Continued use of some anti-migraine drugs has been found to lead to what is known as "rebound headache," a condition marked by frequent and chronic headaches, especially in the early morning hours. The condition can be prevented if the patient takes the drugs only on a doctor's supervision and when taken only in minimal doses. Those suffering from frequent attacks may need preventive therapy (Robinson 1999).
There are alternative treatment modes aimed at preventing migraine (Robinson 1999). Because it is often linked with food allergies and intolerances, the identification and elimination of the offending foods can contain or decrease the frequency of the attacks. Herbal therapy with the use of feverfew or chrysanthemum parthenium can work this way. Biofeedback training may also help prevent some vascular changes when an attack begins by increasing the flow of blood to the extremities. The patient must put the lights down low, put his or her feet in a tub of hot water and place a cold cloth on the back of the head or occipital region. This should draw blood to the feet and relieve pressure in the head (Robinson).
Most migraine sufferers can control migraine attacks by recognizing and avoiding what triggers them and by using appropriate drugs when the attacks begin (Robinson 1999). Those with severe migraines, unfortunately, do not respond to preventive or drug therapy. Prevention can include keeping record of headaches and particulars, taking note of what triggers each attack. Specific actions may be eating at regular times, reducing intake of coffee and pain-relievers, restricting physical exertion, especially during warm days, keeping regular sleep hours without oversleeping, and time management that will avoid or reduce stress at work and at home. Drugs that can prevent migraine are classified into beta blockers, tricyclic antidepressants, calcium channel blockers, anticonvulsants, prozac, monoamine oxidase inhibitors and serotonin antagonists. Preventive drug therapy is not the appropriate option for most migraine patients because it requires the use of powerful drugs. There appears to be limited benefits for preventive treatment for women with migraines that coincide with their menstrual period (Robinson).
There are still other alternatives in the control of migraine headaches (Rowland 2001).. These include acupressure, acupuncture, aromatherapy, cognitive behavior therapy, hydrotherapy, relaxation techniques, the use of supplements, allopathic treatments, the use of a transcutaneous electrical nerve stimulation or TENS, aerobic exercises, taking celery juice twice daily, ginger, and pulsing electromagnetic fields. Acupressure involves pressing the so-called Gates of Consciousness or GB 20 points to relieve migraine. The use of acupuncture as a useful treatment for migraine headache has also been endorsed by a National Institute of Health or NIH panel. The essential oil of rosemary in aromatherapy can also be beneficial. Herbals that can prove of some value include valerian or valerian officianalis, passion flower or passiflora incarnate, ginkgo or ginkgo biloba, goldenseal or hydrastis Canadensis, hawthorn or crataegus oxyacantha, linden, wood betony or stachys officianalis, skullcap or scutellaria lateriflora, or cramp bark or vibrurnum opulus. On the other hand, hydrotherapy involves the alternate use of a short hot shower followed by a long cold shower or a hot enema to relieve migraine pain. Relaxation techniques include meditation, yoga, hypnosis, visualization, breathing exercises and progressive muscular relaxation to inhibit the progression of an attack. Supplements may be in the form of Vitamin B2 or Riboflavin, magnesium, 5-HTP or melatonin (Rowland).
Migraines are thrice more frequent with women than with men throughout their child-bearing years (Walling 2002). Furthermore, women's migraine attacks are linked with their menstrual cycle and thus warrant safety measures in the use of contraceptives and bodily changes in pregnancy and menopause. These are the findings of Matharu and his colleagues in their review of migraine in women. The team found that, while 60% of these women sufferers reported these attacks during menstruation, only 14% of them had migraine exclusively linked with the menstrual cycle and almost always only in the first two days of menstruation. These attacks during the menstrual period do not seem to differ from other migraine headaches and less likely to be preceded by aura. A record of headaches will be needed to confirm the link between migraine and menstruation, especially if the latter is irregular (Walling). Doctors recommend prophylactic medication two days before the start of the menstruation period with drugs like naproxen or fenoprofen. They recommend mefenamic acid if the patient has dysmenorrheal. Perimenstrual estrogen supplementation, like the 100-mcg transdermal estrogen patch, may be effective. Danazol, tamoxifen and bromocriptine may be used in severe cases, the doctors say (Walling).
In the case of women with migraine, headaches get worse in 18 to 50% of the cases, improve in 3 to 35% of the cases or have no change in 39 to 65% of the cases when taking oral contraceptives (Walling 2002). Migraine has also been observed to occur with estrogen withdrawal but this can be contained by the continuous use of oral contraceptives. The most serious concern is an increased risk of ischemic stroke, which at present, is still small but, nonetheless, is increasing at the rate of 5-10% per 100,000 women among those without migraine and at the rate of 17-19% per 100,000 women in those with migraine. The risk appears greater in those with aura and in those women with additional risk factors, such as new and persisting headache or new-onset migraine aura. Hence, doctors recommend that the women use the lowest possible dosage of estrogen and avoid the use of oral contraceptives if they have migraine aura (Walling).
It has been noted that 60-70% of these women experience some relief during pregnancy (Walling 2002). Their treatment options are restricted during this period when ergotamines and triptans are not recommended. Acetaminophen is used for pain during this period rather than ibuprofen and naproxen. Antiemetics like metoclopramide, chlorpromazine, prochloperazine and promethazine are considered safe during pregnancy
It has also been observed that migraines improve in two-thirds of women who go through physiologic menopause, although attacks can be severe and frequent during the perimenopause stage. There appears no increased risk of stroke with the increased use of hormone replacement therapy or HRT in these women. Symptoms may improve or get worse with HRT. Doctors recommend that these women use low-dose and continuous regimens of synthetic ethinyl estradiol if their symptoms become severe or frequent (Walling).
A recent study conducted with 24 subjects uncovered the perceptions and needs of patients with migraine (Cottrell 2002). Results of the study centered on the impact of migraine attacks on family, misunderstanding by others, effect on work, physician care issues and issues concerning medical insurance and insurance companies. These results showed that the subjects were interested in understanding their migraine and would like to acquire information besides relief from their pain. They would want to build a relationship with their physicians with whom they could come up with a treatment plan suited to their particular situation rather than receive only generic educational materials. They preferred a team approach to their treatment (Cottrell).
Duke University report identified and summarized evidence derived from other reports of empirical studies on the cost of care and economic impact of chronic headaches (Life Sciences 1999). Findings covered the utilization of health care resources, such as provider consultation, predictors of securing a headache diagnosis, the use of the emergency department and hospitalization; pharmaceuticals for prescription as well as nonprescription drugs, preventive medications, frequency of medication use and the effect of sumaltriptan; non-pharmacological therapy; and work loss. The report says that chronic headache sufferers come from a diverse population, which is difficult to study. Population-based studies reflect that many of them do not seek medical assistance or use prescription medicines for their pain. Those who consult physicians have more severe headache symptoms, use more prescription drugs and are heavier users of medical resources (Life Sciences).
Of all the surveyed adult sufferers of migraine, less than half have been diagnosed by a physician or received prescription treatment from a physician (Polizzotto 2002). Records show that 2.8 million clinical visits per week are for migraine complaints and that it costs U.S. employers more than $13 billion per year. Direct medical costs account for more than $1 billion annually.
The five approved and available triptan medications for the treatment of migraine headache are sumatriptan, zolmitriptan, rizatriptan, almotriptan and naratriptan (Huffman 2002). They are of comparative effectiveness. Studies show that there are about 3.4 migraine-related strokes for every 100,000 persons each year and link a history of migraine to a higher risk of stroke. Triptans vasoconstrict the meningeal blood vessels and this action links the higher incidence of vascular events to the use of anti-migraine drugs (Huffman).
A randomized trial on subjects who suffered from migraine revealed the benefits of acupuncture in combination with usual pharmacologic care (Vickers et al. 2004). Participants on the trial who received acupuncture scored higher and had fewer visits with medical practitioners and fewer sick days at work. The overall results prompted that a policy using local acupuncture service be adopted to improve clinical benefits of standard…