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    Episodic Migraines: Treating Migraines Doesn’t Have to be a Headache - Part 2

    Michelle Galen, MD Family Medicine, Deaconess Clinic 01/18/2016

    Although migraine symptoms are consistent across classifications, there are two clinical distinctions: Episodic Migraines and Chronic Migraines.  Patients with episodic migraines experience 14 or fewer “headache days” per month whereas chronic migraine sufferers have 15 or more “headache days” per month.

    For episodic migraineurs, headaches average about 12 hours, are present on one or both sides of the head, occur mostly in women and are often accompanied with nausea and/or vomiting.  Genetics play a strong role with 90% of sufferers related to another individual with episodic migraines.  Unfortunately, migraines can be like an oncoming train – even if you see it coming, it’s nearly impossible to stop.  Preventative treatments are tricky because traditional migraine medications pack a big punch and it would be dangerous to use them daily.     

    While migraine symptoms vary from person-to-person, treatment options are similar across the board.  Patient options include:

    • Simple Analgesics – Aspirin, acetaminophen and ibuprofen are somewhat effective against migraine attacks.  However, the large dosage that may be required to eradicate a migraine can cause liver issues or gastrointestinal discomfort.
    • Triptans – Triptans are the most common and usually the most effective in treating a migraine.  Although they are powerful, they come with a host of side effects including dizziness, chest pain and hot flashes.  Triptans are the most potent when administered as close to the onset as possible but that can be tough to determine.
    • Ergotamine – This treatment has been in use for over 50 years but clinical studies have determined it’s only effective for a small group of patients.  In addition to patient specificity, they are known for poor bioavailability and inconsistent absorption.
    • Beta-Andrenergic Blockers – Beta-blockers have demonstrated positive results as a migraine preventative.  Unfortunately, beta-blockers are contraindicated with a number of common conditions like asthma, diabetes and cardiovascular failure.
    • Anti-Epilepsy Drugs (AED) – Also used as a migraine preventative, AEDs are useful but should be prescribed with caution for women of childbearing age.  AEDs can cause fetal abnormalities and interfere with oral contraceptives.
    • Calcium Channel Blockers – Studies have shown calcium channel blockers are more effective than placebo but carry the possibility of side effects like weight gain, abdominal pain and drowsiness.  

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