What You Need To Know About Headaches……Part 3

I had hoped to get my migraine series finished before the end of June, which was migraine awareness month. However, sadly I spent most of the last week of June in the hospital with a MIGRAINE. I had dealt with it for over ten days and finally waved the white flag, cried uncle and went to the hospital. I was hoping that I would be able to break the migraine by just getting medications in the ER. But no luck, I had to be admitted for four days. So finishing this treatment section of the migraine series seems appropriate, as I spent the last couple weeks living in this phase of a migraine.

So how do you treat a migraine??? Well, that’s really a hard question to answer. What works for me may not work for you and vice versa.  And I have found it to be more a case of trial and error of what might work. I have tried SO MANY medications and treatment options over the years. Even thought I have been on this migraine journey for over 15 years I am not totally sure that I have found the perfect mix yet. In the early years I only had migraines periodically, it wasn’t until the last three years that they have really become debilitating.  I also didn’t start having the hemiplegic (stroke like) migraines until 2016. One of the big things I can’t stress enough when you are on the search for the best treatment for your migraines is to keep a journal of your symptoms, what you did, what you ate etc on the day of your headaches so you can see if there is something recurring with each migraine. So lets dig in to treatment options.

The most common treatment for migraines are medications. Whether you take over the counter meds, preventative meds or meds for the acute head. Below you will see the each type of medication explained.

  • Over the counter (OTC) medications are medications that can be bought without a prescription on the counter at any pharmacy.
  • Acute medications are used as soon as a migraine is happening. These are also known as abortive medications.
  • Preventative Medications are used on an ongoing or routine bases, in hope that they will prevent or reduce future attacks. These can also be called prophylactic medications.

Over the counter options for acute symptoms include:

  • Excedrin Migraine
  • Ibuprofen which is also known as Advil and Motrin
  • Naproxen which is also known as Aleve
  • Aspirin (you need to check with your physician before taking this medication as it is also a blood thinner)
  • Acetaminophen which is also known as Tylenol

Examples of prescription drugs you might be given to take for acute (when the headache is happening) symptoms include:

  • Triptans are a class of medications that deal with the chemical Serotonin in the brain, which helps to diminish the swelling of the blood vessels that cause the headaches. These drugs are primarily used in the treatment of acute headaches. This method of treatment goes back to the 1950s. Examples: Maxalt & Imitrex.
  • DHE 45 became a treatment for migraines in the 1940s. It is only used to treat migraines in the ACUTE stage and should not be used as a preventative medication. This medication is available as an injection, IV drip and nasal spray.
  • Ergotamine is a medication that is used for a SPECIFIC kind of headache. It is used to treat vascular and tension headaches. The medication works to narrow the widened blood vessels in the head, which in turn reduces the throbbing effects of vascular headaches. This medication is also used only in treatment of acute headaches.

Examples of medications that are given as  preventive or prophylactic prescription medications include:

  • Beta blockers (Use caution with these as they can also lower the blood pressure and heart rate) This group of medication is used as a preventative medication to treat migraines. They work to relax and open up blood flow thus reducing the frequency of headaches.  Examples: Propanolol or Toprolol.
  • Calcium Channel Blockers (Use caution with these as they can lower the heart rate) This group of medication is used because of the way it works, basically the end result is that this group of medications prevent contraction of the muscle wall of the artery.  Examples: Procardia or Verapamil
  • Antidepressants are often used as a preventative medication for headaches because the tricyclic antidepressants also work to treat chronic pain. Thus they work well for migraines.  Example: Elavil
  • Anticonvulsants this group of medication work to calm the hyperactivity in the brain. Example: Depakote, Topamax, Gabapentin

There are also many other options for migraines. One of the most common is the Complementary & Alternative Medicine. This option includes any medicinal products or practices that are not part of modern medicine. Alternative medicine can be defined by its use an an alternative option to traditional modern medicine. Complementary medicine is used in conjunction with traditional medical treatment. These treatments could be things like: any natural remedies like herbal medications or treatments, vitamins, minerals or any kind of supplements. There are many options of herbal medications, which I have tried, the one I personally had the most luck with was feverfew. Other options would include meditation, yoga, biofeedback, acupuncture, tai-chi. Or even body-based practices like chiropractic adjustments or massage therapy. Like always, before starting any new over the counter medication, herb or supplement. Or any increase in physical activity please check with a dr before doing so!

In addition to medications and alternative or complementary therapy, the U.S. Food and Drug Administration (FDA) has now approved two different nerve stimulators that may be helpful for certain people who have not gotten any relief from all other treatment options. The Cerena Transcranial Magnetic Stimulator is a device that has been approved for anyone over the age of 18 who have migraines that are preceded by an aura. This specific device is help to the back of the head and will deliver a pulse of magnetic energy.

There is also a vagus nerve stimulator that has been approved for use in adults with migraines, as well as those who suffer from episodic cluster headaches. This device is hand-held and is placed over the vagus nerve in the neck and it releases a mild electrical stimulation to reduce pain.

In 2010 Botox, previously primarily known for its use by plastic surgeons, was approved for use with chronic migraines. Currently the FDA has only approved Botox use in those with chronic migraines, which means a person must have 15 or more headache days a month. Research shows that the more frequent the headaches the better the Botox result will be. Botox is given as approximately 30 tiny Injections around the head, the injections are given around pain fibers that are involved in headaches. Botox will enter the nerve endings around the injection site and then blocks the release of chemicals involved in pain. This in turn prevents activations of the pain networks of the brain. Patients who receive Botox can only receive injections every 12 weeks. And it generally takes 3-4 treatments at least to begin to fill the full impact it may have. Botox requires pre-authorization by the insurance company before it can be given. Along with very detailed documentation by the doctor regarding the frequency and duration of your headaches.

In early 2018 the FDA approved the first drug of its kind for migraines. It is said to reduce the number of migraines among those who are prone to migraines. Most of the medications currently used for migraines are used to control the symptoms. The new drug, called Aimovig, is designed to reduce the number of migraines among the population who suffer most frequently. One of the largest studies done during the testing stage showed that the number of migraines dropped from eight to fewer than five. This medication is given as an injection, much like insulin, delivered by a pen-like device. The one big downfall for some is that the medication will cost around $6,900 a year, and insurance coverage is not completely decided at this point!!

I hope each of you enjoyed this series on migraines and that maybe you learned something you didn’t know. I know I learned a LOT while doing the research for this series. Migraines are so complex and I could have probably written a five part series or even more. There are so many options of medications available along with many more non-medicinal treatments available, than in years past. And so much research is being done to find the best treatment available for migraines. I didn’t cover Botox in much detail and there is a lot of information I could share. If you are interested in learning more about Botox or the new medication Aimovig leave me a comment and let me know. Also, if you have a condition that you would like me to do a series of posts on let me know and I will dig in and start my research. This has been pretty popular so I am looking forward to doing more multi-part series in the future.

With Love,

Amber

Tips on Treatments for Migraines.

I by no means am an Expert on Migraines. But I do feel that I know quite a bit about treatment options for migraines as I have tried just about EVERY treatment known to man to get rid of mine. So today I will talk about possible treatment modalities for migraines, oddly enough while suffering from one of the worst migraines I have had in the last few weeks. But our world goes on right? From having so many I have learned that our world just can simply stop just due to a migraine. Do I do all I can to slow my world down during one? YES!!! We all have to do what works best for us to keep our world going. The things I am going to talk about are things that have been recommended to me by Medical PROFESSIONALS, and any thing I discuss should not be started into your regimen without the approval of your medical provider. This may be a little long but I get asked several times a week about what I do to treat my headaches and all of this has been or is currently part of my headache journey.

  1. Pain relievers like Aspirin or ibuprofen (Advil, Motrin IB, others) could potentially help relieve mild migraines. Tylenol can also work to help the mild migraines in some people, especially in the population of people who are on Blood Thinners and can not take medications like Aspirin or Advil.
    There are medications on the marketed that are specifically for migraines, such as the combination of acetaminophen, aspirin and caffeine which is known as Excedrin Migraine, these could potentially ease moderate migraine pain. However, none of the over the counter meds will be effective on their own for a severe migraine. And with many of the over the counter meds like Aspirin, Advil, Ibuprofen if they are taken too often or for too long at one time it is possible for them to lead to bigger problems such as stomach ulcers, GI bleeds and even Medication overuse headaches.
    There is a prescription pain reliever called indomethacin that may help diminished the effects of a migraine and is available in suppository form (not fun I know!!!), which may be helpful if you’re nauseated. Narcotic pain medications are rarely ever used in migraine treatment simply because many Providers feel like narcotics will cause rebound headaches in the long run and cause more problems than good, which is controversial to many, So I won’t go into it any further at this point
  2. If over the counter meds don’t work for you migraine than the next step is usually a medication group call The Triptans, which often used in treating migraines. Triptans make blood vessels constrict and block pain pathways in the brain. You have probably heard of them, they are medications like Imitrex, Zomig, Relpax. Triptans effectively relieve the pain and other symptoms that are associated with migraines. They are available in pill, nasal spray and injection form. The fact that they offer different forms is helpful due to the fact that if you are vomiting it is hard to keep down a pill for said migraine.
  3. If the Triptan class of drugs do not work to control your headaches and you are having to take them more than a couple times a week it is time to call your Provider again. At this point they may talk to you about how often your headaches are happening and if you have been able to pinpoint a cause. If no cause has been noted they mas discuss with you about doing some imaging like CT SCAN or MRI just as a precaution to rule out anything further that could be causing your migraines.
  4. If you have vomiting with your migraines, first let me say how very very sorry I am! I have terrible nausea and vomiting with mine. And thankfully my Providers have been nice enough to prescribe me anti-nausea meds to help when or should I need it, so don’t be afraid to ask!!
  5. Another kind of medication that your Provider may discuss putting you on if the Triptans and Over the counter meds like Aleve are not helping with the migraine is what they call Preventatives. These are medications that you take daily to help prevent your headaches from getting to the point of a migraine. However, there are requirements one must meet in order to be considered for a preventative med, which I will list below. Taking preventative medications can help to reduce the frequency, severity and length of a migraine and couple potentially increase the effectiveness of other meds used to relieve symptoms during attacks.  These medications will not take effect overnight it can take several weeks to see results. It could be recommended that you take preventative meds daily or just around your triggers. For instance if you get migraines around menstruation you might take the medication just around that time of the month for you,. Eventually if you have good results on the preventative meds your doctor may discuss tapering you off the medications to see how your headaches do without the medications.  The most common classifications of medications used as Preventative meds are Cardiovascular (heart) Medications, Antidepressants and Seizure medications. The qualifications I mentioned above are:
    1. You have four or more debilitating attacks a month.
    2. If attacks last more that 12 hours.
    3. If pain-relieving medications are not helping.
    4. If your migraine signs and symptoms include a prolonged aura or numbness and Weakness
  6. The last prescription medication I will discuss is Botox. I know you are thinking, “Wait, isn’t that the stuff that people put in their faces so they can’t move them and get no more wrinkles? Yup, same stuff! Just works a little different. I have yet to find an exact explanataion as to why it works but it does. There are some terms that have to be met before you can sign up for Botox. Here is what the Botox website says “BOTOX® is a prescription medicine that is injected to prevent headaches in adults with Chronic Migraine who have 15 or more days each month with headache lasting 4 or more hours each day in people 18 years or older.
    It is not known whether BOTOX® is safe or effective to prevent headaches in patients with migraine who have 14 or fewer headache days each month (episodic migraine).
    BOTOX® prevents on average 8 to 9 headache days and migraine/probable migraine days a month (vs 6 to 7 with placebo) after 2 treatments (at 24 weeks).”Botox website
  7. Some over the counter supplements that are often encouraged for migraine sufferers are Fever Few, Magnesium and B12, B6 and Folic Acid. Fever Few which is known as a herb used to control the pain of migrain. While Magnesium is used in hopes of preventing migraines. Some research has shown magnesium levels in the brain if often low during migraine attacks. And because magnesium is needed for a persons nerves to function properly, some think that low magnesium and migraines are somehow related. Vitamins B6, B12, and folic acid have been found that they  may reduce the frequency, severity and disability of migraines, according to new research. Daily vitamin supplements were found to produce a two-fold reduction in migraine disability.
  8. Invest in GOOD DARK SUNGLASSES- This may sound silly but you can never had dark enough sun glasses when you have migraines so invest in a good pair that is super dark and will really shield your eyes. There are multiple places to buy these but there are four good pairs on Amazon ranging in price from $49.99- $99.99, and are available as indoor and outdoor lenses!!!
  9. Another item that you can’t go wrong with and would be a great Christmas gift would be a good EYE MASK!!  These like anything vary in thickness and size and in bandwidth. You can find them at many different locations from the pharmacy to Amazon to Bed, Bath and Beyond,. The one below Is one that I recently purchased from Amazed that is desidned for those of us with migraines and has the ability to be frozen. And was only $10.
  10. If I had to pick one non-pharmacological item that has helped me the most it would be my ICEKAP!!! It is exactly what it sounds like. I hat with ice. But the ice packs are spaced properly so you don’t have to try and keep one on the front of your head and the back and keep them from sliding, It has really been a game changer. The Icekap website And last but not least Peppermint Oil. I am not big into oils but this is one things that I can carry in my purse and use anywhere when I feel a migraine coming on. And it also works for nausea. So killing two birds with one stone so to speaks with one oil. Unlike many of the other things that I have talked about. The more well known companies are the best to buy for like Young Loving because you know that their oils are 100% pure.

I hope that you find this list helpful and maybe I was able to give you a tip or two that you had not tried before. If you have any questions or comments or suggestions please don’t hesitate to leave them below!!

With Love,

Amber