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Treatment for migraines should combine two approaches preventive and abortive:
Abortive therapies are utilized once the headache episode has started and the traditional treatment is predominantly medications. The medications classically used for the non-vascular type of migraine are the TRIPTANS which represents a class of medications, the first of which is Imitrex. Other medications have been helpful for some patients including opioids, NSAID’s, Excedrin Migraine, Midrin and Ergotamine products.
Preventive treatments have traditionally included high blood pressure medications such as beta blockers (Inderal) and calcium channel blockers (Verapamil). Other medications that have been effective include the use of antidepressants - both the older versions called the Tricyclics and the newer SSRI’s (Lexapro) and NSRI’s(Cymbalta). These medications address the neural transmitter serotonin which is frequently used in the treatment of many different chronic pain syndromes. It not only has an effect on mood but can improve sleep patterns and decrease sensitivity to the pain. Antiseizure medications will affect the Neural transmitter Gaba and works by stabilizing the cell membrane of the nerve cell or axon. These include Gabapentin(Neurontin), Topamax and Lyrica.
Nontraditional treatment options that should be considered include the use of a feverfew, butter bur, magnesium, CoQ10, Vitamin B2 and Malic Acid. Studies for most of these products are not conclusive but assessments indicate that they are worthy of trying.
It remains my philosophy that treatment planning for migraine may take several of the above strategies in the right combination to be effective. What works for one person may not for another. Additional strategies that are helpful for the muscle tension component of the headache include Osteopathic Manipulation, Massage, and Acupuncture. Botox has been very helpful in the management of migraines that fail to respond to the above treatments and I have used it effectively on many occasions. In an acute setting with severe headache I have been successful with aborting the episode with a block procedure called a Spheno-palatine block. This procedure uses lidocaine which is placed on a swab and inserted in to the nose and gives us access to the ganglion.