Modern Management of the Migraine Headache

Abstract

Migraine headache is a debilitating disorder that affects millions of people in the United States and worldwide. The diagnosis of migraine can significantly affect quality of life, health care costs, and daily productivity. Hundreds of trials and many guidelines have documented various approaches to migraine management, whether via acute treatment or chronic migraine prophylaxis. Acute or abortive migraine management encompasses specific and nonspecific migraine therapeutics, including nonopioid and opioid analgesics, triptans, and ergotamines. Prophylactic migraine management data span the pharmacological spectrum from antiepileptic and antihypertensive agents to botulinum toxin type A. Special considerations for migraine management also must be applied in various populations, including children, pregnant women, and the elderly. The following review serves as an introduction to current therapeutic approaches for acute migraine treatment and provides an overview of available literature for pharmacological prophylaxis.

Migraine: treatments, comorbidities, and quality of life, in the USA

“…Pharmacological treatments are common, with both abortive and prophylactic medications used; however, these medications are burdened by side effects and cost. 5 Non-pharmacological interventions, such as behavioral therapy, 6 relaxation therapy, and cognitive behavioral therapy, have also been employed, with varying degrees of success. 5 Despite the variety of treatment approaches available, migraineurs report that they feel their treatment is insufficient or unsatisfactory.…”

Migraine therapy during pregnancy and lactation

“…A recent Cochrane review on acupuncture has reported that it is effective and could be considered a treatment option for migraine prophylaxis [17]. Other nonpharmacological alternatives (i.e., transcutaneous electrical nerve stimulation, cervical manipulation and hypnosis) have insufficient evidence to be recommended as approaches for migraine treatment [16]. With regard to the pharmacologic approach, there are only a few clinical trials evaluating drug treatment of migraine during pregnancy.…”

“…Drug therapy during the first 12 weeks after conception is, moreover, particularly challenging because the fetus is most vulnerable to a possible teratogenic factor as most organ development occurs during this period [15]. Non-pharmacological approaches (i.e., acupuncture, relaxation training, thermal or electromyographic biofeedback, and cognitive behavioral therapy) with reported evidence of efficacy [16,17] can be used in disease management. A recent Cochrane review on acupuncture has reported that it is effective and could be considered a treatment option for migraine prophylaxis [17].…”

Effect of Different Meditation Types on Migraine Headache Medication Use

“…Opiates, benzodiazpines, and triptans are commonly employed as rescue medications for migraines, but these medications are burdened by side effects and risks such as medication-overuse headaches, abuse, and addiction. 5 Prophylactic medications used in the treatment of migraine headaches tend to fall into the categories of antidepressants, anticonvulsants, and beta-blockers. 6 Similar to abortive medications, prophylactic medications can carry serious side effects that can interfere with patients’ daily lives.…”