How can you treat a migraine once an attack comes on?
The key is to treat it as early as possible, within 15 to 30 minutes of the onset of pain symptoms. I ask my patients to keep a diary and include what they think are triggers — caffeine, stress, or a combination of things — so we can reduce a person’s vulnerability to migraines.
There are over-the-counter analgesics that can be helpful for people; things like ibuprofen, naproxen, Excedrin, or caffeine may help. Hydration is also helpful.
The goal is to get rid of the headache within two hours and not allow it to recur. There are also prescription-as-needed treatments that were specifically designed to treat migraines. These are called triptans, and they can be very effective in eliminating a migraine attack. These medications cannot be used in folks with risk factors for heart disease or stroke. Some patients may also need anti-nausea pills if they experience nausea during a migraine.
All these as-needed medications should not be used more than twice a week. Those who are experiencing frequent migraines should speak to their doctor, neurologist, or headache specialist about ways to reduce their frequency and reliance on these medications.
What can you tell us about the new drug that claims to prevent migraines?
Aimovig is the first migraine-specific preventive medication developed. It directly treats part of the underlying mechanism of migraines. Prior to this, we have been using medications from other classes, such as blood pressure agents, antidepressants, seizure drugs, and Botox, to reduce migraine frequency.
Given as a recurring monthly injection, Aimovig blocks the inflammatory molecule CGRP, which is elevated during a migraine attack, and keeps it from escalating further, thereby reducing the chances of future attacks. It’s not a cure because no migraine treatment is a cure, but the data suggests that some patients will see about a 50 percent reduction or more in their migraine frequency.
It’s very promising because it is a treatment specific to the mechanism of migraines, has very few reported side effects, and seems to have really dramatically helped people. However, because it’s just come out on the market, we don’t know the long-term side effects. We are hoping they’re going to be minimal.
If someone is suffering from migraines, what’s your key piece of advice?
Basically, if people have moderate to severe headaches that interfere with activities, or if they are getting more frequent headaches, they should speak to their doctor.
This is a great moment for people to understand that there are many treatments available, and if they haven’t responded to prior treatments, we’ve got a new class of drugs coming out, and that’s exciting news.
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