Medicines for migraines
One of the keys to dealing with a migraine is to treat it early; otherwise, the headache causes chemicals in your body to activate pain receptors and cause nausea. Tylenol and over-the-counter anti-inflammatory drugs, or NSAIDs (pronounced en-saids), such as Aleve, Naprosyn and Advil, are meant for pain but may not work for migraine patients.

A class of drugs introduced in the 1990s called triptans is used to stop the attack once a migraine starts by targeting chemicals in the brain.

Triptans, which include Imitrex, Relpax, Frova, Amerge and Zomig, were put on the market expressly for migraines.

“They’re very effective, with most giving 50 percent relief within two hours,” Dr. Sinclair says, “and they can be repeated in two hours if there’s a recurrence of the headache.”

Triptans usually allow patients to get through the workday without becoming drowsy. “But, sometimes, there’s nothing you can do but go to bed,” Dr. Sinclair says.

Many insurance companies will authorize only eight to 12 triptan pills each month. If more medication is needed, prophylactic medication should be used to prevent migraines.

According to Dr. Sinclair, anyone with more than four headaches a month or severe headaches that last two to three days needs to go on a prophylactic medication. The wide range of choices includes beta-blockers, calcium channel blockers and tricyclic antidepressants. Examples are Topamax and Depakote. Both are taken daily and not just when migraines occur.

If other medical issues are involved, medication may be prescribed to treat those conditions plus the migraine. Beta-blockers also treat high blood pressure, and Topamax has a weight-loss component.

The tricyclic antidepressants, such as Nortriptyline (sold as Pamelor or Aventyl) are used to treat patients who suffer from both insomnia and migraines.

It usually takes two to four weeks to see the effects of preventive medication.

Emergency treatment
According to Dr. Sinclair, you should go to a hospital emergency department if you experience a sudden onset “thunderclap” headache. That severe, sudden pain could mean a blood vessel has ruptured just outside the brain.

Numbness or weakness, symptoms associated with a stroke or a seizure, could mean a ruptured aneurysm; and a CT scan may be necessary to look at the vessels in the brain. A ruptured aneurysm could be fatal, but a surgical procedure may be able to stop the leaking blood.

It’s also important to seek medical attention if the severity of a headache leaves a patient dehydrated or if there is prolonged pain or vomiting. “Emergency departments are adept at taking care of migraines,” Dr. Sinclair says.

Trips to the emergency department, weakness, numbness or migraines during pregnancy may all be reasons that your primary are physician will refer you to a neurologist who specializes in treating migraines. Dr. Sinclair looks at family history and will do a neurological exam. An MRI may be necessary if there’s concern about a possible brain tumor.

If you’re suffering from a migraine and can’t get to a doctor, Dr. Sinclair advises that you rest or sleep in a quiet room and try to drink fluids. Some patients take a warm shower or warm bath to relax.

“Reduce stress and eliminate noise,” she says.

The menthol in Bengay, an over-the-counter analgesic cream for muscle and joint pain, works for some patients, and lidocaine patches may also be helpful. Alternative treatments that work for some patients include biofeedback, which electronically monitors the body’s senses in an effort to reduce stress and tension; cognitive therapy or self-coping skills; and acupuncture.

“Whatever works for you,” Dr. Sinclair says.

The migraine sufferer may begin to experience headaches between the ages 12 of 19. Hormonal changes during pregnancy may mean more migraines or they may go away. Menopause may also mean that they come back or end forever.

“We’re looking at migraines more seriously,” Dr. Sinclair says. “They could increase the risk for stroke.”

Botox injections show success
For patients who don’t find relief or can’t tolerate side effects from headache medications, some physicians are giving Botox injections to prevent headaches.

Before she joined Pinehurst Neurology, Dr. Sinclair trained with Todd Troost, M.D., professor and chairman of neurology at Wake Forest University Baptist Medical Center. Dr. Troost is one of the original proponents of Botox use for headache treatment.

A purified form of the toxin that causes botulism and is most often used cosmetically to reduce frown lines, Botox is injected into muscles around the eyes and forehead in a diluted form to weaken the muscles and prevent headaches. Treatments last from three to five months for most patients.

According to Dr. Sinclair, who offers a Botox clinic at her Pinehurst practice, Dr. Troost has treated hundreds of patients with Botox. In a Botox study reported at the American Headache Society in Seattle in 2002, Dr. Troost reported evaluations of 134 patients, most of whom had already had been treated with at least three other preventive headache medications without success.

“Their success rate with Botox was pretty remarkable,” says Dr. Sinclair, noting that 84 percent of the patients reported improvement.

U.S. Food and Drug Administration approval of Botox for migraine treatment is expected in 2007, but Medicaid and Medicare have approved it off-label. Most insurance companies won’t cover the treatments, which cost about $800 to $1,300, until FDA approval is granted, however.