If You Know a Migraine Is Coming, Here’s How to Prepare
If you suffer from regular migraines, what are you doing to treat your head pain right now?
For a lot of patients, the answer involves what are known as “abortive treatments.”
Those are treatments which are designed to stop a migraine once it is in progress. A common example is the medication Imitrex.
But have you ever thought about trying out preventative treatments? This article will run over some of your options in-depth if you want to try to stop migraine attacks before they start.
What Are Preventative Treatments for Migraines?
Preventative treatments are designed to reduce the severity, frequency and duration of migraine headaches.
Unlike with an abortive treatment, you take a preventative treatment on a daily basis, whether or not you have had pain that day.
If you can effectively reduce the number of migraine attacks you have each month using preventative treatments, that can improve your quality of life and also reduce your reliance on abortive measures.
Many Patients Have No Idea They Could Benefit from Preventative Migraine Treatments
Despite the potential value of preventative treatment of migraine, preventative therapy options are frequently overlooked by patients and their doctors.
As reported by the Migraine Research Foundation, “Although 25% of sufferers would benefit from preventive treatment, only 12% of all sufferers receive it.”
In other words, more than half of the people it is believed should be taking advantage of preventative migraine treatments are actually doing so.
Why is there such a gap here? There are a number of possible explanations:
- Patients often rely on over-the-counter drugs to manage their headaches, and may believe that an acute treatment is the only option they have.
- Many people are under the misapprehension that migraines are episodic only, and never take a chronic form. But the Migraine Research Foundation reports that there are over 4 million chronic daily migraine sufferers. Many of these people may believe they have another condition, and never think to pursue migraine preventative treatments for frequent headaches.
- Even people with frequent migraines can easily go completely undiagnosed. In fact, the Migraine Research Foundation writes, “More than half of all migraine sufferers are never diagnosed. The vast majority of migraine sufferers do not seek medical care for their pain. Only 4% of migraine sufferers who seek medical care consult headache and pain specialists.”
Who Can Benefit from Preventative Treatments for Migraines?
Anybody! Anybody with migraine attacks could feasibly benefit from preventative treatments if their migraine headaches are responsive to those treatments.
But the ideal candidates for migraine prophylaxis are those who are classified as having “chronic migraines.” That means migraines for a minimum of 15 days per month.
If you have migraine attacks this frequently, you can derive only limited benefit from Imitrex, Ibuprofen, and other acute treatments (whether prescription or OTC).
Treatments like these can get rid of some migraines and take the edge off others. But they have a couple of major limitations:
- You cannot take some of them frequently enough to mitigate the majority of your head pain. You can only get 9 Imitrex tablets per month, for example. If you take it too often, you can get rebound headaches.
- If you have chronic migraines, the moment you stop one, you might have another coming on. This is especially likely if you have triggers you cannot escape. For example, those with menstrual migraines have internal triggers in the form of their own hormones. So even if an abortive medication stops a migraine in progress, the hormonal issues can just spawn a new one right away.
If you are not getting the relief you need from frequent migraines using acute treatments alone, consider talking to your healthcare provider about migraine prophylaxis.
Keep in mind that for insurance reasons, it may be important to say that you have headaches at least 15 days a month (it would be quite upsetting to be denied coverage because you only have them 14 days a month).
A Few Common Medications Used for Migraine Prevention to Remember
So what options do you have for migraine prophylaxis?
Most medications for migraine management through prevention fall into these categories:
- Beta blockers: Some examples include propranolol (Inderal), Timolol (Blocadren), atenolol (Tenormin), metoprolol (Toprol XL), and nadolol (Corgard).
- Antidepressants: The most common example is the tricyclic Amitriptyline.
- Anticonvulsants: Examples include Divalproex (Depakote) and sodium valproate, gabapentin (Neurontin) and topiramate (Topamax).
Sometimes, the NSAIDs naproxen sodium (Anaprox) and naproxen (Naprosyn) are used to prevent migraine attacks. Research also shows that the angiotensin-converting enzyme inhibitor lisinopril (Zestril) may work for migraine prophylaxis.
Migraines Preventative Treatment Medication Side Effects
Alas, most preventative medications for migraines can have problematic side effects over the short-term. Some can also cause health complications in the long term. You can read up on side effects of some of these drugs at American Family Physician.
There are a couple of medical treatments for migraine prevention which may have fewer side effects.
- The anti-CGRP treatment: FDA-approved anti-CGRP treatments include Erenumab-aooe (Aimovig), fremanezumab-vfrm (Ajovy) and galcanezumab-gnlm (Emgality). These are very new medications. Aside from some mild injection site pain, I haven’t seen any data suggesting any other side effects. There are some cardiovascular concerns, but we will require long-term data to know whether there are long-term health drawbacks or not to using this treatment.
- Botox treatments: Botox, the same substance which is used to get rid of wrinkles, has also been shown to be effective as a migraine treatment for some patients. It is generally very well-tolerated. But it can be expensive and difficult to get insurance coverage for.
For some patients, the benefits of migraine prophylaxis medications outweigh the drawbacks. For others, it might be a tough call.
Consider These Natural Treatments for Preventing Migraines as Well
Considering that most medications used for migraine prophylaxis either have questionable side effects or are difficult to procure, you might be wondering if there are any alternatives to preventative drugs to reduce your migraine days.
Following are some natural preventative treatments for migraine attacks:
- Magnesium for migraines in high doses (i.e. around 600 mg daily). Several months of taking magnesium daily may be necessary before results are apparent.
- Riboflavin: Also known as vitamin B2, riboflavin may be able to prevent migraines if one takes around 400 mg per day. As with the magnesium, it may take several months before results are evident.
- CoQ10: Initial research suggests that taking coenzyme Q10 several times a day may be able to reduce the frequency of migraine attacks.
- Feverfew: This perennial herb may have potential in treating migraines. As this paper describes, “The first modern, public account of its use as a preventative for migraine appeared in 1978. The story, reported in the British Health Magazine, Prevention, concerned a patient who suffered from severe migraine since 16 years of age. At 68 years of age, she began using 3 leaves of feverfew daily, and after 10 months her headache ceased completely.”
- Butterbur: Research shows that butterbur is an herb which may be both effective and well-tolerated in migraine prevention. In the linked study, “77% of all patients reported a reduction in the frequency of migraine attacks of at least 50%. Attack frequency was reduced by 63%. 91% of patients felt substantially or at least slightly improved after 4 months of treatment. About 90% of each, doctors and patients, reported well-being or even improved well-being.”
- Ginger: There is research which shows that ginger can be used as an acute treatment for migraines, and that it may have preventative value as well. In fact, it can block CGRP, which is the same thing that anti-CGRP medications are designed to do. But unlike this medications, ginger has a long history of use, and does not pose the same potential concerns.
- Vitex: Also known as chaste tree berry, Vitex has shown effectiveness in treating a variety of menstrual-cycle related issues, including headaches. I take this herb on a daily basis, and it has been the single best preventative treatment for my migraines to date.
- Melatonin: This research reports that the effectiveness of melatonin—the hormone associated with sleep—for preventing migraines is comparable to that of the antidepressant amitriptyline. The study states, “Melatonin is an accessible and affordable option for preventing migraine headaches in chronic sufferers. The 3-mg dosing reduces headache frequency—both in terms of the number of migraine headache days per month and in terms of the percentage of patients with a >50% reduction in headache events—as well as headache intensity, with minimal adverse effects.”
Research is ongoing in terms of both mainstream and alternative options for migraine prevention. If you conduct additional research yourself, you may find some more ideas to try. You should also routinely look up new developments in the field. You never know when something amazing might come along.
Six Solid Tips for Success With Migraine Prevention
- Be aware that migraines are complicated. There seem to be a variety of mechanisms involved with them and a great deal of variation between patients. That means a treatment which works for somebody else may not work for you, and vice versa. You may need to be willing to try a variety of preventative drugs or herbs before you find the relief you are looking for.
- It can take weeks or months to see a reduction in the frequency, intensity and/or duration of your migraine attacks with some of these preventative options. If you give up before you reach that point, you may never find out whether a particular migraine prophylaxis option would have worked for you.
- It is important to take careful daily notes about your head pain while you are trying out different migraine prevention herbs or drugs. Doing so will help you to track whether you are experiencing improvements. It also can help you to deal with your insurance company.
- Conduct your own research on the possible drawbacks of first-line migraine medications. There’s a tendency for doctors to prescribe these without going over them in the fullest detail. It is important to understand that “first-line” generally means “cheapest to your insurance company.”
- Make your goals clear to your healthcare provider, and advocate aggressively for yourself. Headache patients are often treated quite dismissively by doctors, who would prefer to deal with easier cases. To some degree, you also need to be prepared to become an expert in pain treatment. Your doctor doesn’t have nearly the time and motivation you do to devote to your case. There is a good chance it will be you who stumbles on solutions that work through your own efforts.
- Combine your efforts with preventative migraine treatments with other lifestyle changes to support your health. That means avoiding migraine triggers, getting consistent sleep each night, eating a healthy diet, exercising regularly, and regulating stress to the best of your ability. You also might make use of heat and cold therapy, chiropractic treatments, and other home and alternative remedies.
Perhaps the most important advice is simply to be consistent, patient and determined. You will probably encounter some frustrating setbacks along the way. But if you keep careful notes and continue to work toward solutions, you may be surprised by what you can accomplish in terms of migraine prevention and relief.
Conclusion: Preventative Options for Migraine Are Well Worth Exploring
We have just explored some of the possibilities for migraine prophylaxis which you may want to check into if you suffer from frequent head pain.
As many of the patients who have the potential to reduce headaches through these treatment options are unaware of them, there is a substantial possibility that you could be an ideal candidate while not even being aware of it.
As recommended, give your body some time to adjust to these preventative migraine treatments. It may take you a few months before you experience a significant drop in migraine headaches.