Headache Treatment Center

Common Questions About Migraine Prevention

1. I have had migraines for a very long time. I did not know that they could be prevented. How can I prevent migraines?
   The prevention of “triggers” is one of the most effective ways to prevent migraines. A “migraine trigger” is an event or situation which may cause a migraine to occur in some individuals. Common triggers are loss of sleep, stress, hormonal fluctuations in women, and certain foods. Many people learn to avoid their most common triggers, but identifying triggers can be difficult for some people.
2. How can I identify my triggers?
   A headache diary is the most effective way to learn about your migraines and the how your lifestyle can influence the frequency of your migraines. A headache diary will ask you to record your activity, weather, stress, diet, and other factors that are very important in learning more about your migraines.
3. How do I avoid stress? It seems impossible!
   Avoiding stress is a common recommendation and very seldom feasible with an active lifestyle. Exercise, biofeedback, meditation, and other relaxation techniques can do a lot of good in helping to cope with stress and reduce migraine attacks. Talk to your physician or counselor about resources for stress management.
4. What about my diet? Can certain foods cause migraines?
   Many people report that certain foods such as strong cheese, red wine, chocolate, yeast, and cured meats can trigger migraines. The most important triggering substances in foods are “nitrites, nitrates, and sulfites.” Preservatives, artificial sweeteners, and food additives are the most common sources of these compounds. Monosodium Glutamate or “MSG” in Chinese food and other foods has been implicated as a common migraine trigger.
5. What types of medical treatments are available for migraine prevention?
   Migraine prevention medications fall into two very basic categories: vascular medications, and nervous system medications. The vascular medications are drugs which were developed to treat high blood pressure, such as verapamil, propranolol, and atenolol. The nervous system drugs are drugs that were developed to treat either seizures (most commonly) or depression. Examples of nervous system drugs include topiramate (Topamax), valproic acid (Depakote), and amitriptyline (Elavil).
6. How do I know which preventive treatment is best for me?
   The one that is best for you is the one that works the best yet produces few or no side effects. The basic goals are to provide you with more headache free days yet not impair your ability to function on days when you do not have a headache. Your physician will discuss the options with you to determine which of the preventive therapies are best for you.
7. How do the migraine preventions work?
   The nervous system drugs are believed to alter the chemicals in the brain which trigger the migraine attack. One important chemical is called serotonin. When serotonin levels in the brain are kept steady and not depleted, migraine attacks seem to occur less frequently. Blood pressure medications like calcium channel blockers and beta blockers block the chemicals which cause the constriction or tightening of blood vessels. It is believed that blood vessel constriction is an important phenomenon in migraine headaches.
8. How do depression medications prevent migraines?
   The older antidepressant drugs, such as Elavil, Pamelor, and Trazodone, also affect the levels of serotonin in the brain. These medications can be very effective for migraine prevention, and are usually dosed nightly. Many individuals are concerned about some of the side effects of these older medications, such as weight gain, dry mouth, and daytime sedation.
9. How do seizure medications work to prevent migraines?
   The medications used for seizures such as gabapentin, topamax, and valproic acid also affect brain chemicals which are involved in the condition of migraine. Seizure drugs are more likely to affect “ions” flowing through “channels” which affect the chemical charges of brain cells. These ions include sodium, calcium, potassium, and magnesium. Although the exact explanations for how these medications prevent migraines are not known, these medications can be very effective in migraine prevention.
10. I heard that Botox was recently approved for migraine, how effective is it?
    Botox works by the blocking certain hormones in muscles around the scalp. Clinical studies showed that Botox reduced headaches by at least half in persons who suffered chronic migraines (persons with more than 2 or 3 headaches per week). Although the exact explanation for how Botox works is not known, the drug can be a very effective option when other medications do not work or are not well tolerated.