Health Notes
Irvine Family Practice Medical Group
serving the community since 1984
Migraine: what to do about it
1. Trigger management is important in preventing Migraine attacks. Triggering factors can cause Migraine, and if
recognized and/or avoided, may impede an impending attack. Triggers vary from person to person. See list in section
5.
2. Abortive treatment: Some medications are used to relieve the severity and/or duration of Migraine and
associated symptoms. They should be
taken as early as possible in an attack.
Certain cerebral vasoconstrictor abortive agents are designed specifically for Migraine. They may be administered
by subcutaneous, oral, rectal, sublingual, intranasal, or intramuscular means. These medications include ergotamine
tartrate, dihydroergotamine (Migranal®, DHE45®), sumatriptan (Imitrex®), naratriptan (Amerge®), rizatriptan
(Maxalt®), zolmitripan (Zomig®), and isometheptene mucate (Midrin®). However using ergot compounds may
cause rebound headaches.
3. Preventive, or prophylactic, medications are prescribed to prevent or reduce the number of attacks in patients
who experience frequent Migraines, typically two or more per week. In general, these medications act over time to
prevent blood-vessel swelling.
Beta-blockers, such as propanolol and atenolol, are the most commonly prescribed prophylactic treatment for
Migraine and are considered to be an effective preventive treatment.
Antidepressants are believed to have a possible effect on serotonin or possible analgesic effects. Amitryptiline is an
example.
Calcium channel blockers are also used to decrease the frequency of Migraine attacks. It is thought that calcium
channel blockers play a role in vessel constriction.
Methysergide is thought to block the inflammatory and vessel-constricting effects of serotonin. Methysergide is
generally used only on select patients. This medication also requires a four to six week drug hiatus every six months
Divalproex Sodium (Depakote®) is very useful in the prevention of Migraine. This drug originally developed for
Epilepsy, is prescribed in much smaller doses when used to treat Migraine thus lessening the side effects.
Alternative to Prevent Migraines
Feverfew Leaf may be a good preventative treatment of migraines. Some evidence suggest that it prevents the spasms
of blood vessels in the head that trigger migraines.
4. General pain management may include the prescription of narcotic analgesics which act on the central
nervous system and alter our perception of pain. However, they are narcotic, may be addictive, and such usage should
be done in an appropriate manner to return a reasonable quality of life for the intractable Migraine sufferer. These
medications include Fiorinal® with codeine, Tylenol with codeine, Vicodin, Darvocet. In addition, there are some
strong non-narcotic analgesics that are very effective too, such as Midrin® or Fiorinal®.
NSAIDs (non-steroidal anti-inflammatory drugs) act by inhibiting blood vessel inflammation. These medications
include naproxen, ibuprofen and ketorolac.
Simple analgesics, available over-the-counter, such as aspirin, tylenol, excedrin are generally used for mild pain.
They relieve pain by acting on peripheral pain receptors. (Some analgesics also have anti-inflammatory effects).
5. List of Possible Triggers for Migraine.
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Dietary Factors
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alcoholic beverages
foods containing tyramine:
 aged cheeses
 Chianti wine
 pickled herring
 dried smoked fish
 sour cream
 yogurt
 yeast extracts
chocolate
citrus fruits
dairy products
onions
nuts
beans
caffeine (excess, withdrawal)
fatty foods
food additives:
 nitrites (e.g., in hot dogs, luncheon meats)
 monosodium glutamate (MSG)
 aspartame artificial sweetener (NutraSweet, Equal)
Environmental Factors
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bright light
flickering light sources
fluorescent lighting
perfumes
strong odors
fumes from industrial complexes
air pollution
secondhand cigarette smoke
motion
travel
complex visual patterns (e.g., checks, zig-zag lines)
weather changes
Lifestyle Factors
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stress
disrupted sleep patterns
fatigue
irregular eating habits
cigarette smoking
Medications
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blood vessel dilating drugs (e.g., nitroglycerin)
drugs for high blood pressure (e.g., hydralazine, reserpine)
diuretics
anti-asthma medications (e.g., aminophylline)
too-frequent use of analgesics, ergotamine
Physical Factors
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head trauma
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invasive medical tests (adverse effect)
exertion (e.g., sports, sexual orgasm)
disorders of the neck
Hormonal Factors
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onset of puberty in girls
 menstruation
 menopause
 pregnancy
 delivery
 birth-control pills
 estrogen replacement therapy
(Source: "Migraine: The Complete Guide," American Council for Headache Education, copyright 1994)
Headache Help
American Council for Headache Education
19 Mantua Road
Mount Royal, NJ 08061
1-800-255-ACHE (1-800-255-2243)
www.achenet.org
National Headache Foundation
428 West Saint James Place, 2nd Floor
Chicago, IL 60614
1-800-843-2256
www.headaches.org
National Institutes of Health
Neurological Institute
P.O. Box 5801
Bethesda, MD 20824
301-496-5751
www.ninds.nih.gov
Magnum :
113 South Saint Asaph Street, Suite 300
Alexandria, VA 22314
703-739-9384
www.migraines.org
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