Preventative Therapy for Chronic Migraines
How do I know if I need it?
There are two type of migraine –Episodic migraine and Chronic Migraine. Each of these subtypes are determined by the frequency of headache days.
Chronic Migraine occurs when patients suffer headaches on at least 15 days of the month, with migraine on at least 8 of those days.
Typical characteristics of migraine without aura are unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity and association with nausea and/or light and noise sensitivity. Migraine attacks usually last 4-72 hours.
If you migraine has become chronic, preventative therapy is required to help you achieve remission back to episodic migraine.
Preventative Therapy for Chronic Migraines –What does this involve?
This will typically involve non drug measures as well as medications.
Non drug treatment examples include an aerobic conditioning program, avoidance of triggers, eating healthy, regular spaced meals, allowing for relaxation time, and attention to good sleep hygiene.
Medication treatment for chronic migraine requires effective use of drugs for acute migraine treatment and medications for prevention.
Preventative Therapy for Chronic Migraine –Important issues
The key to success is persistence, with an adequate dose of the medication for an adequate duration required
It is difficult to predict initially whether the treatment prescribed will be effective, and the process is a matter of educated trial and error, which can be frustrating for both the patient and the doctor.
If you have however been taking an adequate dose of a preventative for an adequate time period, and have not experienced a significant improvement, or are experiencing intolerable side effects, then it is time for a change of therapy.
Preventative Therapy for Chronic Migraine- Other considerations
Aggressive and early treatment of acute, as well as prolonged migraine attacks will help in achieving remission of chronic migraine.
Avoid Medication Overuse Headaches. Overuse of acute medications is associated with the transformation of episodic migraines to chronic migraine disorder.
If you suffer from a migraine co-morbidity such as chronic insomnia, anxiety, depression or other medical problems, talk to your GP about treatment for that condition
References:
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalagia 2013;33(9):629-808
Preventative (Prophylactic) Therapy. Headache 2009 American Headache
