Last week, we talked about migraine headaches, focusing primarily on the causes and symptoms. Today, we will continue our conversation, with emphasis on how migraine headaches are diagnosed and treated, as well as how you can help prevent migraines.
How are Migraine Headaches Diagnosed?
The diagnosis of migraine headaches is made primarily by good, old-fashioned clinical means. There is not a specific test that can be used to make the diagnosis. Your doctor will review your symptoms, medical history, and triggers. We talked last week about the symptoms or patterns that make migraines different from other headaches. If you missed last week’s Health Tip, you can see it here: Migraine Headaches – eDocAmerica
If your headaches have any of these patterns, other members of your family have had migraine headaches, and/or you have typical migraine triggers, a clinical diagnosis can be made easily without other testing.Imaging tests such as CT scans or MRI scans are not necessary in most cases. They are used only when symptoms are atypical, severe, or suggest another cause.
How are Migraine Headaches Treated?
Treatment of migraine headaches focuses on two goals. First, to relieve symptoms during an acute headache and second, to prevent future headaches.
Acute (also called abortive) treatments – These work best when taken early. They include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen
- Triptan medications – These medications block one part of the migraine pain pathway.
- Gepants – Newer medications such as ubrogepant, which block a different part of the pain pathway.
- Ditans – Another new class of medication, such as lasmiditan, which block yet another part of the pain pathway. This class of drugs works more on the neurologic pathway, rather than the vascular aspects, making it safer for patients with cardiovascular conditions.
- Antiemetics for nausea
- For severe attacks, some patients may require injectable or nasal medications.
Preventive treatments
These treatments reduce frequency and severity of migraine headaches. First on the list is lifestyle-based prevention. Then we’ll talk about medication treatments.
What Lifestyle Changes Help Reduce Migraines?
- Consistent sleep schedule
- Regular meals and avoiding known food triggers
- Staying well hydrated
- Daily physical activity
- Stress reduction (yoga, meditation, breathing exercises)
- Limiting caffeine and alcohol
- Avoiding strong odors or bright, flickering lights
- Keeping a headache diary can help you identify patterns and triggers.
What are the Medication Options for Prevention?
If you have infrequent migraines that respond well to acute treatment, you likely don’t need preventive medication. For those who have frequent migraines, preventive medications are a key component of treatment. Options include:
- Beta-blockers – Such as propranolol
- Anticonvulsants – Such as topiramate
- Antidepressants – At low doses, such as amitriptyline
- CGRP monoclonal antibodies – Such as erenumab, and fremanezumab
- Botox injections – For chronic migraine
Migraine is a common but highly treatable neurological condition. With the right combination of medication, lifestyle adjustments, and trigger awareness, most people can significantly reduce the impact of migraines on their daily lives.
If you would like a deeper dive into the cascade of events that happens during a migraine, and how different medications work to block them, use this link:
If you have any questions about migraine headaches, please log into your account and send us your question. We are here to help.
Dr. Anita Bennett MD – Health Tip Content Editor