Knowledge
Treatment of migraine
Treatment of migraine often involves a combination of medication and non-drug based methods. Medical treatment is divided into emergency and preventive care.
Treatment of migraine often involves a combination of medication and non-drug based methods. Medical treatment is divided into emergency and preventive care.
Medicinsk godkendt artikel
Treatment of migraines often involves a combination of medication and non-drug methods. Medical treatment can be divided into emergency care, which is initiated to relieve or stop a seizure, and preventive treatment, which aims to provide milder or fewer seizures.
It is important to understand that there is no cure for migraine, but with timely and appropriate treatment, the quality of life can be significantly improved. This article describes evidence-based treatment that can relieve or prevent migraine attacks.
It's not the same thing that works for everyone. It is therefore important that treatment methods are discussed with healthcare professionals to find the best individual treatment. There are many variants of medication of the same type, where one variant may work for some but not for others, which is why close follow-up by your healthcare professional is important for you as a patient.
Read more about what migraine is and the symptoms of migraine hereto.
To prevent migraine attacks, it can be crucial to try to avoid trigger factors such as stress, lack of sleep, and alcohol. There is also evidence for other non-drug treatment methods to prevent migraines! 1 - it is worth noting that it is individual what one experiences has an effect:
When these measures are not sufficient to prevent and relieve seizures, there are both over-the-counter migraine medications and prescription medications as alternatives.
It is crucial to have a plan for emergency treatment of a migraine attack. Resting in a dark and quiet room with a cooling compress on the forehead can relieve light seizures, but often it is not sufficient. Pain relieving medications, such as ibuprofen, naproxen, paracetamol and taro, can be effective, and possibly also in combination with metoclopramide or domperidone to relieve nausea! 1. However, it is important to avoid overuse of pain medication, as it can lead to more headaches, what we call medication overuse headaches. Therefore, do not apply pain medication for migraine attacks more than 9 days per month or, on average, 2 days a week.
For migraine attacks in which ordinary pain medication is not sufficient, doctors often recommend triptans. These drugs relieve the pain by briefly narrowing the blood vessels in the brain.
Triptans are a medicine specifically developed to treat migraines. Triptans are available both over-the-counter and on prescription. Triptans can be combined with nausea and/or pain medications to achieve better effect if you do not feel that there is enough effect of a triptan. It is important to limit the use of triptans to no more than twice a day and no more than nine days a month! 1.
Several have the “migraine form” called migraine with aura. In the case of aura (visual disturbances, sensory disturbances and/or speech difficulties), triptans should not be taken until the aura is gone and the headache occurs. The period from the end of the aura phase until a possible headache occurs can last anywhere from 5-60 minutes. Not everyone gets headaches after aura.
Preventive treatment! 1 should be considered if:
First choice treatment includes blood pressure lowering medications such as beta blockers (metoprolol and propranolol) and the angiotine II sine receptor blocker candesartan. Another first-choice treatment that is most commonly used is antidepressant medications such as amitriptyline. Treatment is very individual and it may be necessary to try different preparations before the right treatment is found.
A new step in migraine treatment is CGRP inhibitors, which have shown positive results in preventing migraine attacks. These drugs inhibit a substance called calcitonin gene-related peptidethat plays a role in a migraine attack.
Treatment with Botulinum Toxin Type A, often referred to as Botox, also has proven good efficacy. Botulinum toxin is given via 31 injections into specific points of the forehead, temples, back of the head, skull edge and neck every 12 weeks
CGRP inhibitors and Botulinum toxin type A are prescribed only to people with chronic migraine, which means that one should have at least 15 days of headache per month, of which at least 8 days should be with migraine.
Many of the types of medicines used for both preventive and seizure treatment cannot be used during pregnancy and lactation, either because they are harmful to the fetus or baby or because they are relatively new types of medicines and therefore we do not yet know if they are actually harmful. Read more hereto.
We are all different and respond differently to medication. Therefore, some are lucky to find a good and effective treatment after the first attempt, where others have to try more than one preparation before experiencing effect.
It is important to consult a doctor to get a correct diagnosis and develop an individually tailored treatment plan based on symptoms, health history and any underlying causes of migraine. It is therefore also important that you preparing for the doctor's consultation.
A holistic approach that combines medication, lifestyle changes and non-drug methods can provide the best control over migraines and improve quality of life.
“It is recommended to get the right treatment as soon as possible so that you minimize the risk of the migraine developing and you can improve your quality of life.”
- Neurologist, Signe Bruun Munksgaard, Hemi Hovedpineklinik
The article is based on the standard of treatment in Denmark, last reviewed and presented in the Reference Program in 2020 by the Danish Headache Society.
Read about migraine treatment at Hemi Headache Clinic hereto.
1. Danish Headache Society 2020, Reference Programme 2020, https://dhos.dk/wp-content/uploads/2020/06/2932-Referenceprogram_2020_final_web-24.06.20.pdf
