A migraine is more than just a headache; it is a complex neurological disorder that happens to be the sixth most disabling illness worldwide. The pain, rather than the dull ache of a typical headache, is more of a sharp, throbbing sensation that can last hours to several days. It is also associated with other symptoms, such as blurred vision, difficulty concentrating, light and sound sensitivity, nausea, and vomiting. Fortunately, we have treatments at the Virginia Spine Institute to get patients through the worst of their migraines.
For mild migraines, something that may be readily available at home or over-the-counter may be the best option. Tylenol or anti-inflammatory medications, such as naproxen (Aleve) or ibuprofen (Motrin, Advil), can sometimes provide relief. For moderate to severe headaches, prescription triptan medications such as sumatriptan (Imitrex) or rizatriptan (Maxalt) can be considered. These medications are strong and are not to be used by patients who have a history of heart disease, a stroke, or uncontrolled high blood pressure. But for other patients without those conditions, a triptan can be effective in eliminating headache pain at two hours after the headache starts in about two thirds of people with migraines.
For the most severe migraines, we have a few other options. A triptan such as sumatriptan, delivered by intranasal spray or an injection under the skin, may work when a tablet does not. Office-based procedures, such as nerve blocks over the areas of pain, may also provide relief. An injection of a high dose of an anti-inflammatory medication may also be an option in the office.
It is best to treat a migraine as soon as you start feeling that you might have one. This may mean different things to different patients with migraines. For patients who have auras, such as vision changes before their migraines, this means taking medication as soon as you feel your aura starting. Patients who have migraines without auras should take medication as soon as they feel the pain start. Timing can be difficult for patients who wake up with a headache, but taking a medication first thing in the morning may be the best option. The later into a headache you are, the less likely a medication aimed at stopping a headache is to work.
When headaches occur a few times a month, it is best to treat them as they happen. However, when you have eight or more days with headaches in a month, preventing even half those headaches can really help. Such medications have two purposes. The first is to reduce the amount of headaches you are having per month, and the second is to make the headaches you do have less severe. You take these medications every day or every month, rather than as needed when you are having a headache. If the medication is successful, you will find yourself needing less medication to treat migraine attacks.