Emergencies
| Q: |
Do I need to go to the emergency room when I have a severe attack?
| | A: |
Few people who have suffered severe migraine attacks will be able
to imagine anything much worse than going to a hospital’s emergency
department with a migraine. Waiting for hours to be seen in a noisy,
stressful environment, and then being given drugs that are only going to
make the migraine recur the next day is unlikely to offer much in the
way of relief. A much better option for very severe attacks is abortive
therapy using suppositories and injectable medications, which your
doctor can provide.
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| Q: |
How can suppositories and injectable medications keep me out of the emergency room?
| | A: |
Once a migraine attack progresses past the 2-hour point, gastric stasisand central sensitization make it very difficult to stop the attack. The quicker you get the
effective dose of medication, the more successful you will be in
aborting the attack. A rectal suppository or injection provides rapid
delivery of medication into the blood when a migraine attack is not
aborted with oral medication in the first 2 hours.
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| Q: |
Can I give myself an injection?
| | A: |
Of course you can; diabetic patients and women undergoing
fertility treatments are taught how to self-inject their medications.
You need to discuss the use of injectable medications for abortive
migraine treatment with your doctor. One of the triptans (sumatriptan)
is available in an autoinjector and is very helpful for severe migraine
attacks. The other injectable medications must be given by a traditional
injection, but if your doctor agrees, you can learn how to give
yourself your own “shot.”
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Complementary and Psychological Therapies
| Q: |
Are there complementary therapies for treatment of migraine attacks?
| | A: |
Yes. Many complementary therapies (such as relaxation techniques
or massage), if initiated early in a mild attack, can defer the use of
medication. It is important for many reasons to reduce the use of
abortive medications, but if you delay treatment too long, more
medication will be needed. In addition, the longer you have a migraine
attack the more attacks you will have. If you want to cut back on the
use of medication, you will need to treat attacks early and use
nonmedication treatments to prevent attacks.
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| Q: |
Is it true that the herb called feverfew can help with migraine?
| | A: |
Yes, feverfew can abort an attack .
It is a herbal supplement with the same properties as nonsteroidal
anti-inflammatory drugs (NSAIDs). As with NSAIDs, avoid feverfew if you
have a stomach ulcer or gastrointestinal problems. Feverfew should not
be used in combination with NSAIDs since this could have a cumulative
effect.
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| Q: |
How does my migraine prevention help me abort an attack?
| | A: |
The prevention of migraine attacks reduces the severity and
duration of individual attacks as well as their frequency. When migraine
attacks are less severe, they are easier to stop with abortive therapy.
Maintaining an aggressive migraine prevention program with daily
exercise and relaxation, stress management, and dietary restrictions can
reduce the severity and frequency of attacks to the point where they
can be aborted without medication.
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| Q: |
How do I know when alternative abortive therapy is not working and I need medication?
| | A: |
This is a very important question. The answer is time. You can
try complementary therapy for the migraine attack, but if you get no
relief within 20 minutes you must proceed with medication. The longer
you wait, the more difficult it will become to stop the attack. A
migraine attack is caused by disturbances in brain function that
progress over time. When medication is taken early in this process you
are more likely to become pain-free within 2 hours. The longer a
migraine attack continues past the 2-hour mark, the more likely you are
to have another attack.
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| Q: |
Can biofeedback training and relaxation techniques help prevent a migraine attack?
| | A: |
Yes, biofeedback, relaxation techniques, and even hypnosis can
help prevent migraine attacks and, for some people, abort individual
attacks. These techniques cause the release of natural painkillers
called endorphins that relieve the headache and relax tense muscles. The
goal of all relaxation techniques is to help you relax all your tense
muscles. Once you learn some of these techniques, you can use them as
part of abortive migraine attack therapy.
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| Q: |
Will acupuncture help with my migraine attacks?
| | A: |
Acupuncture can be very helpful for both migraine prevention and
relieving the muscle tension associated with an acute attack. Although
it is not well understood how acupuncture works, it is thought to cause
the release of natural painkillers called endorphins. Acupuncture is
probably most effective when it is used as part of a comprehensive
treatment approach. Indeed, this could be said about all treatment
approaches: the most successful treatment programs are comprehensive,
bringing the best parts of each treatment approach together to help you
successfully treat your migraine.
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| Q: |
How can psychological therapies help with a migraine attack?
| | A: |
The middle of a migraine attack is probably not the best time to
dive into deep-seated emotional or mental problems—but there is much
more to psychology than this. Techniques such as cognitive-behavioral
therapy (CBT) offer practical ways to avoid anxiety and break free from
negative patterns of thinking. The professionals available to help us
with our psychological, social, and/or spiritual health have a wealth of
knowledge and are trained in techniques that can reduce stress and
increase relaxation, and therefore help abort a migraine attack.
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| Q: |
How does the way I think prevent me from aborting a migraine attack?
| | A: |
Irritability and anxiety are biological symptoms of a migraine
attack. Once the attack begins, anxious thoughts can escalate the
migraine by causing excitation of the biological stress response system.
For many people with migraine, the thought of another attack can be
quite fearful. The possibility that the migraine attack will disrupt
your day or, worse, bring your day to a halt is very frustrating. The
more frustration you feel, the more you fuel the attack. Searching out
professional help to learn coping strategies can reduce the anxiety and
frustration that is associated with a migraine attack.
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| Q: |
How can I reduce the muscle tension caused by the migraine attacks?
| | A: |
Nonpharmacological methods of treating migraine attacks become
important when the frequency of attacks increases. These methods include
the use of TENS units, heat or cold application, and relaxation
techniques. TENS units are medical devices applied to the skin that
deliver stimulating impulses to muscles, causing tense muscles to relax.
People who have significant muscle tension with their migraine may
benefit from massage therapy and/or physical therapy.
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| Q: |
Will I need to seek the help of a professional to reduce the muscle tension?
| | A: |
If you experience significant muscle tension with your migraine
attacks, you will need the help of an appropriate professional. Dental
splints may help those who have facial muscle tightness. There is a
significant overlap between people who have migraine and those with
temporomandibular joint dysfunction (misalignment of the jaw bones,
causing face pain). An ergonomic analysis of your work-related posture
and movements might help alleviate the muscle tension associated with
attacks. Discussion with a physical therapist regarding your work
setting and activities may help you to identify mechanical triggers for
attacks and factors that aggravate attacks.
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| Q: |
Can rubbing a cream or ointment directly on the forehead work to stop a headache?
| | A: |
The application of herbal or nonpharmacological creams or
ointments may or may not help a migraine attack. Before using them you
should ask your doctor whether they can be absorbed through your skin
and thus possibly cause a drug interaction with your other medications.
If you find that rubbing a cream or ointment on your forehead helps
abort your migraine and you feel it is worth the money, then there is no
reason not to use it.
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| Q: |
Can chiropractic or osteopathic treatment abort a migraine attack?
| | A: |
Yes. The techniques used by chiropractors or osteopaths can
sometimes be particularly useful when your migraine has progressed for
hours or days and developed into central sensitization,
and you are experiencing neck pain and muscle tension. This type of
manipulative therapy can be effective in relieving neck pain and muscle
tension. However, you should be evaluated by your doctor for neck
problems that could be made worse by such techniques before you start
this type of treatment program.
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