What Not To Do for Migraine

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Harvard Medical School
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What Not To Do for Migraine

November 22, 2013

News Review from the Harvard Medical School - What Not To Do for Migraine


New recommendations for migraine treatment focus on avoiding harmful and unnecessary care. The recommendations were made by the American Headache Society. They say that opioid painkillers used to treat migraines pose a danger of addiction. Long-term use of over-the-counter pain relievers is not wise, the recommendations say. People should take them no more than twice a week. Regular, frequent use poses risks to the kidneys, liver and stomach. The group recommends MRIs over CT scans to help diagnose migraine. About 12% of Americans get migraines. They are three times as common in women as in men. The recommendations were published in the November-December issue of the journal Headache. HealthDay News wrote about them November 21.


By Howard Lewine, M.D.
Harvard Medical School


What Is The Doctor's Reaction?

People often use the term “migraine” to describe any severe headache. But not all severe headaches are migraines. And a mild headache can still be a migraine.

This confusion often leads to inadequate treatment of migraine. A primary goal of the new guidelines is to emphasize that the symptoms, severity and frequency of migraine are highly variable. Therefore, treatment has to be tailored to each person.

The headaches can be awful. So, it’s natural to want immediate pain relief. However, too many people with migraine overuse short-term pain relievers.

People may use over-the-counter remedies, such as ibuprofen, acetaminophen, aspirin or combination headache products. Or they might use prescription medications, sometimes with strong narcotic pain relievers.

Over time, these drugs become less effective. So people naturally take higher doses or take the drugs more frequently. The overuse can lead to a problem called chronic daily headache, in addition to migraine.

The experts writing the guidelines want people with migraine and the doctors that treat them to understand the importance of looking at migraine as a long-term condition.


What Changes Can I Make Now?

If you have three or fewer headaches per month and the headaches can be quickly relieved with one or two doses of a pain reliever or a specific migraine medicine, then there is no need to change what you’re doing.

But if you have four or more headaches per month, or most of your headaches linger for many hours, then talk to your doctor about starting daily migraine preventive therapy.

The medicines with the best evidence for preventing migraines include:

  • Anti-seizure medicines:
    • Divalproex sodium (Depakote)
    • Sodium valproate
    • Topiramate (Topamax)
  • Beta-blockers:
    • Propranolol (Inderal, generic versions)
    • Metoprolol (Lopressor, generic versions)
    • Timolol

There are many other choices, such amitriptyline (Elavil, generic versions) and venlafaxine (Effexor) at low doses. Many people with migraine have fewer and less-severe headaches with daily verapamil, a drug used to treat high blood pressure. However, the medical evidence for verapamil for migraine prevention is not as strong, compared with the evidence for the other medicines mentioned above.


What Can I Expect Looking To The Future?

When there are so many possible treatment options, it often means we don't understand the exact cause of a symptom or disease. This is true for migraine.

The brain itself doesn't have pain receptors like skin does. It processes brain signals from other parts of the body. But why do the brain's pain centers trigger a head pain reaction?

When scientists put this puzzle together, we will have even better migraine therapies.

Last updated November 22, 2013

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