Second of two parts
By Jo Gott
Adult Nurse Practitioner
Last week in Part 1, we explained the facts about migraines. This week, we’ll explore how these headaches are diagnosed and what treatment options are available.
If you experience migraines or have a family history of migraines and if the symptoms are typical of a migraine, then a health care provider will diagnose migraines based on your medical history, signs/symptoms and a physical exam, including neurological tests.
However, if the headaches seem complex or atypical, you will be referred to a neurologist. He/she may do tests to rule out other causes for your pain. The tests might be one of the following:
- MRI: Uses a powerful magnetic field and radio waves to produce detailed images of the brain and blood vessels. MRI scans can diagnose tumors, strokes, bleeding in the brain or infections.
- CT scan: Uses a series of X-rays to create detailed cross-sectional images of the brain. This helps to diagnose tumors, infections, brain damage, bleeding in the brain and other possible medical problems that may be causing headaches.
Once a migraine is diagnosed, treatment needs to be initiated. Medications are generally prescribed and treatment is aimed at either: (1) medications taken to immediately help the headache go away or (2) preventive medications taken so migraines will not develop.
The following information is taken from the Mayo Clinic regarding medications for migraines:
- Pain relievers: These over-the-counter medications include aspirin or ibuprofen (Advil, Motrin). Migraine relief medications that combine caffeine, aspirin and acetaminophen (Excedrin Migraine) may be helpful.
- Triptans: These are prescription drugs such as sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt) used for migraines because they block pain pathways in the brain. Taken immediately when the migraine starts, as either pills, shots or nasal sprays, they can relieve many symptoms of migraines.
- Dihydroergotamines (DHE 45, Migranal): Available as a nasal spray or injection, these are most effective when taken shortly after the start of migraine symptoms for migraines that tend to last longer than 24 hours.
- Opioid medications: People with migraines who cannot take other migraine medications might be aided by narcotic opioid medications, especially those that contain codeine. Because they can be highly addictive, these usually are used only if no other treatments are effective.
- Anti-nausea drugs. These can help if your migraine with aura is accompanied by nausea and vomiting. These are usually taken with pain medications.
The Mayo Clinic recommends the following categories of preventive medications:
- Blood pressure-lowering medications: These include beta blockers such as propranolol (Inderal) and metoprolol tartrate (Lopressor). Calcium channel blockers such as verapamil (Calan, Verelan) can be helpful in preventing migraines with aura.
- Antidepressants: A tricyclic antidepressant (amitriptyline), in some individiauls, can prevent migraines.
- Anti-seizure drugs: Valproate (Depacon) and topiramate (Topamax) might help you have less frequent migraines.
- Botox injections: Injections of onabotulinumtoxinA (Botox) about every 12 weeks help prevent migraines in some adults.
Migraine headaches can be incapacitating; however, people who suffer with them may find relief with medications and/or by resting in a dark, quiet room with an ice pack on their head. Others try to prevent headaches by doing yoga, taking magnesium or using herbs such as feverfew. Additionally, there are certain triggers that can be avoided.
People with migraines generally learn how to cope and adapt to the lifelong changes associated with these headaches. Family members and co-workers can help by understanding that migraines are true neurologic conditions that affect people in different ways, and sometimes numerous treatments must be tried before relief is obtained.