In their otherwise very comprehensive review of this subject in your October issue of Education and Practice,1 Drs Barnes and Jayawant limit themselves to only two aspects of management in the prophylaxis of migraine: drug treatments, and psychological/behavioural therapy.
While it may be difficult to find hard evidence for some of the environmental areas they omitted,some mention of avoidance of obvious trigger factors would surely have been in order. These may vary in importance from child to child, but hypoglycaemia/hunger, lack of sleep, stress, vigorous exercise, and obvious dietary triggers can each be relevant in individual cases and therefore worthy of common sense advice.
Of probably far greater importance as an omission from this paper, and one for which there is an excellent evidence base, is the use of dietary measures in prophylaxis. Egger et al, in their Lancet paper in 1983,2 showed that a dietary approach could be very effective in a series of cases of severe intractable migraine, achieving a significant response in >80% of cases. They used an “oligoantigenic” or “few foods” diet followed by challenge with individual items of diet in a sequential manner. They found that a large number of “healthy” foods could be implicated in their cases, including wheat, cows' milk, other cereals, and fruits, with many children having multiple intolerances. In other words there is more to diet and migraine than simply excluding the 5 Cs (cheese, chocolate, coffee, co*ke, and citrus fruits).
They performed double blind challenges in a selection of their cases; these were confirmatory of the results of open challenge in the majority of cases.
Such an approach to management can in my experience be extremely helpful in individual cases of severe intractable abdominal or cranial migraine. It is quite feasible to administer on an outpatient basis with good support from an experienced dietician. When successful this approach may make drug treatment unnecessary. When not attempted it can render drug treatment ineffectual.
1. Barnes N, Jayawant S. Migraine. Arch Dis Child Educ Pract Ed 200590ep53–ep57. [Google Scholar]
2. Egger J, Carter C M, Wilson J.et al “Is migraine food allergy? A double‐blind controlled trial of oligoantigenic diet treatment”. Lancet 1983ii865–869. [PubMed]
Acetaminophen and nonsteroidal anti-inflammatory drugs are first-line treatments for mild to moderate migraines, whereas triptans
triptans
Triptans are a family of tryptamine-based drugs used as abortive medication in the treatment of migraines and cluster headaches. This drug class was first commercially introduced in the 1990s. While effective at treating individual headaches, they do not provide preventive treatment and are not considered a cure.
Triptans. Prescription drugs such as sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt, Maxalt-MLT) are used to treat migraine because they block pain pathways in the brain. Taken as pills, shots or nasal sprays, they can relieve many symptoms of migraine.
Use NSAIDs (including aspirin), nonopioid analgesics, acetaminophen, or caffeinated analgesic combinations for mild‐to‐moderate attacks and migraine‐specific agents (triptans, dihydroergotamine) for moderate or severe attacks and mild‐to‐moderate attacks that respond poorly to NSAIDs or caffeinated combinations.
Effective acute migraine treatment includes acetaminophen, nonsteroidal anti-inflammatory drugs and triptans. Ubrogepant and rimegepant are new, effective migraine treatments, suitable for patients with cardiovascular disease in whom triptans are contraindicated.
Whether it's a run-of-the-mill tension headache or a migraine, caffeine can often help. That's why it's an ingredient in a lot of popular pain relievers. It can make them as much as 40% more effective. Sometimes you can stop head pain in its tracks just by having caffeine.
Migraines, which affect children and teenagers as well as adults, can progress through four stages: prodrome, aura, attack and post-drome. Not everyone who has migraines goes through all stages.
Prescription medications called triptans are the current gold-standard for acute migraine treatment, but they are not safe or effective for every person.
Atogepant is a new type of anti-calcitonin gene-related peptide (CGRP) drug, which is specifically designed to treat migraines. They work by blocking the receptor of the CGRP protein. This is found in nerves in the head and neck and is thought to cause inflammation and migraine pain.
A CGRP inhibitor called atogepant significantly prevented the number of headaches per month compared to a placebo. Users were also able to cut back on the amount of medication they needed to stop an attack and were also more likely to achieve a 50 percent or higher reduction in migraine days per month.
Propranolol is the most common and one of the most effective first-line medications used for migraine prophylaxis. [11] The starting dose is 40 mg and can go up to 320 mg daily. It may take up to 12 weeks at an adequate dose for therapeutic benefits to become apparent.
Divalproex (Depakote), topiramate (Topamax), metoprolol, propranolol, and timolol are effective for migraine prevention and should be offered as first-line treatment.
What are the 5 Cs of migraine headaches? While dehydration can be a migraine trigger, it's not the best-known one. One commonly suspected set of triggers is known as the 5 Cs – cheese, chocolate, coffee, cola, and citrus fruits. But it's not clear how often those specific foods and drinks are triggers.
There is good evidence that a major cause of migraine is sensitivity to specific foods. Certain foods are well known to trigger migraine. Sometimes referred to as 'the five Cs', these are: chocolate, cheese, claret (and other red wines), coffee (and other sources of caffeine) and citrus fruits.
Stimulating Pressure Points for Migraine Relief. Stimulating pressure points, including “ear gate” and “daith” on the ears, “union valley” on the hands, and “great surge” on the feet, among others, may provide relief for some people with migraine.
Eat a carbohydrate with a protein or a good fat to stay full longer.Don't eat or drink anything that you KNOW triggers your migraine. Some common food “triggers” are alcohol, aged cheeses, caffeine, and chocolate. Drink water throughout the day instead of sugary drinks like soda or juice.
Introduction: My name is Arline Emard IV, I am a cheerful, gorgeous, colorful, joyous, excited, super, inquisitive person who loves writing and wants to share my knowledge and understanding with you.
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