My mother suffers from migraine headaches. And although heredity has been shown as a cause for having them, I have been lucky to never have suffered through one. But in seeing what she has dealt with, I understand why the 25 percent of women and 8 percent of men in our population who do, struggle with this debilitating problem.
Most migraine sufferers are between the ages of 25 and 50, but there are cases of children as young as 5 getting a migraine. And although most of us can say we have had a headache, migraines are not just “bad” headaches.
A migraine is often described as an intense pulsing or throbbing pain that usually occurs in one area of the head. Migraine attacks may cause severe pain for hours to days, causing a need to retreat to a dark, quiet place.
It’s often accompanied by additional symptoms, such as nausea, vomiting, and sensitivity to light and sound. About one-third of affected people can predict the start of a migraine because they experience sensory warning symptoms such as flashes of light, blind spots, zig-zag lines, temporary loss of vision, or tingling in the arm or leg.
Scientists still do not know for certain what causes migraines. However they could involve “disturbances in nerve pathways and brain chemicals that affect blood vessels near the brain causing them to swell, sending pain to the brain stem.
Recurring migraine attacks are caused by a number of different triggers. These include weather at up to 50 percent, missing a meal (40 percent), stress (about 50 percent), alcohol (50 percent) and various types of food (45 percent).
And if you do suffer from migraines you know there is no cure, but here are two ways to approach treating them with medicine. You can take medicine during migraine attacks to relieve symptoms (acute treatment) or you can take medicine daily to prevent or reduce attacks and lessen the intensity of the pain (preventive treatment).
According to Dr. Beyzarov, the scientific director for the Pharmacy Times Office of Continuing Professional Education, “Acute treatment consists of over-the-counter pain relievers (or analgesics) such as acetaminophen, aspirin, and ibuprofen. If these products do not work for you, your doctor may prescribe medication that may include a stronger analgesic and/or a drug that acts more specifically on the cause of migraines. These migraine-specific treatments may include drugs from the ‘triptan’ class (such as sumatriptan, almotriptan, or zolmitriptan), or ‘ergot-type’ products such as dihydroergotamine nasal spray. If needed, drugs for nausea and vomiting may also be prescribed. The sooner these treatments are administered, the more effective they are.”
If you have frequent migraine attacks, if your attacks do not respond consistently to migraine-specific treatments, or if acute medications are ineffective or cannot be used because of other medical problems, then preventive treatment may be prescribed. Beyzarov suggests “drugs originally developed for epilepsy, depression, or high blood pressure have been shown to be effective in preventing migraine attacks. Botulinum toxin A, which is injected into muscles in the head and neck, has also been shown to be effective in prevention of chronic migraine.”
Pharmacists are often on the front lines of care for migraine patients seeking relief from their headaches and are often in a position to direct the initial care and education for these patients. The importance of a thorough understanding of migraine and its management is essential for pharmacists, because as many as 57 percent of patients self-treat migraine headaches, and inappropriate use of OTC analgesics can increase the risk of medication overuse headaches. By advising, educating, and instructing patients in the appropriate use of OTC analgesics in migraine, the pharmacist can be a valuable addition to the management team for this chronic disorder. Having the knowledge of how and when to use the OTC therapies and when to recommend further evaluation is important when interacting with headache patients seeking advice.
Mike DeCinti can be reached at email@example.com or 910-827-2439.