Management
Gone is the day that we just use treatment options that were approved for other indications for our migraine patients…. We are now in an era where we understand what is happening in migraine inside of the brain - Amaal J. Starling MD
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HWN Suggests
A new generation of headache drugs
Unfortunately, because migraine is so complex, it has proved to be a difficult condition to treat. Many migraine therapies are drugs intended for other diseases. Antidepressants, anticonvulsants, blood pressure-lowering drugs and onabotulinumtoxin A — otherwise known as Botox — are all used to prevent migraine. In the 1990s, a class of migraine-specific drug called triptans emerged. These treat attacks as they happen by activating serotonin receptors, and provide at least two hours of pain relief for up to half of people with migraine.
CGRP-targeted drugs are similarly effective. In those who take them to prevent migraine, they almost entirely cease attacks for about 25% of people,…
Featured
A Million Ways I Tried to Cure My Chronic Migraine
One woman's journey into the good, the bad, and the absurdly pricey remedies that promise to ease severe headache pain.
Migraine sufferers have treatment choices – a neurologist explains options beyond just pain medication
Granted, alternative approaches are not necessarily miracle therapies, but their potential to relieve pain and suffering is notable. As a physician, it is truly gratifying to see some of my patients respond to these treatments.
Migraine Treatment Has Come a Long Way
This ‘woman’s disease’ doesn’t get a lot of research funding, but the medical establishment has made strides in developing new drugs and devices to combat migraine over the last five years.
What a headache: Updates on Migraine Management
There are new FDA approved abortive medications for acute migraine, CGRP antagonists and Ditans, that are in the early stages of research. They may be a good option for those who have failed or have contraindications to triptans or other abortives.
Articles of Interest
Many Migraines Can Be Prevented With Treatments, But Few People Use Them
Preventive treatment can reduce migraines by 50 percent. "For a given patient, half [the migraines] is usually a significant improvement," says Flippen. "If you go from 15 headache days per month down to seven, that's a significant change." In April, the American Academy of Neurology released new guidelines to help physicians treat migraine patients and help them reduce both frequency and severity of headaches.
Seven ways ... to manage migraines
One in seven of us suffer from migraines, but the ailment remains poorly understood with few truly effective treatments available
A new era for migraine relief
Gone is the day that we just use treatment options that were approved for other indications for our migraine patients…. We are now in an era where we understand what is happening in migraine inside of the brain - Amaal J. Starling MD
An Update on the Management of Chronic Migraine
In 1672, Thomas Willis provided the first description of chronic migraine (CM) when he reported the case of the philosopher, Anne, Viscountess Conway, who was also treated by William Harvey and Robert Boyle without success. Has our treatment of chronic migraine since improved?
Changing Treatment Landscape for Chronic Migraine Shows Promise Over 5 Years
New treatments for chronic migraine have been increasing since 2018, with robust evidence for eptinezumab, erenumab, fremanezumab, galcanezumab, and onabotulinumtoxin A.
Chronic Migraine Pathophysiology and Treatment: A Review of Current Perspectives
While topiramate, BoNT-A and recently approved anti-CGRP monoclonal antibodies are currently the only efficacious therapeutics in chronic migraine prophylaxis, neurostimulation creates new and promising outcomes in chronic migraine management.
Diagnosis and management of migraine in ten steps
Treatments for migraine include acute and preventive medications and a range of non-pharmacological therapies. Despite these treatment options and the comprehensive diagnostic criteria, clinical care remains suboptimal — misdiagnosis and under-treatment of migraine are substantial public health challenges.
Does Botox reduce the frequency of chronic migraine?
A recent meta-analysis pooled the results of multiple prior studies to investigate the usefulness of Botox, a brand of BoNT, in reducing the frequency of chronic migraine. The results suggested that there was benefit from this treatment; it not only improved quality of life and significantly reduced the frequency of chronic migraine headaches, but did so with few and mild side effects.
Injecting Migraine Pain Away
Botox "does not help everybody," Dr. Saper says. "It may not even help most everyone. But it does in my personal anecdotal experience help some people."
Latest Approach for Migraine Sufferers: Stopping Headaches Before They Start
Migraine sufferers have long been told to treat their painful headaches when they feel them coming on. Now, many doctors are prescribing daily drugs to prevent migraines from ever starting at all.
Managing Chronic Migraine Through Treatment and Lifestyle Decisions...
It’s really important to understand the multidisciplinary approach. It’s not just one shot, come take a pill and go. You have to assess the patient and the different directions. That’s why I always work with a lot of holistic approaches, using a lot of vitamins,
Migraine and Current Pharmacologic Management
Recent developments in novel genetic findings have increasingly dispelled the mystery surrounding migraine. This case series and the discussions highlight the most recent developments and trends in pharmacologic treatments for migraine. In agreement with all other recent findings, our patients responded to both the existing and novel medications. Recently, synaptic and axonal inhibitions have made headlines, with CGRP and CGRP receptor inhibition prominent examples. These newer medications' mechanisms have created a flood of interest in migraine treatment research.
Migraine Overview and Summary of Current and Emerging Treatment Options
Patients with migraines may have coexisting conditions limiting the medications available for treatment. In patients with migraine with brainstem aura, coronary artery disease, hemiplegic migraine, peripheral vascular disease, and uncontrolled hypertension, the use of DHE and triptans is contraindicated.
Migraine Treatment: What’s Old, What’s New
Migraine is a very common and disabling illness. Picking an agent that is best for each individual patient requires considering the patient’s history, lifestyle, comorbid conditions, and individual preferences. There are a few new treatment options, including TMS and ketamine.
New Headache and Migraine Treatments On the Horizon for Kids
Although most new migraine treatments focus on the adult population, many of those same treatments are being studied for use in adolescent and pediatric populations.
OTC: Wrapping Your Mind Around Migraine Medications
But if you’re among the unlucky hordes who endure migraines, which purported remedy should you pick? And how do you know when to ask your doctor about a prescription treatment rather than an over the counter one?
SEEDS for success: Lifestyle management in migraine
Primary care physicians can help their patients with migraine modify their triggers, and thereby mitigate the severity and frequency of their symptoms, by offering lifestyle modification counseling based on the mnemonic SEEDS (sleep, exercise, eat, diary, and stress). The authors review evidence associated with each of these factors and provide best-practice recommendations.
So Many Migraine Therapies, So Many Decisions Here's How the Experts Choose
Therapy options for patients with migraines have expanded over the past couple of years, with several new drug classes specific to the disorder. Leading migraine experts discuss how they decide to choose one therapy over another.
Suffer from Migraines? The Most Cutting-Edge Treatment Isn’t a Drug
While medication is an important treatment option for many patients, especially for chronic migraine sufferers, Dr. Carolyn Bernstein and her colleagues have found that integrative approaches to migraine treatment, focusing on lifestyle modifications, can be effective in lessening the intensity and duration of chronic and episodic migraines.
The diagnosis and treatment of chronic migraine
There are three broad approaches to treating chronic migraine: lifestyle and trigger management, acute treatments (i.e. those taken during attacks or exacerbations of chronic pain), and preventive treatments (medication or other interventions designed to reduce the tendency to have attacks).
Therapeutic novelties in migraine: new drugs, new hope?
The development of ditans, gepants and anti-calcitonin gene-related peptide monoclonal antibodies for the treatment of migraine is one of the greatest advances in the migraine field. Lasmiditan, rimegepant and ubrogepant will extend our therapeutic armamentarium for managing acute migraine attacks when triptans are not effective or contraindicated due to cardiovascular disorders.
