Treating Chronic Migraine: Acute and Preventive Approaches
Chronic migraine can be managed both acutely and preventively through a variety of medications and integrative treatments that may provide relief.
Understanding Chronic Migraine
Chronic migraine is defined as experiencing migraine headaches on 15 or more days per month for at least three consecutive months. On at least 8 of these days, the headaches will resemble typical migraine attacks.
These migraines can last from 4 to 72 hours and involve moderate to severe pain. Additional symptoms may include nausea or sensitivity to light and sound.
Acute vs. Preventive Treatment
Acute treatment aims to provide immediate relief from migraine symptoms, while preventive treatment is designed to reduce the frequency and severity of migraines from occurring in the first place. Alongside both acute and preventive treatments, complementary therapies can help manage coexisting conditions.
Acute Treatments for Chronic Migraine
Acute treatments refer to medications taken at the first sign of a migraine. These drugs do not prevent migraines but can offer significant pain relief during an episode. For optimal results, most of these medications should be taken as soon as migraine symptoms appear.
1.The most commonly prescribed acute treatments include:
- Analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs)
- Dopamine antagonists
- Ergotamines
- Ubrogepant and rimegepant
- Triptans, available as pills, injections, or nasal sprays
- Dihydroergotamine, available as a nasal spray, injection, or IV
2.In recent years, oral drugs targeting the CGRP pathway linked to migraine disease have emerged. These include:
- Ubrogepant (acute treatment)
- Rimegepant (used both acutely and preventively)
- Reyvow
- Zavegepant
Reyvow operates differently from other medications in this class by targeting serotonin receptors on the brain’s nerve endings to halt migraine attacks as they begin. However, it can cause sedation, and driving up to 8 hours after taking it is not advised.
Newer treatments for migraines may have fewer side effects than traditional options like triptans and antidepressants. They are also considered safe for individuals with other medical conditions, such as a history of heart disease, stroke, or vascular diseases.
Preventive Treatments for Chronic Migraine
Preventive medications for chronic migraine aim to stop migraines from occurring altogether. This treatment approach is typically considered when headaches occur more than 4 days per month and are accompanied by other severe side effects, such as debilitating auras.
Preventive treatments include:
- Beta-blockers
- Anticonvulsants
- Antidepressants
- OnabotulinumtoxinA (Botox injections)
- Anti-CGRP monoclonal antibodies
The effects of most preventive migraine treatments may take 2-3 months to become noticeable. Your doctor may recommend continuing the preventive medication for up to a year, depending on your migraine history and how your body responds to the treatment. Finding the right dose is also a crucial part of the process.
Complementary Treatments for Chronic Migraine
Prescription medications are not the only potential source of relief for chronic migraine. Natural or integrative remedies can also be beneficial when used alongside traditional treatments.
These include:
- Aerobic exercise
- Biofeedback
- Relaxation techniques
- Cognitive therapies
- Acupuncture
- Dietary supplements such as magnesium, CoQ10, butterbur, or feverfew
- Cyanocobalamin (vitamin B12) with folate and pyridoxine (vitamin B6)
Lifestyle changes may further aid in managing migraine symptoms. Ensuring adequate sleep, staying hydrated, and limiting caffeine intake can all contribute to relief from migraine symptoms.
Antidepressants and Migraine
Depression and anxiety disorders are common among individuals who suffer from migraines. Research suggests that worsening depression is frequently associated with an increased risk of episodic migraines progressing to chronic migraines. Therefore, it is crucial for doctors to evaluate and treat migraine patients for the presence of depression or anxiety.
Certain antidepressant medications have been successfully used to treat depression and also reduce the recurrence of migraines.
Key Takeaway
Chronic migraine is treated both acutely to provide immediate relief from pain and other symptoms, and preventively to reduce the likelihood of migraine occurrences. While chronic migraine isn’t life-threatening, it is a serious condition due to its disruptive and often debilitating nature.
Consider keeping a migraine journal to track the frequency and symptoms of your migraines, as well as the effectiveness of different medications. This will help your doctor determine the best course of treatment for you.