Migraine headaches are painful and often debilitating. They are complex, however, and still not completely understood. Fortunately, doctors are finding better ways to prevent these headaches through prevention. As a leader in pain medicine, Dr. Torres provides cutting-edge therapies to provide relief and lessen the frequency of migraines.
In 2004, an expert panel developed recommendations for the use of preventive medication in treating migraines. The study followed over 160,000 individuals 12 years of age and older for a year and found that more than one in four migraine sufferers were candidates for preventive therapy. The study also found a substantial proportion of those who might benefit from migraine prevention therapy do not receive it.
And in a 2015 study, almost half (45%) of patients receiving preventive therapy experience a reduction in the monthly frequency of attacks by 50% or more.
Current preventive treatment options have made an impact on patients. Research shows patients have seen a 50% reduction in migraine diagnosis-related office and other outpatient visits. A preventive migraine drug is considered successful if it reduces migraine attack frequency by at least 50% within 3 months from the start of use.
Decrease migraine attack frequency by 50% while also decreasing the duration and intensity.
Improve patient responsiveness to acute therapy.
Improve patient function, and decrease disability.
Prevent the occurrence of “medication overuse headaches” and chronic daily headaches.
Studies show that almost half (45%) of patients receiving preventive therapy experience a reduction in the monthly frequency of attacks by 50% or more. Additionally, the study found that 38% of people who suffer from migraine attacks could benefit from preventive treatments; unfortunately, less than a third currently use these treatments.
Migraine Prevention Treatments
Right now, there are two drug treatment approaches for migraine headaches.
Acute treatment. A drug stops a migraine headache after it starts by affecting the release of certain brain chemicals and blocking pain pathways in the brain. However, drugs aren’t for everyone. Patients with uncontrolled high blood pressure, coronary artery disease, a history of strokes, and other heart problems, are typically advised not to take them. There are also risks for pregnant women.
Preventive Treatment. For frequent attacks, there are drugs to reduce the number of migraines a patient may have. These drugs can also help acute treatment drugs work better. Some of the drugs now in use to prevent migraines include:
Antidepressants: amitriptyline and venlafaxine.
Anti-seizure drugs: topiramate and valproate.
Beta-blockers: metoprolol, propranolol, and timolol.
Although these medications can provide relief, they were made to treat other health problems. Their effect on migraines was a chance discovery. As with most drugs, these work better for some people than others, and there are side effects.
There are also non-drug treatment options that can abort or prevent migraines:
Transcranial Magnetic Stimulation (TMS). This treatment involves holding a small device called SpringTMS to the back of the head. The device emits a split-second pulse which interrupts abnormal electrical activity caused by the migraine. The pulse stops the migraine and appears to produce a preventative effect over time.
External Trigeminal Nerve Stimulation (e-TNS). An external device (called a Cefaly) uses transcutaneous supraorbital nerve stimulation. It can be worn as a headband on the forehead or as a self-adhesive electrode on the forehead. Precise micro-impulses sent through the trigeminal nerve can help relieve the migraine pain during an attack. When used daily for 20 minutes, it can help prevent a migraine from developing.
Noninvasive Vagus Nerve Stimulator (nVNS). This external, non-invasive, hand-held device (called the gammaCore (nVNS)) stimulates the vagus nerve in the neck. It works by releasing a mild electrical stimulation to the nerve’s fibers to relieve pain.
Alternative Migraine Treatments
Natural, drug-free techniques can also help with migraine prevention since stress is a common migraine trigger. Studies show that people who learn to better control stress start to have fewer migraines. Some of those techniques include:
Biofeedback is a type of therapy that teaches one to be aware of how their body reacts to stress (e.g., tense muscles, a fast heart rate, etc.). A trained professional teaches the migraine sufferer how to change their response to stress and calm down. People who use biofeedback have 55% fewer migraines. This therapy may work even better for people taking medicine that prevents headaches.
Progressive muscle relaxation (PMR) is a relaxation technique that helps stop the body’s response to stress before it triggers a migraine. The technique involves tightly contracting and fully releasing muscles and deepening and slowing one’s breathing.
Cognitive behavioral therapy (CBT) uses a psychologist to help the patient learn how thoughts and habits affect their migraines. The process also teaches how to change the way the body reacts to the pain of a migraine attack.
Who Should Consider Preventative Migraine Treatments?
Prevention therapy is not necessarily right for all migraine patients.
Prevention should be offered when a patient reports one of these three symptoms:
Six or more headache days per month.
Four or more headache days with at least some impairment.
Three or more headache days with severe impairment or requiring bed rest.
Prevention should be considered if the patient reports one of the following:
Four or five migraine days per month with normal functioning.
Three migraine days per month with some impairment.
Two migraine days with severe impairment.
However, prevention is not indicated if the patient reports either of the following:
Less than four headache days per month with no impairment.
No more than one headache day per month regardless of the impairment.
The doctor and migraine sufferer must work together to determine if prevention therapy is appropriate for the individual patient.
The Future of Migraine Prevention
Previously, there was not a specific migraine-preventive drug. Now, erenumab, the first medication for preventing migraines in adults, has been approved by the FDA. This injectable migraine drug works by blocking a small, migraine-related protein molecule. The protein is released from pain nerves called the calcitonin gene-related peptide (CGRP), which is a key part of the migraine process.
Researchers keep looking for a drug that can stop migraines before they start. It is believed that prostaglandins (hormones that boost inflammation) play a role in migraines. Research seems to indicate that EP4 Receptor Antagonists can block prostaglandins in people.
Medication is a proven way to treat and prevent migraines. But medication is only part of the story. It’s also important to take good care of yourself and understand how to cope with migraine pain when it strikes.
The same lifestyle choices that promote good health can also reduce the frequency and severity of your migraines. In fact, knowing how to manage migraine pain with lifestyle and behavioral measures, as well as medication, can often be the most effective way to handle the pain of a migraine.
A diary may help you determine what triggers your migraines. Make a note when a migraine starts, what you were doing at the time, how long the headache lasts, and what, if anything, provides relief. This Printable Migraine Diary can help you track your migraines and help your doctor when developing a treatment plan.
To help you prepare for talking to your doctor about your migraines, download and fill out this downloadable guide before speaking to your doctor. The guide has questions you may want to ask your doctor.
Novus Spine & Pain Center
Dr. Torres established Novus Spine & Pain Center in Lakeland, Florida with a goal of providing the highest quality pain management care to every patient. Whether pain is the result of a migraine, an injury, or from another condition, Dr. Torres offers many different treatment options.
Novus Spine & Pain Center utilizes a comprehensive approach and cutting-edge therapies to restore normal function and allow patients to regain an active lifestyle while minimizing the need for opiates. As our patient, you are our top priority. Our goal is to help you achieve the best possible quality of life.
Our Mission Statement:To provide the best quality of life to people suffering from pain, by providing state of the art treatments, knowledge and skill, compassion, and respect for all.