Headaches are a common complaint that comes into my office. Migraine headaches are one of the most common and debilitating. 6% of men and 10% of women in this country suffer from acute migraines.
Symptoms of migraine headaches-
-Pain lasting 4–72 hours without treatment or with ineffective treatment, made worse with physical activity
-On one side of the head
-Moderate to sever intensity
-Pulsating in nature
-Nausea or vomiting
-Made worse with light or loud noise
Some people can have auras prior to a migraine such as flickering lights or spots in front of vision, pins and needles or numbness sensation, speech disturbance that is reversible
Symptoms of auras can last 5 minutes to less than 60 minutes and then are followed by a migraine headache during the aura or within the next 60 minutes following the aura.
Many migraines can be treated with over the counter anti-inflammatory medications like ibuprofen or Motrin with or without caffeine. Acetaminophen is not effective in treating migraine headaches. Triptan prescription medications are effective in treating migraines. They are available in rapidly dissolving tablets, nasal sprays, and injectables.
IV Dexamethasone can help with migraine pain in emergency departments as well as IV Reglan. Some patients benefit from anti-nausea medications. Intranasal lidocaine can temporarily help with migraine pain until other longer-acting medications can take effect.
IV dihydroergotamine combined with anti-nausea medications can be used in emergency departments for migraines.
Studies show the earlier a patient takes medication for the acute migraine, the better the response and may decrease the need for repeat treatment and chances of recurrence of the headache.
Triptan medications should not be used in people with ischemic heart disease, stroke, uncontrolled hypertension, or basilar migraine. Triptans are contraindicated with patients taking monoamine oxidase inhibitors.
Migraine treatment in pregnancy suggests acetaminophen is safe until the third trimester. The American Congress of Obstetricians and Gynecologists recommends limiting caffeine intake to less than 300 mg per day during pregnancy. Taking more than 100 mg of caffeine per day during pregnancy may cause mild fetal growth restriction
Some patients may need prophylactic treatment of migraine headaches if they cannot tolerate available acute abortive medications for migraines or if headaches occur more than 2 days per week. For more information about migraine headaches contact your primary care physician.
If you would like to submit a question please email to: Ask Dr. Kent