Migraines: The right treatment spells relief

People who don’t suffer from migraines can easily believe that they are just regular headaches, but they couldn’t be further from the truth. A migraine can cause intense pain for several hours or even days, and can be accompanied by other very debilitating symptoms. The attacks are sometimes so painful that the person affected has no choice but to lie down in a dark room until the episode passes. Migraines can considerably interfere with the person’s school, professional and social life.

Causes and triggers While migraines remain shrouded in mystery, we do know that they have both genetic and environmental causes. Many factors that trigger migraines have been identified, but they do not affect all sufferers equally. The factors include:
- Hormonal changes in women
- Foods
- Common culprits include alcohol (especially beer and red wine), aged cheese, chocolate, aspartame, too much caffeine, monosodium glutamate, salty foods, and processed foods that contain preservatives. Skipping meals or fasting can also trigger migraines.
- Stress
- Sensory stimuli
- Bright lights, loud noises and unusual smells, whether pleasant or unpleasant, can trigger migraines.
- Changes in sleep pattern
- Fatigue or physical exhaustion
- Environmental changes
- Changes in climatic conditions or atmospheric pressure can trigger a migraine.
- Certain medications

Adopting a healthy lifestyle can help prevent migraines. The following measures are recommended:
- Having a regular meal schedule and not skipping meals
- Reducing your level of stress
- Sleeping sufficiently, but without sleeping in late
- Exercising regularly
- Avoiding triggers

Treating migraines As soon as you feel a migraine coming on, stop your regular activities and go to a dark and quiet room to sleep if possible. Some people find that applying cold compresses to their head and neck provides relief, while others find heat more effective, such as taking a warm bath or shower. Massaging the sore areas may help reduce the tension.

Analgesics to treat mild- to moderate-intensity migraines can be purchased at the pharmacy. Ibuprofen is usually the first line of migraine treatment and is effective when used adequately. Pharmacies also carry analgesic combinations designed to treat migraines. They often contain caffeine, an ingredient used to enhance the analgesic effect. When the migraines are accompanied by nausea or vomiting, the pharmacist may recommend medication to relieve these symptoms. These agents are also available as suppositories, for individuals who can’t swallow because of nausea. Whenever possible, these medications should be taken at the first signs of a migraine. It is always advisable to consult your pharmacist for advice on the most appropriate medication for your situation.

Stronger medication is also available with a physician’s prescription. These include triptans, ergot derivatives, barbiturates and opiates.
- Triptans are considered first-line options for moderate- to severe-intensity migraines. They are effective in relieving the pain, nausea and light sensitivity associated with migraines. They are usually well tolerated. Many molecules are now available on the market, in various dosage forms: regular tablets, quick-dissolve tablets, nasal sprays and injections. Adverse effects include nausea, dizziness and muscle weakness. Individuals with migraines may obtain greater relief from a specific drug in the triptan category, which is why some people need to try a few different agents before finding the one that works best for them. Triptans are not recommended for persons at risk for strokes or heart problems.
- Ergot derivatives (e.g. ergotamine) are effective in treating migraines, but they are more likely to produce adverse effects. Triptans are favoured because they are better tolerated.
- Because of their adverse effects, potential for addiction and high risk of rebound migraines (a migraine caused by the medication itself), barbiturates and opiates are usually only considered for treating migraines if all the other medications have proven ineffective or are contraindicated.

Medications aimed at relieving migraine-related pain should not be used on a regular basis for more than a few days. If such a case arises, inform your doctor or pharmacist.

When individuals suffer very debilitating or frequent migraines, doctors sometimes prescribe preventive medication. Most of these products were originally developed for another indication but proved effective in reducing the frequency, severity or duration of migraines, even if they do not usually eliminate them entirely. Their effectiveness varies from one person to another, which is why several trials are sometimes required before patients find the most effective product for them.

When to see a doctor While we still can’t prevent all migraines, it is possible to reduce their frequency and severity, which is why it is important to see a physician. If you think you suffer from migraines, keep a journal of the symptoms you experience and the way you treat them. You should also see a doctor if you’ve had migraines for many years and they suddenly present differently.

There are situations where you should go to the hospital emergency, namely if a headache:
- starts abruptly and is very violent;
- is accompanied by fever, neck stiffness, a rash, confusion, convulsions, double vision, weakness, numbness or difficulty speaking;
- appears after a head injury, especially if it worsens instead of improving over time;
- is aggravated by coughing, fatigue or sudden movements.

Living with migraines can be a daily challenge. However, a healthy lifestyle can help improve quality of life for migraine sufferers. For your treatment to be effective, take your medication as soon as the first signs of a migraine appear. Lastly, don’t hesitate to ask your healthcare professionals for help if your migraine pain is not sufficiently relieved.