HeadWise HeadWise: Volume 4, Issue 1 | Page 21

Paul G. Mathew, MD, FAHS Brigham and Women’s Hospital Department of Neurology John R. Graham Headache Center Boston, Massachusetts Cambridge Health Alliance Division of Neurology Cambridge, MA Harvard Medical School Boston, MA Migraine is a common headache disorder that affects approximately 1 in 5 women and 1 in 20 men. It is a complex disorder, which tends to be inherited in families, and in recent years more genes have been identified that play a role in the genesis of migraines. Although many sufferers will deny a family history of migraines, the truth of the matter is that they actually have family members who suffer with migraines. Some family members have infrequent migraines, and down play the level of disability that they suffer by calling it “my normal headache.” Alternatively, family members often blame another disease process for their symptoms such as a sinus infection or the flu, when they are actually in denial or fail to realize they are experiencing a migraine. Migraine medication treatment can be divided into two major categories. Abortive medications are medications that are taken at the time of a migraine attack for termination of the headache and associated symptoms. Abortive medications include many different classes including nonsteroidal anti-inflammatory drugs (ibuprofen, naproxen), triptans (sumatriptan, rizatriptan, naratriptan, almotriptan, zolmitriptan, frovatriptan, eletriptan), ergotamines (dihydroergotamine), and anti-nausea agents (metoclopramide, promethazine). Preventative medications, as the name implies, are taken on a daily basis to prevent migraine attacks from occurring. Preventative medications include many different classes, such as blood pressure medications (verapamil, atenolol, propranolol, nadolol, timolol, metoprolol), tricyclic antidepessants (amitriptyline, nortriptyline, protriptyline), anti-seizure medications (topiramate, gabapentin), and injectable therapies such as botulinum toxin (Botox, BTX). Although people with migraines can suffer from similar symptoms such as throbbing pain, nausea, vomiting, and sensitivity to light, sound, and smell, individual patients can have very different responses to treatment. As such, it is not uncommon for physicians to try several different medications before finding the right combination of abortive and preventative medications to adequately control a patient’s headaches. This approach in most cases leads to an improvement of headache frequency and intensity. However, in some cases, it may require months to achieve a good outcome as each medication trial can typically take weeks. For some medications, side effects can limit increasing the dose to one that would be effective for the treatment of the patient’s migraines. Considering the large number of individuals experiencing migraine, the inadequate number of www.headaches.org 142651_A_NHFHeadWise–June.indd 21 | National Headache Foundation 21 6/2/14 8:10 PM