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Treating migraine

Currently there is no cure for migraine, but there are a number of treatments available to help ease the symptoms. These take the form of painkiller medications, usually over the counter and a family of prescription only drugs called triptans. Sufferers also use physical methods such as cold or hot presses or use devices such as TMS and TENS machines.

The usual over the counter pain killers may help reduce the symptoms. Generally these are analgesics such as paracetamol or NSAIDS commonly aspirin and ibuprofen. They work best when taken at the first signs of the migraine, but before it has fully developed. This gives it a chance to be absorbed into the blood stream and so ease the symptoms.

There are always cautions to be considered with medication, such as always following the dosage recommendations. NICE - the National Institute for Health and Care Excellence issued a clinical knowledge summary in January 2013 in which they discuss the prescribing issues associated with NSAIDs, including adverse affects which arise from their long term use. Most commonly these come from gastrointestinal problems, including ulcers and bleeding. NSAIDs can also cause complications such as myocardial infarction and high blood pressure, but these are rare. However NSAIDs are contraindicated where high blood pressure is present.

Taking over the counter painkillers over a long period, or frequently, can make migraines worse, leading to what are often called rebound or bounce back headaches, or a more persistent background headache. It may be necessary to visit your GP if this occurs, to discuss ways to safely withdraw from medication, and to find alternatives to the self medicating strategy, such as prescription drugs.

In some instances the use of painkillers will not be successful in controlling the migraine. Where this occurs the GP may recommend using the family of drugs known as triptans.

For many years there was an assumption that migraines were caused by dilation or swelling of blood vessels in the brain. Recent research has cast doubt on this theory - it is now thought that a more complete picture involves the view that some chemicals in the brain increase in activity and parts of the brain may then send out confusing signals which cause the symptoms.

Triptans are an effective medication when taken during the early stages of an attack. They relieve migraine by not only reducing the swelling of blood vessels, but also by affecting the nerve endings, reducing these confusing signals. As with over the counter medication, however, there is a risk of triptan rebound headaches and other unwanted side effects (such as serotonin syndrome) resulting from prolonged use.

Sufferers can employ a variety of self help techniques such as temperature therapy – the application of ice packs to numb pain or heat (via a hot water bottle or shower) to relax tense muscles. Applying pressure to the temples or scalp can help ease pain for many with migraine, and a massage to the neck and shoulder area may help relieve tension.

In 2014 NICE approved a treatment called transcranial magnetic stimulation or TMS for the prevention of migraine. This is not a cure, and the evidence available for its effectiveness is not strong, but the treatment involves using a small electric device which is held to the head, that delivers magnetic pulses through the skin. Studies show that it can reduce the severity of the attack, particularly if used right at the start of an attack. It is not clear how TMS works, and it appears to be only effective for people who experience the aura stage before the headache.

TENS machines or Transcutaneous electrical stimulation is method of pain relief that can help some people with pain relief, including migraine attacks. It is a small box like device that can be worn on the body. It is attached by wires to sticky pads which adhere to the skin. The machine delivers small electrical pulses to the body that can help with pain relief. In the instance of migraine typically someone might use it on the shoulder and neck. Before using a TENS machine it is advisable to seek advice from a health professional such as a physiotherapist on how and how not to use the machine.

References

http://cks.nice.org.uk/nsaids-prescribing-issues

http://www.migrainesurvival.com/medication-overuse-headache

Managing Migraine. Drug & Therapeutics Bulletin. 1998; 36:41-44.

http://www.migrainetrust.org/treatment

https://healthunlocked.com/migrainecentre/questions/447246/tens-machines

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