Definition
By some estimates, migraine is the third most common illness in the world. And migraines disproportionately affect women.
What is a migraine?
Migraines are severe headaches, experienced as an intense throbbing pain that can last up to 72 hours.
Migraine is the most common type of vascular headache and can be divided into migraine with aura and migraine without aura.
Migraine does not discriminate. Migraine is the 8th most disabling illness in the world, according to the Migraine Research Foundation.
because of their condition – and for some the fear becomes a reality.
Types of migraine
As the most common type of vascular (from blood vessels) headache, migraine headaches can be divided into two main types:
- Migraine with aura (previously known as classic migraine)
- Migraine without aura (previously known as common migraine)
From 20–30% of migraines occur with an aura, which is a collection of symptoms that usually occur 15 to 30 minutes before a migraine headache begins.
How are migraines currently treated?
Migraines are now treated with a number of medications. These range in strength from over-the-counter pain relivers, such as Advil, to opioid medications, which are highly addictive painkillers that kill thousands of Americans who overdose on them every year. In addition, medications known as triptans are used to treat migraines. These are prescription drugs that obstruct pain pathways in your brain, Mayo Clinic explains.
However, triptans can cause recurring migraines, sometimes called “rebound headaches,” the American Migraine Foundation (AMF) says.
Two opioids used for emergency relief of migraines, oxycodone and hydrocodone, can also cause rebound headaches, the AMF says. “Even taking them just once per week can cause headaches to get worse in frequency and severity, the foundation notes.
And for some patients who take triptans, the medications don’t relieve migraine symptoms at all, according to the new report.
Rimegepant “may be effective in patients whose symptoms do not respond to triptans, owing to their different mechanisms of action,” the report says.
RELATED: The Keto Diet Might Prevent Migraines—Here’s What You Need to Know
Triptans also present problems for cardiovascular patients. The new report notes that triptans can cause what’s called vasoconstriction, which is the technical term for the narrowing of blood vessels. For this reason, triptans aren’t ideal for heart patients.
“Currently available treatments may not work at all, may not work fast enough, may have undesirable side effects,” Mia Minen, MD, headache neurologist and assistant professor in the departments of neurology and population health at NYU Langone Health, tells Health.
How will rimegepant work differently?
The new report says rimegepant could work as a treatment for cardiovascular patients for whom triptans aren’t safe.
The new medication does not present the vasoconstrictive effects that triptans sometimes produce, the report says.
And this population of people who have both cardiovascular trouble and migraine is probably larger than you imagined: 3.5 million of the 40 million Americans who get migraines either can’t take triptans or have to take them with caution due to heart trouble, the new report says.
But, Dr. Minen points out, more research needs to be done on the safety of this medicine for cardiovascular patients.
Research also needs to be conducted on the long-term effects of the drug, Dr. Minen says. And before the drug is available to the public, it must undergo FDA review. But, Dr. Minen adds, because of problems with the currently available medications, “we always look for new abortive migraine treatments for our patients.
Researchers still do not know exactly what causes migraine attacks, but both environmental factors and genetics seem to be involved. Although scientists have yet to determine the exact cause of migraine, environmental factors and genetics seem to be involved.
The brain chemical serotonin may also play a role. Serotonin assists in regulating pain in the nervous system and levels of this neurotransmitter drop during migraine episodes.
Most migraine pain originates in the arteries of the scalp or from the jaw and neck muscles. When the muscles become tense, the arteries can become painful.
Although migraine has an arterial component to the pain, it can often be prevented by treating the tension in the jaw and neck muscles. When the muscles relax, the arterial pain often subsides as well. The opposite is also often true – arterial pain can cause the muscles to react by becoming more tense, and this can result in muscle pain. When the arteries are treated, the muscle pain often subsides.
The arteries involved in migraine are usually the superficial temporal arteries (on the temple) or the occipital arteries (at the back of the head). However, in many patients other smaller arteries are also involved.
A number of potential triggers for migraines have been identified. (Triggers don’t, however, always cause migraines.) Some of these are:
– Alcohol
– Allergic reactions
– Foods like chocolate, fermented foods, dairy products, citrus fruit, avocado, bananas
– Foods that contain MSG, nitrates or tyramine
– Hormonal fluctuations associated with menopause, birth control and menstrual cycles
– Irregular or insufficient sleep
– Irregular eating patterns
– Loud noise, bright light and strong smells
– Smoking
– Stress
Symptoms of migraine
The pain of a migraine is felt as an intense, throbbing pain in the forehead, temple, ear, jaw or even around the eyes. It usually starts on one side of the head, but may eventually spread to the other side.
Migraines are sometimes preceded by an aura that usually starts about 30 minutes before the headache starts. The following are symptoms of aura:
– Blind spots
– Blindness in part of your visual field
– Zigzag lines
– Flashing lights
– Numbness of the lips and arm
– Hallucinations
– Weakness
– Difficulty speaking
The migraine is often accompanied by other symptoms such as:
– Nausea and vomiting
– Sensitivity to light
– Sensitivity to noise
– Irritability
– Low blood pressure
An attack usually lasts from 4 to 72 hours and may be incapacitating enough to disrupt daily activities
Treating migraines
Most migraine sufferers are treated with medication, but non-drug treatment is sometimes a better option.
Migraine treatment often includes medication, but the majority of migraine sufferers respond very well to non-drug treatment.
Medication
Two types of drugs are used to treat migraines:
– Medication to treat an attack
– Medication to prevent an attack
Medication to treat an attack
In some people, migraine headaches can be relieved by a mild painkiller – for example, paracetamol, aspirin or naproxen (NSAID) – if taken in high enough doses and if taken early enough. Stronger analgesics, containing codeine or caffeine, are often necessary.
If nausea or vomiting accompanies the migraine, tablets may not be absorbed efficiently from the gut. Effervescent tablets or suppositories are then often more effective.
Anti-nausea medication can help to reduce accompanying nausea and vomiting.
Ergot alkaloids (made from a fungus that grows on grain) such as Cafergot or Migril, might help if taken early enough. They are, however, not effective once the headache is established.
When taken in excess and especially with poor timing, these medications may exacerbate rather than alleviate a headache. Ergotamine has a number of side-effects. Care should be taken not to exceed the recommended dose.
The triptan drugs, Imigran, Maxalt, Relpax, Zomog and Axert are effective in many cases. These medications are available on prescription and can be used at any stage of a migraine – bringing rapid relief in about half an hour in approximately 80% of patients.
The triptans, Cafergot and Migril all have the same mode of action – they constrict the painfully dilated and stretched arteries in the scalp. If they are effective, it means that the pain originates in the scalp arteries. In these patients, surgical treatment of these scalp arteries is often a permanent solution to the problem.
Medication overuse headache
The biggest problem with the “rescue” medications is that if they are taken on a regular basis, they may cause a condition called medication overuse headache (MOH). This means that the drugs themselves gradually cause the headaches to get worse, more severe and more frequent.
The patient then has to increase the dose, starting a vicious cycle of worsening headaches and increasing amounts of drugs. This is why the non-drug approach is preferable.
Medication to prevent an attack
If attacks occur more often than three times a month, drugs to prevent attacks are often prescribed. The drugs commonly used to prevent migraine are not often effective, though, and frequently cause such unpleasant side effects that patients stop taking them and prefer to live with the pain instead.
Unfortunately there has still been no progress in the area of developing new drugs to prevent migraine.
Current migraine-preventing drugs include
– Beta-blockers such as propranolol (i.e. Inderal), which will reduce blood vessel dilatation
– Pizotifen (Sandomigran) – unfortunately often associated with weight gain
– Anti-epileptic drugs
– Anti-depressants such as amitryptyline
– Clonidine, which inhibits blood vessel contraction and dilatation
– Flunarizine (Sibelium) methysergide
– Cyproheptadine (Periactin)
Non-drug treatment
Most patients, given the option, opt for non-drug treatment.
The first step in non-drug treatment is to diagnose where the pain is actually coming from. In migraine, there are two anatomical structures where the pain most often starts. It may come from:
- The muscles of the jaw and neck
- The arteries of the scalp (not from inside the brain)
Muscle pain
The best treatment for the muscle component of migraine pain is by means of a plate worn in the palate, called a Posture Modifying Appliance or PMA. Wearing the PMA causes the jaw and neck muscles to relax, and is effective in many migraine sufferers.
In five out of six cases, this is all that is necessary. Other treatments such as physiotherapy, exercise, traction, Botox and minimally invasive bloodless surgery are also used for the muscle tension component.
Artery pain
It is interesting that in many patients with artery pain, when the muscles are relaxed by means of the PMA, the artery pain also subsides. In patients where the pain doesn’t improve with the PMA, the arteries can be treated surgically. In many migraine sufferers this is a permanent cure for their migraines. The opposite sometimes also happens; when the artery pain is successfully treated with surgery, the muscle pain often subsides
Treating migraines
Most migraine sufferers are treated with medication, but non-drug treatment is sometimes a better option.
Migraine treatment often includes medication, but the majority of migraine sufferers respond very well to non-drug treatment.
Medication
Two types of drugs are used to treat migraines:
– Medication to treat an attack
– Medication to prevent an attack
Medication to treat an attack
In some people, migraine headaches can be relieved by a mild painkiller – for example, paracetamol, aspirin or naproxen (NSAID) – if taken in high enough doses and if taken early enough. Stronger analgesics, containing codeine or caffeine, are often necessary.
If nausea or vomiting accompanies the migraine, tablets may not be absorbed efficiently from the gut. Effervescent tablets or suppositories are then often more effective.
Anti-nausea medication can help to reduce accompanying nausea and vomiting.
Ergot alkaloids (made from a fungus that grows on grain) such as Cafergot or Migril, might help if taken early enough. They are, however, not effective once the headache is established.
When taken in excess and especially with poor timing, these medications may exacerbate rather than alleviate a headache. Ergotamine has a number of side-effects. Care should be taken not to exceed the recommended dose.
The triptan drugs, Imigran, Maxalt, Relpax, Zomog and Axert are effective in many cases. These medications are available on prescription and can be used at any stage of a migraine – bringing rapid relief in about half an hour in approximately 80% of patients.
The triptans, Cafergot and Migril all have the same mode of action – they constrict the painfully dilated and stretched arteries in the scalp. If they are effective, it means that the pain originates in the scalp arteries. In these patients, surgical treatment of these scalp arteries is often a permanent solution to the problem.
Medication overuse headache
The biggest problem with the “rescue” medications is that if they are taken on a regular basis, they may cause a condition called medication overuse headache (MOH). This means that the drugs themselves gradually cause the headaches to get worse, more severe and more frequent.
The patient then has to increase the dose, starting a vicious cycle of worsening headaches and increasing amounts of drugs. This is why the non-drug approach is preferable.
Medication to prevent an attack
If attacks occur more often than three times a month, drugs to prevent attacks are often prescribed. The drugs commonly used to prevent migraine are not often effective, though, and frequently cause such unpleasant side effects that patients stop taking them and prefer to live with the pain instead.
Unfortunately there has still been no progress in the area of developing new drugs to prevent migraine.
Current migraine-preventing drugs include
– Beta-blockers such as propranolol (i.e. Inderal), which will reduce blood vessel dilatation
– Pizotifen (Sandomigran) – unfortunately often associated with weight gain
– Anti-epileptic drugs
– Anti-depressants such as amitryptyline
– Clonidine, which inhibits blood vessel contraction and dilatation
– Flunarizine (Sibelium) methysergide
– Cyproheptadine (Periactin)
Non-drug treatment
Most patients, given the option, opt for non-drug treatment.
The first step in non-drug treatment is to diagnose where the pain is actually coming from. In migraine, there are two anatomical structures where the pain most often starts. It may come from:
- The muscles of the jaw and neck
- The arteries of the scalp (not from inside the brain)
Muscle pain
The best treatment for the muscle component of migraine pain is by means of a plate worn in the palate, called a Posture Modifying Appliance or PMA. Wearing the PMA causes the jaw and neck muscles to relax, and is effective in many migraine sufferers.
In five out of six cases, this is all that is necessary. Other treatments such as physiotherapy, exercise, traction, Botox and minimally invasive bloodless surgery are also used for the muscle tension component.
Artery pain
It is interesting that in many patients with artery pain, when the muscles are relaxed by means of the PMA, the artery pain also subsides. In patients where the pain doesn’t improve with the PMA, the arteries can be treated surgically. In many migraine sufferers this is a permanent cure for their migraines. The opposite sometimes also happens; when the artery pain is successfully treated with surgery, the muscle pain often subsides.
.
Treating migraines
Most migraine sufferers are treated with medication, but non-drug treatment is sometimes a better option.
Migraine treatment often includes medication, but the majority of migraine sufferers respond very well to non-drug treatment.
Medication
Two types of drugs are used to treat migraines:
– Medication to treat an attack
– Medication to prevent an attack
Medication to treat an attack
In some people, migraine headaches can be relieved by a mild painkiller – for example, paracetamol, aspirin or naproxen (NSAID) – if taken in high enough doses and if taken early enough. Stronger analgesics, containing codeine or caffeine, are often necessary.
If nausea or vomiting accompanies the migraine, tablets may not be absorbed efficiently from the gut. Effervescent tablets or suppositories are then often more effective.
Anti-nausea medication can help to reduce accompanying nausea and vomiting.
Ergot alkaloids (made from a fungus that grows on grain) such as Cafergot or Migril, might help if taken early enough. They are, however, not effective once the headache is established.
When taken in excess and especially with poor timing, these medications may exacerbate rather than alleviate a headache. Ergotamine has a number of side-effects. Care should be taken not to exceed the recommended dose.
The triptan drugs, Imigran, Maxalt, Relpax, Zomog and Axert are effective in many cases. These medications are available on prescription and can be used at any stage of a migraine – bringing rapid relief in about half an hour in approximately 80% of patients.
The triptans, Cafergot and Migril all have the same mode of action – they constrict the painfully dilated and stretched arteries in the scalp. If they are effective, it means that the pain originates in the scalp arteries. In these patients, surgical treatment of these scalp arteries is often a permanent solution to the problem.
Medication overuse headache
The biggest problem with the “rescue” medications is that if they are taken on a regular basis, they may cause a condition called medication overuse headache (MOH). This means that the drugs themselves gradually cause the headaches to get worse, more severe and more frequent.
The patient then has to increase the dose, starting a vicious cycle of worsening headaches and increasing amounts of drugs. This is why the non-drug approach is preferable.
Medication to prevent an attack
If attacks occur more often than three times a month, drugs to prevent attacks are often prescribed. The drugs commonly used to prevent migraine are not often effective, though, and frequently cause such unpleasant side effects that patients stop taking them and prefer to live with the pain instead.
Unfortunately there has still been no progress in the area of developing new drugs to prevent migraine.
Current migraine-preventing drugs include
– Beta-blockers such as propranolol (i.e. Inderal), which will reduce blood vessel dilatation
– Pizotifen (Sandomigran) – unfortunately often associated with weight gain
– Anti-epileptic drugs
– Anti-depressants such as amitryptyline
– Clonidine, which inhibits blood vessel contraction and dilatation
– Flunarizine (Sibelium) methysergide
– Cyproheptadine (Periactin)
Non-drug treatment
Most patients, given the option, opt for non-drug treatment.
The first step in non-drug treatment is to diagnose where the pain is actually coming from. In migraine, there are two anatomical structures where the pain most often starts. It may come from:
- The muscles of the jaw and neck
- The arteries of the scalp (not from inside the brain)
Muscle pain
The best treatment for the muscle component of migraine pain is by means of a plate worn in the palate, called a Posture Modifying Appliance or PMA. Wearing the PMA causes the jaw and neck muscles to relax, and is effective in many migraine sufferers.
In five out of six cases, this is all that is necessary. Other treatments such as physiotherapy, exercise, traction, Botox and minimally invasive bloodless surgery are also used for the muscle tension component.
Artery pain
It is interesting that in many patients with artery pain, when the muscles are relaxed by means of the PMA, the artery pain also subsides. In patients where the pain doesn’t improve with the PMA, the arteries can be treated surgically. In many migraine sufferers this is a permanent cure for their migraines. The opposite sometimes also happens; when the artery pain is successfully treated with surgery, the muscle pain often subsides.
Healthy and wealthy 