ibuprofen, then the combination agent should be the
over-the-counter (OTC) drug of choice in treating a
migraine headache. According to headache experts, the
caffeine used in the combination agent can make a big
difference (see sidebar). Just a small amount–about the
same as that contained in a regular cup of coffee–makes
the combination agent about 40% more effective than
painkillers without caffeine, like acetaminophen or
aspirin.
Like every treatment decision, a lot depends on you.
You should work closely with your doctor to make sure
you understand and are comfortable with any approaches
that may be recommended.
To explain how migraine self-care is supposed to work, I
ask my patients to view the situation as a pyramid
(Figure 1).
As you work your way up the pyramid,
the doctor’s active role increases.
At the base, where patients can do the most to help
themselves, it is important to remember that treating
migraine is often not limited to finding the right medication. Lifestyle choices, such as proper diet and exercise,
and efforts such as correct posture can be very important
factors. Avoiding common dietary triggers–foods that can
trigger an attack (Table 3)–can be one of the best ways to
reduce the chances that you will experience an attack.
Aged cheeses
Chocolate
Alcohol*
Nuts
Caffeine Processed meats
*Especially red wine
Another way to help prevent attacks is with the use of
natural remedies (such as feverfew) and self-regulation
techniques (biofeedback or relaxation). A number of
my patients have been successful with a treatment that
combines magnesium, riboflavin, and coenzyme Q10 in
a single tablet.
The next step up the pyramid are the OTC medications, which require more supervision on the physician’s
part. This stage is followed by the prescription-only
painkillers and the migraine-specific medications, which
require an office visit and considerably more active supervision by the doctor. At the top are the opioids, which
requires very close supervision of the patients, often on
a daily basis. As we work our