My wife has terrible migraine headaches. She has tried caffeine, vitamins, and Motrin. Motrin works occasionally. Any suggestions?

— Low tolerance

Dear Low tolerance,

Coping with migraines can be a real pain, and it can be frustrating to try multiple treatments with mixed results. Migraines are a type of neurovascular headache, in which abnormalities in the constriction and dilation of blood vessels and subsequent interactions with nerves causes a throbbing pain, often on one side of the head. Among primary headaches (headaches not caused by another medical condition), migraines are the second most common. They can be episodic (only occurring occasionally) or chronic (occurring more days than not). The good news is that above and beyond what your wife has already used to treat these headaches, there may be a few additional methods worth trying in order to successfully treat and even prevent migraines.

While experiences vary, the four phases of a migraine are: prodome (early symptoms), auras (changes in vision or other neurological symptoms), attack (pain sometimes accompanied by vomiting), and postdrome (fatigue). People may either experience them “with aura” or “without aura.” According to the University of Maryland Medical Center (UMM), 75 percent of those who experience migraines are women. Although the cause of migraines is still not well understood, there seems to be a genetic component. It is believed that neurotransmitters (like serotonin), and nerve pathways disrupters play a role in causing migraines in some people.

For someone who experiences migraines, it’s recommended to keep a headache journal. It may be easier to select appropriate prevention and treatment strategies when a record of symptoms, frequency, duration, and triggers is presented to a health care provider. When a migraine hits, here are some of the treatments that are largely recommended:

  • Medication can provide relief from the pain and sometimes from other symptoms (like nausea). Over-the-counter medications (such as acetaminophen or ibuprofen) may be sufficient, but depending on the severity, your health care provider may prescribe other medication. Triptans are the most popular type of migraine medication. A word of caution: overuse of medication may cause Medication Overuse Headaches (MOH), or rebound headaches. If a patient takes medication often due to frequent migraines, a preventive medication may be prescribed.
  • Non-medication treatments can be categorized as:
    • Behavioral treatments, like cognitive-behavioral therapy, biofeedback, or relaxation strategies may be helpful in treating migraines.
    • Acupuncture may help treat the pain and other symptoms, although the jury is still out on its effectiveness for treating migraines.
    • Lifestyle changes may reduce any triggers, which may include keeping a regular schedule of sleep, exercise, and eating. Healthcare providers may also suggest refraining from taking medications that contain the hormone estrogen.
    • Herbs and supplements, such as butterbur, feverfew, riboflavin, and magnesium, may also provide some relief for those suffering from migraines.

List adapted from the University of Maryland Medical Center (UMM).

  • Prevention might also be a key component of a treatment plan. Preventing migraines typically involves determining triggers to avoid. Often, people with migraines don't have enough serotonin to quiet the body's response to various triggers. Although each person is different, common triggers include:
    • Stress
    • Physical exertion
    • Intense lights or smells
    • Skipping meals or lack of sleep
    • High altitudes, weather changes, and traveling
    • Some foods and drinks (including those with caffeine or alcohol)
    • Some food additives (including monosodium glutamate — known as MSG)

List adapted from the University of Maryland Medical Center (UMM).

Your wife may benefit from seeing a health care provider to get a diagnosis, to discuss her treatment possibilities, and to come up with a migraine management plan that'll meet her needs. The National Headache Foundation and American Council for Headache Education (ACHE) are also great national resources for additional information about migraines. Best of luck to you and your wife!


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