What migraine patients need to know about treatment options

Patients not only want to know the cause of the headaches but what can be done to stop the pain.

Those who experience migraine know the pain. It’s not sinuses or “just a normal headache.” But do they know all of the migraine treatments that are available?

The numbers bear it out: Migraine is a common condition and not centered in Louisville or Southern Indiana. More than 47 million Americans live with migraine, over 15% of the U.S. population. Worldwide, it is the second leading cause of years lived with disability.

The question on the minds of most patients who experience migraine is twofold:

  • What likely is triggering my migraine?
  • What is the best course of action?

“A patient’s treatment choices depend on the frequency and severity of their migraine attacks,” said Mandy J. Whitt, M.D., a headache specialist with Norton Neuroscience Institute. “It depends whether there is accompanying nausea and vomiting, how disabling the headaches are, and other medical conditions the patient may have.”

What are the causes of a migraine?

It is unclear as to what the “cause” of migraine is — it is generally believed that an individual with migraine has a brain that is more sensitive to stimulation/change. This can be a genetic predisposition, due to head injury, infection (such as meningitis), etc.

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The symptoms of migraine include:

  • At least five attacks lasting four to 72 hours
  • At least two of the following characteristics:
    • One side of the head
    • Pounding pain
    • Moderate to severe pain
    • Gets worse with activity
  • During the headache, at least one of the following:
    • Nausea and/or vomiting
    • Intolerance to light and sound
  • No other explanation

There doesn’t need to be a specific trigger, but rather a culmination of several triggers together. Common triggers include menstruation, certain foods/alcohols, sleep deprivation and changes in stress.

The biggest thing to be concerned about is rare, or episodic, migraine attacks being left untreated and becoming more frequent and difficult to treat in what can then become chronic migraine.

Options for treating a migraine

There is no single test for migraine, but the diagnosis instead is based on the clinical symptoms. Common over-the-counter treatments for sinus headaches actually can cause more issues for those who experience migraine.

“Prescription drugs such as opiates, triptans, dihydroergotamine and butalbital can trigger medication overuse,” Dr. Whitt said. “It can make the headaches worse.”

A new treatment for migraine, gepants, block CGRP — a protein in the brain that has been identified as a migraine trigger. The treatments have a relatively low risk of serious side effects and a low risk of medication overuse.

Currently there are two gepants available by prescription and two more on the way. Rimegepant is now for acute and preventive treatment of migraine, while ubrogepant is for acute treatment of migraine. Both can be taken orally as needed. After two hours, about 20% of patients are free of pain. The drugs are not recommended during breastfeeding or pregnancy.

Botox injections about every 12 weeks also have been successful in preventing migraine in some adults with chronic migraine.

What patients can do to ease migraine pain

When migraine symptoms start, patients should try to rest, preferably in a quiet, darkened room. A cool compress or ice pack wrapped in a towel and placed on the forehead or back of the neck also can help with pain mitigation.

Patients also should try to maintain routines for eating and sleeping. Regular exercise, especially aerobic exercise, helps reduce tension and provides a way to deal with stressful situations that often trigger the onset of a migraine.


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Vicki L. Owczarzak, M.D.

Vicki L. Owczarzak, M.D., is a pediatric otolaryngologist at Norton Children’s ENT & Audiology, affiliated with the UofL School of Medicine, and an assistant professor at the medical school.

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