine and prevention of migraine headache. From: Snow V, Weiss K, Wall EM, Mottur-Pilson C. Pharmacologic management of acute attacks of migraine and prevention of migraine headache. Ann Intern Med 2002 Nov 19;137(10):840-52. [121 references].

National Guideline Clearinghouse. Treatment of primary headache: acute migraine treatment. Standards of care for headache diagnosis and treatment.

Patwardhan MB, Samsa GP, Lipton RB, Matchar DB. Changing physician knowledge, attitudes, and beliefs about migraine: evaluation of a new educational intervention. Headache. 2006 May;46(5):732-41.

Ramadan NM. Migraine headache prophylaxis: current options and advances on the horizon. Curr Neurol Neurosci Rep. 2006 Mar;6(2):95-9.

Roger Cady, MD, David W. Dodick, MD. Diagnosis and Treatment of Migraine. Mayo Clin Proc. 2002;77:255-261.

Stephen D. Silberstein, MD, FACP. Practice parameter: Evidence-based guidelines for migraine headache (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2000;55:754-762.

Vincenza Snow, MD. Acute Migraine Treatment Guideline. Annals of Internal Medicine. 2003 Oct 1; 139(7):603-4.

Previous contributing author and editor: Dennis Lee, MD and Harley I. Kornblum, MD, PhD

By Medicinenet.com 

What is the proper way to use preventive medications?

• Doctors familiar with the treatment of migraine headaches should prescribe preventive medications.

• Decisions about which preventive medication to use are based on the side effects of the medication and the presence of any medical conditions.

• Propranolol (Inderal) often is used first, provided that the individual does not have asthma, COPD, or heart disease. Amitriptyline (Elavil, Endep) also is used commonly.

• Preventive medications are begun at low doses and gradually increased to higher doses if needed. This minimizes side effects from the medications. Preventive medications are to be taken daily for months to years. When they are stopped, the dose needs to be gradually reduced rather than abruptly stopped. Abruptly stopping preventive medications can lead to headaches.

• In some instances, more than one drug may be needed. Non-medication and behavioral therapies also may be needed.

What is the treatment for menstrual migraine?

There are several aspects to treating menstrual migraines:

1. To abort menstrual migraine, take medications after the onset of menstrual migraine. Generally, medications that are effective in aborting non-menstrual migraines are effective at aborting menstrual migraines.
2. To prevent menstrual migraine, take medications just before the onset of menstruation and continue for the duration of the expected headache. Taking hormones such as estrogens or estrogen-related medications also help to prevent migraine.
3. To reduce the frequency and duration of menstrual migraine, take prophylactic medications (such as beta blockers, calcium channel blockers, anticonvulsants, tricyclic antidepressants) that are normally used on a continuous basis to prevent non-menstrual migraines.

NSAIDs such as naproxen sodium (Aleve) or ibuprofen (Advil, Motrin) have been used effectively to abort menstrual migraines. A combination analgesic containing acetaminophen, aspirin, and caffeine (ACC) can also be used to treat menstrual migraines. For women whose menstruation and menstrual migraines occur on a regular and predictable pattern, NSAIDs may be used 24 hours before the expected onset of menstrual migraine and continued for the expected duration of the headache. Since NSAIDs inhibit prostaglandins, they have the added benefit of relieving menstrual cramps as well. For NSAIDs side effects and precautions, please read the "Medication therapies for migraine" section of this article.
Triptans (naratriptan, rizatriptan, sumatriptan, zolmitriptan) have been found to be effective in aborting menstrual migraines, as well as controlling the associated nausea and vomiting. Sumatriptan given two to three days before and continued for the duration of the expected headache was found to be effective in reducing the frequency and severity of menstrual migraine. Naratriptan used in the same manner has also been found to be effective in preventing menstrual migraine. However, in those cases where breakthrough headaches occurred, they were just as severe as in patients taking placebo. For side effects and precautions of triptans, please read the "Triptans" section of this article.
Dihydroergotamine (DHE) can be used as a nasal spray or given intramuscularly or intravenously to abort menstrual migraines. Ergotamine (oral, rectal, or intranasal) and DHE (intranasal, intramuscular, or intravenous) can be used around the time of menstruation (several days before and continued for the duration of the expected headache) to prevent menstrual migraines. For ergot side effects and precautions, please read the "Ergots" section in this article.
If these medications are ineffective, doctors may try daily preventive medications such as beta-blockers, anticonvulsants, calcium channel blockers, and tricyclic antidepressants to reduce the frequency and the severity of menstrual migraines. The choice of the preventive medications is based on the experiences and preferences of the doctor, the medication side effects, and the woman's other associated medical conditions.
For women already taking preventive medications and yet still experience headaches, the doses of preventive medications can be increased around the time of the menstruation (some doctors use preventive medications only around the time of menstruation). Alternatively doctors may try hormone treatment.
Since a drop in estrogen level just prior to menstruation is the trigger for menstrual migraines, estrogen replacement before menstruation has been used in preventing menstrual migraines. For some women with menstrual migraine, Estradiol skin patches (such as TTS 50, TTS 100) applied 2 days before and continued for 7 days during the expected headache period is effective. However, the dose of estrogen must be closely monitored, as too high of a dose can actually trigger migraine in susceptible individuals.
Some women with difficult to treat menstrual migraines may be helped by using low dose oral contraceptives to reduce the estrogen fluctuations. Other less frequently used medications for menstrual migraines include tamoxifen, bromocriptine, danazol and gonadotropin-releasing hormone (GnRH).

By Medicinenet.com

What should migraine sufferers do?

Individuals with mild and infrequent migraine headaches that do not cause disability may require only OTC analgesics. Individuals who experience several moderate or severe migraine headaches per month or whose headaches do not respond readily to medications should avoid triggers and consider modifications of their lifestyle. Lifestyle modifications for migraine sufferers include:

• Go to sleep and wake up at the same time each day.

• Exercise regularly (daily if possible). Make a commitment to exercise even when traveling or during busy periods at work. Exercise can improve the quality of sleep and reduce the frequency and severity of migraine headaches. Build up your exercise level gradually. Over-exertion, especially for someone who is out of shape, can lead to migraine headaches.

• Do not skip meals, and avoid prolonged fasting.

• Limit stress through regular exercise and relaxation techniques.

• Limit caffeine consumption to less than two caffeine-containing beverages a day.

• Avoid bright or flashing lights and wear sunglasses if sunlight is a trigger.

• Identify and avoid foods that trigger headaches by keeping a headache and food diary. Review the diary with your doctor. It is impractical to adopt a diet that avoids all known migraine triggers; however, it is reasonable to avoid foods that consistently trigger migraine headaches.

What are prophylactic medications for migraine headaches?

Prophylactic medications are medications taken daily to reduce the frequency and duration of migraine headaches. They are not taken once a headache has begun. There are several classes of prophylactic medications:

• beta blockers,
  
• calcium-channel blockers,
  
• tricyclic antidepressants,
  
• antiserotonin agents, and
  
• anticonvulsants.

Medications with the longest history of use are propranolol (Inderal), a beta blocker, and amitriptyline (Elavil, Endep), an antidepressant. When choosing a prophylactic medication for a patient the doctor must take into account side effects of the drug, drug-drug interactions, and co-existing conditions such as diabetes, heart disease, and high blood pressure.

Beta blockers

Beta-blockers are a class of drugs that block the effects of beta-adrenergic substances produced by the body, specifically the nerves and the adrenal gland, such as adrenaline (epinephrine). By blocking the effects of adrenaline, beta-blockers relieve stress on the heart by slowing the rate at which the heart beats. Beta-blockers have been used to treat high blood pressure, angina, certain types or tremors, stage fright, and abnormally fast heart beats (palpitations). They also have become important drugs for improving survival after heart attacks. Beta-blockers have been used for many years to prevent migraine headaches.
It is not known how beta-blockers prevent migraine headaches. It may be by decreasing prostaglandin production, though it also may be through their effect on serotonin or a direct effect on arteries. The beta-blockers used in preventing migraine headaches include propranolol (Inderal), atenolol (Tenormin), metoprolol (Lopressor, Lopressor LA, Toprol XL), nadolol (Corgard), and timolol (Blocadren).
Beta-blockers generally are well-tolerated. They can aggravate breathing difficulties in patients with asthma, chronic bronchitis, or emphysema. In patients who already have slow heart rates (bradycardias) and heart block (defects in electrical conduction within the heart), beta-blockers can cause dangerously slow heartbeats. Beta-blockers can aggravate symptoms of heart failure. Other side effects include drowsiness, diarrhea, constipation, fatigue, decrease in endurance, insomnia, nausea, depression, dreaming, memory loss, impotence.

Tricyclic antidepressants

Tricyclic antidepressants (TCAs) prevent migraine headaches by altering the neurotransmitters, norepinephrine and serotonin, that the nerves of the brain use to communicate with one another. The tricyclic antidepressants that have been used in preventing migraine headaches include amitriptyline (Elavil, Endep), nortriptyline (Pamelor, Aventyl), doxepin (Sinequan), imipramine (Tofranil), and protriptyline.
The most commonly encountered side effects associated with TCAs are fast heart rate, blurred vision, difficulty urinating, dry mouth, constipation, weight gain or loss, and low blood pressure when standing (orthostatic hypotension).
TCAs should not be used with drugs that inhibit monoamine oxidase such as isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane), since high fever, convulsions and even death may occur. TCAs are used with caution in peole with seizures, since they can increase the risk of seizures. TCAs also are used with caution in men with enlargement of the prostate because they can make urination difficult. TCAs can cause elevated pressure in the eyes in some glaucoma sufferers. TCAs can cause excessive sedation when used with other medications that slow the brain's processes, such as alcohol, barbiturates, narcotics, and benzodiazepines, for example, lorazepam (Ativan), diazepam (Valium), temazepam (Restoril), oxazepam (Serax), clonazepam (Klonopin), and zolpidem (Ambien). Epinephrine should not be used with amitriptyline, since the combination can cause severe high blood pressure

Antiserotonin medications

Methysergide (Sansert) prevents migraine headaches by constricting blood vessels and reducing inflammation of the blood vessels. Methylergonovine is related chemically to methysergide and has a similar mechanism of action. They are not widely used because of their side effects. The most serious side effect of methysergide is retroperitoneal fibrosis (scarring of tissue around the ureters that carry urine from the kidneys to the bladder). Retroperitoneal fibrosis, though rare, can block the ureters and cause backup of urine into the kidneys. Backup of urine into the kidneys can cause back and flank (the side of the body between the ribs and hips) pain and ultimately can lead to kidney failure. Methysergide also has been reported to cause scarring around the lungs that can lead to chest pain, shortness of breath, as well as scarring of the heart valves.

Calcium channel blockers

Calcium channel blockers (CCBs) are a class of drugs that block the entry of calcium into the muscle cells of the heart and the arteries. By blocking the entry of calcium, CCBs reduce contraction of the heart muscle, decrease heart rate, and lower blood pressure. CCBs are used for treating high blood pressure, angina, and abnormal heart rhythms (for example, atrial fibrillation). CCBs also appear to block the effects of a chemical within nerves, called serotonin, and have been used occasionally to prevent migraine headaches. The CCBs used in preventing migraine headaches are diltiazem (Cardizem, Dilacor, Tiazac), verapamil (Calan, Verelan, Isoptin), and nimodipine.
The most common side effects of CCBs are constipation, nausea, headache, rash, edema (swelling of the legs with fluid), low blood pressure, drowsiness, and dizziness. When diltiazem or verapamil are given to individuals with heart failure, symptoms of heart failure may worsen because these drugs reduce the ability of the heart to pump blood. Verapamil and diltiazem may reduce the elimination and increase the blood levels of carbamazepine (Tegretol), simvastatin (Zocor), atorvastatin (Lipitor), and lovastatin (Mevacor). This can lead to toxicity from these drugs.

Anticonvulsants

Anticonvulsants (antiseizure medications) also have been used to prevent migraine headaches. Examples of anticonvulsants that have been used are valproic acid, phenobarbital, gabapentin, and topiramate. It is not known how anticonvulsants work to prevent migraine headaches.
Who should consider prophylactic medications to prevent migraine headaches?
Not all migraine sufferers need prophylactic medications; individuals with mild or infrequent headaches that respond readily to abortive medications do not need prophylactic medications. Individuals who should consider prophylactic medications are those who:

1. Require abortive medications for migraine headaches more frequently than twice weekly.
   
2. Have two or more migraine headaches a month that do not respond readily to abortive medications.
   
3. Have migraine headaches that are interfering substantially with their quality of life and work.
   
4. Cannot take abortive medications because of heart disease, stroke, or pregnancy, or cannot tolerate abortive medications because of side effects.

How effective are prophylactic medications?
Prophylactic medications can reduce the frequency and duration of migraine headaches but cannot be expected to eliminate migraine headaches completely. The success rate of most prophylactic medications is approximately 50%. Success in preventing migraine headaches is defined as more than a 50% reduction in the frequency of headaches. Prophylactic medications usually are begun at a low dose that is increased slowly in order to minimize side effects. Individuals may not notice a reduction in the frequency, severity, or duration of their headaches for 2 to 3 months after starting treatment.

ByMedicinenet.com

What other medications are used for treating migraine headaches?

Narcotics and butalbital-containing medications sometimes are used to treat migraine headaches; however, these medications are potentially addicting and are not used as initial treatment. They are sometimes used for individuals whose headaches fail to respond to OTC medications but who are not candidates for triptans either due to pregnancy or the risk of heart attack and stroke.
In migraine sufferers with severe nausea, a combination of a triptan and an antinausea medication, for example, prochlorperazine (Compazine) or metoclopramide (Reglan) may be used. When nausea is severe enough that oral medications are impractical, intravenous medications such as DHE-45 (dihydroergotamine), prochlorperazine (Compazine), and valproate (Depacon) are useful.

How are migraine headaches prevented?

There are two ways to prevent migraine headaches: 1) by avoiding factors ("triggers") that cause the headaches, and 2) by preventing headaches with medications (prophylactic medications). Neither of these preventive strategies is 100% effective. The best one can hope for is to reduce the frequency of headaches.

What are migraine triggers?

A migraine trigger is any environmental or physiological factor that leads to a headache in individuals who are prone to develop headaches. Only a small proportion of migraine sufferers, however, clearly can identify triggers. Examples of triggers include:

• stress,
  
• sleep disturbances,
  
• fasting,
  
• hormones,
  
• bright or flickering lights,
  
• odors,
  
• cigarette smoke,
  
• alcohol,
  
• aged cheeses,
  
• chocolate,
  
• monosodium glutamate,
  
• nitrites,
  
• aspartame, and
  
• caffeine.

For some women, the decline in the blood level of estrogen during the onset of menstruation is a trigger for migraine headaches (sometimes referred to as menstrual migraines).
The interval between exposure to a trigger and the onset of headache varies from hours to two days. Exposure to a trigger does not always lead to a headache. Conversely, avoidance of triggers cannot completely prevent headaches. Different migraine sufferers respond to different triggers, and any one trigger will not induce a headache in every person who has migraine headaches.

Sleep and migraine

Disturbances such as sleep deprivation, too much sleep, poor quality of sleep, and frequent awakening at night are associated with both migraine and tension headaches, whereas improved sleep habits have been shown to reduce the frequency of migraine headaches. Sleep also has been reported to shorten the duration of migraine headaches.

Fasting and migraine

Fasting possibly may precipitate migraine headaches by causing the release of stress-related hormones and lowering blood sugar. Therefore, migraine sufferers should avoid prolonged fasting.

Bright lights and migraine

Bright lights and other high intensity visual stimuli can cause headaches in healthy subjects as well as patients with migraine headaches, but migraine people who suffer from migraines seem to have a lower than normal threshold for light-induced headache pain. Sunlight, television, and flashing lights all have been reported to precipitate migraine headaches.

Caffeine and migraine

Caffeine is contained in many food products (cola, tea, chocolates, coffee) and OTC analgesics. Caffeine in low doses can increase alertness and energy, but caffeine in high doses can cause insomnia, irritability, anxiety, and headaches. The over-use of caffeine-containing analgesics causes rebound headaches. Furthermore, individuals who consume high levels of caffeine regularly are more prone to develop withdrawal headaches when caffeine is stopped abruptly.

Chocolate, wine, tyramine, MSG, nitrites, aspartame and migraine

Chocolate has been reported to cause migraine headaches, but scientific studies have not consistently demonstrated an association between chocolate consumption and headaches. Red wine has been shown to cause migraine headaches in some migraine sufferers, but it is not clear whether white wine also will cause migraine headaches.
Tyramine (a chemical found in cheese, wine, beer, dry sausage, and sauerkraut) can precipitate migraine headaches, but there is no evidence that consuming a low-tyramine diet can reduce migraine frequency.
Monosodium glutamate (MSG) has been reported to cause headaches, facial flushing, sweating, and palpitations when consumed in high doses on an empty stomach. This phenomenon has been called Chinese restaurant syndrome.
Nitrates and nitrites (chemicals found in hot dogs, ham, frankfurters, bacon and sausages) have been reported to cause migraine headaches.
Aspartame, a sugar-substitute sweetener found in diet drinks and snacks, has been reported to trigger headaches when used in high doses for prolonged periods.

Female hormones and migraine

Some women who suffer from migraine headaches experience more headaches around the time of their menstrual periods. Other women experience migraine headaches only during the menstrual period. The term "menstrual migraine" is used mainly to describe migraines that occur in women who have almost all of their headaches from two days before to one day after their menstrual periods. Declining levels of estrogen at the onset of menses is likely to be the cause of menstrual migraines. Decreasing levels of estrogen also may be the cause of migraine headaches that develop among users of birth control pills during the week that estrogens are not taken.

 By Medicinenet.com

Treatment for moderate to severe migraine headaches?

Migraine-specific abortive medications usually are necessary for moderate to severe migraine headaches. The abortive medications for moderate or severe migraine headaches are different than OTC analgesics. Instead of relieving pain, they abort headaches by counteracting the cause of the headache, dilation of the temporal arteries. In fact, they cause narrowing of the arteries. Examples of migraine-specific abortive medications are the triptans and ergot preparations.

Triptans

The triptans attach to serotonin receptors on the blood vessels and nerves that surround them, constrict the blood vessels, and reduce the inflammation. This stops the headache. The triptan with the longest history of use is sumatriptan (Imitrex). Sumatriptan is available in the US as an injection, oral tablet, and nasal inhaler. Zolmitriptan (Zomig) and rizatriptan (Maxalt) are newer triptans that are available as oral tablets and as tablets that melt in the mouth. Naratriptan (Amerge), almotriptan (Axert) and frovatriptan (Frovalan) are available only as oral tablets.
Traditionally, triptans were prescribed for moderate or severe migraines after OTC analgesics and other simple measures failed. Newer studies suggest that triptans can be used as the first treatment for patients with migraines that are causing disability. (Significant disability is defined as more than 10 days of at least 50% disability during a three-month period.). Triptans should be used early after the migraine begins, before the onset of pain or when the pain is mild. Using a triptan early in an attack increases its effectiveness, reduces side effects, and decreases the chance of recurrence of another headache during the following 24 hours. Used early, triptans can be expected to abort more than 80% of migraine headaches within two hours.
The U.S. Food and Drug Administration (FDA) has issued a warning about taking triptans together with medications of the SSRI (selective serotonin reuptake inhibitor) or SNRI (selective serotonin/norepinephrine reuptake inhibitor) classes. Taking these medicines together can cause a serious condition called serotonin syndrome.
Side effects of triptans
The most common side effects of triptans are facial flushing, tingling of the skin, and a sense of tightness around the chest and throat. Other less common side effects include drowsiness, fatigue, and dizziness. These side effects are short-lived and are not considered serious.
The most serious side effects of triptans are heart attacks and strokes. Triptans are effective in migraine headaches because they narrow arteries in the head; however, they also can narrow arteries in the heart. In individuals without existing carotid or coronary artery disease, the narrowing caused by triptans usually does not cause problems. However, persons whose carotid and coronary arteries are narrowed by atherosclerosis or who suffer from intermittent spasm of the coronary arteries (a condition called Prinzmetal's or variant angina), the narrowing caused by triptans can further reduce the flow of blood through the arteries and have been reported to cause heart attacks and strokes. Therefore, triptans should not be used by those who have had heart attacks and strokes, or those who have symptoms of atherosclerosis such as angina, transient ischemic attack (TIAs), and intermittent claudication.
Healthy adults may have atherosclerosis and narrowing of the coronary arteries that are "silent", that is, without past strokes, transient ischemic attacks, heart attacks, or angina. Therefore, before prescribing a triptan, a doctor should evaluate patients for possible atherosclerosis if they have one or more risk factors for developing atherosclerosis. These risk factors include cigarette smoking, diabetes mellitus, high blood pressure, high levels of LDL ("bad") cholesterol in the blood, obesity, male and over 40 years of age, female and postmenopausal, or a family member(s) who has had heart attacks at an early age. Some patients who are at risk should receive their first dose of a triptan in the doctor's office while being monitored with an electrocardiogram (EKG).
Triptans can interact with other drugs. For example, there have been rare reports of triptans causing a "serotonin syndrome" when given together with a selective serotonin reuptake inhibitor. Selective serotonin reuptake inhibitors (SSRIs) are a class of medications widely used to treat depression. The symptoms of serotonin syndrome include confusion, fever, tremor, high blood pressure, diarrhea, and sweating. Certain triptans such as sumatriptan, zolmitriptan, and rizatriptan can interact with monoamine oxidase inhibitors. Propranolol (Inderal) can raise rizatriptan blood levels. Cimetidine (Tagamet) can increase zolmitriptan blood levels.
Triptans should not be used in pregnant women and are not generally used in young children.

Ergots

Ergots, like triptans, are medications that abort migraine headaches. These may be combined with caffeine and/or other pain relief medications in combination products. Examples of ergots include ergotamine preparations (Ergomar, Wigraine, and Cafergot) and dihydroergotamine preparations (Migranal, DHE-45). Ergots, like triptans, cause constriction of blood vessels, but ergots tend to cause more constriction of vessels in the heart and other parts of the body than the triptans, and their effects on the heart are more prolonged than those of the triptans. Therefore, they are not as safe as the triptans. The ergots also are more prone to cause nausea and vomiting than the triptans. The ergots can cause prolonged contraction of the uterus and miscarriages in pregnant women.

Midrin

Midrin is used to abort migraine and tension headaches. It is a combination of isometheptene (a blood vessel constrictor), acetaminophen (a pain reliever), and dichloralphenazone (a mild sedative). It is most effective if used early during a headache; however, because of its potent blood vessel constricting effect, it should not be used in persons with high blood pressure, kidney disease, glaucoma, atherosclerosis, liver disease, or taking monoamine oxidase inhibitors.

By Medicinenet.com