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"Three Rs of Migraine Management" focus for Headache Awareness Week

The first week of June was nominated "Headache Awareness week" by the National Headache Foundation (NHF). This year, the NHF chose "Follow the Three Rs of Migraine Management" as its program theme.

The foundation wants to encourage migraine sufferers (and their physicians) to:

  • Recognize migraine symptoms
  • Respond and see a healthcare provider
  • Relieve pain and associated symptoms.

A migraine attack usually lasts from four to 72 hours. The pain is usually unilateral (affecting one side of the head), although it can change sides or sometimes be bilateral.

The pain is usually throbbing or pulsating, and can be aggravated by physical activity. A migraine attack is almost always accompanied by at least one of the following: nausea/vomiting, phonophobia (sensitivity to sound), photophobia (sensitivity to light).

When many people think "migraine" they think only of the pain. In reality, a typical migraine episode consists of four parts, referred to as phases or components.

The NHF notes that not all doctors are trained and experienced in migraine management. Sufferers should educate themeselves about migraine so they can be "treatment partner" with their doctors.

If the patients are not getting results, they should not hesitate to seek a new doctor. It's often advisable to see a neurologist who specializes in migraine or go to a reputable headache/migraine clinic.

Effective migraine management begins with a definitive diagnosis, and continues with trigger management, migraine prevention, abortion of migraine attacks, and pain management (including both traditional and complementary therapies -- relaxation, proper breathing, medications, and other methods).

A preventive regimen is recommended for those with frequent migraine attacks. This may include all or any of vitamin/mineral/herbal supplements, exercise, and medications.

Migraine "abortive" medications are those used specifically for migraine attacks to "abort" the attack itself rather than masking the pain as pain medications do.

Abortive medications include:

  • Triptans: Imitrex (sumatriptan), Maxalt (rizatriptan), Zomig (zolmitriptan), Amerge (naratriptan), and Axert (almotriptan). Frova (frovatriptan) has been approved by the FDA and should be available by the end of June, 2002. Relpax/Elitriptan is in the final stages of the FDA approval process.
  • Ergotamine Derivatives: Cafergot, D.H.E.45, Migranal Nasal Spray, Ergomar, Ergostat, Wigraine, Megral. These medications are dihydroergotamine, ergotamine, or ergotamine compounds that may also contain caffeine and pain relievers.
  • Midrin: A compound containing Isometheptene, Dichloralphenazone, and Acetaminophen. Also produced under the names Duradin, Migquin, Amidrine, Migrend, Migrazoen, and others. Midrin is also sometimes prescribed for tension-type headaches.

In addition to preventive and abortive medications, pain medications and antinausea medications may be prescribed. Complementary therapies, including acupuncture, aromatherapy and biofeedback, may be recommended.

Posted: June 2002

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