Pharmacy Guide: Migraine

Pharmacy Times, September 2010 Pain Awareness, Volume 76, Issue 9

Overview

Headache is any pain or discomfort in the head region, which may also involve neck and shoulder discomfort. While there are different types of headaches, migraines are common and debilitating, significantly decreasing work productivity and quality of life. Approximately 28 million Americans suffer from migraines. Although migraines affect both children and adults, women tend to experience these headaches more often than men.

Signs and Symptoms

Some patients may be able to predict migraines before they occur. Individuals can experience food cravings, mood changes, or muscle stiffness hours and days preceding a migraine in what is called the “prodrome.”

Another predictive sign of an oncoming attack is the migraine aura. An aura is defined as sensory disturbances that may include flashing lights, wavy lines, strange odors, and blind spots. It is important to remember, however, that not all migraine sufferers experience auras or prodrome.

Each patient with migraines can experience episodes differently. Symptoms may include:

• Pulsing or throbbing pain

• Pain on 1 side of the head

• Nausea and vomiting

• Light and sound sensitivity

Causes and Triggers

Researchers once believed that the dilation and constriction of blood vessels caused headache pain. New developments now link the pain pathway being triggered by abnormal brain chemistry and changes in nerve signaling. Different factors may cause a headache in each individual with migraines. Triggers can involve:

• Foods (eg, red wine, cheese, alcohol, chocolate)

• Psychological factors (eg, stress, depression)

• Fatigue

• Strong odors

• Overuse of headache medications (eg, triptans, ergotamines)

Tests and Diagnosis

A physician should be sought out when headaches are severe, recurring, disturb sleep, or are associated with other symptoms such as changes in movement, drowsiness, loss of consciousness, seizures, or a very stiff neck. These headaches may be a sign of a more serious health condition that should be addressed. A physician may look into the patient’s history, conduct neurologic exams, or perform an MRI to examine the brain to establish or rule out other medical causes.

Treatment

No cure exists for migraine headaches. Acute treatment with prescription medications, called “abortive agents,” can be taken to relieve symptoms when a migraine occurs. Some migraines may be halted if certain medications are taken at the first sign of the prodrome. A health care provider will determine a regimen based on the recurrence and severity of the migraine. Abortive agents include prescription medications such as:

• Triptans such as Imitrex (sumatriptan) and Maxalt (rizatriptan)

• Ergotamines such as Migranal (dihydroergotamine)

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen

Prevention

Individuals can help prevent migraines by avoiding triggers and keeping a consistent, adequate sleep schedule. Physicians can also prescribe certain medications to help prevent migraine headaches. When taken daily, they help to decrease the severity and frequency of migraines.

Self-Care

It is recommended that patients keep a migraine diary to track symptoms and find patterns in migraine occurrence. OTC products are also available to treat headaches, including NSAIDs, acetaminophen, and combination products containing acetaminophen/aspirin/caffeine. A pharmacist can help choose the appropriate product to treat the symptoms and screen for any contraindications and drug—drug interactions. Pharmacists should also counsel migraine sufferers on the side effects of their treatment regime and help avoid the overuse of pain medications, which can worsen headaches.

Homeopathic and Alternative Remedies

Some patients may want to find nonpharmacologic means to control their symptoms. Examples include:

• Meditation

• Staying inside a dark and quiet room

• Receiving psychological counseling

• Massage therapy

• Biofeedback

Additional Resources

National Headache Foundation

www.headaches.org

Mayo Clinic

www.mayoclinic.com

National Institute of Neurologic Disorders and Stroke

ninds.nih.gov