Long-term Effects of Migraine

Q: Are there long-term physical side effects of migraine? Could it possibly lead to brain damage?
A: There is no evidence to suggest that having migraine causes any damage to the brain. There may be a very small increased risk of stroke for people who have migraine with aura . The exact reason for this increased risk is unknown, but it may be related to a congenital heart defect called patent foramen ovale. The risk of stroke does increase if a woman with migraine with aura is a smoker or is taking combined hormonal contraceptives.
Q: Are there long-term psychological and social effects of migraine?
A: Left untreated, migraine causes significant suffering and disability. Poorly controlled migraine is associated with higher levels of unemployment and an increased risk of depression. Although our understanding of migraine has improved in recent years, little is known about the extent to which this chronic illness affects people’s lives.
Q: Will my migraine get worse if it isn’t treated?
A: Yes, a progression of the condition is a very possible long-term effect of untreated migraine. For many years doctors involved in the treatment of headache patients have observed how some individuals experience more migraine attacks over time. As the attacks become more frequent they become more severe and last longer. For those who are given analgesics, their frequent migraine attacks quickly turn into chronic daily headache due to medication overuse.
Q: I have developed chronic daily headache. What are my prospects for improvement?
A: With appropriate treatment, your headaches should decrease and you will revert back to intermittent migraine attacks that can be controlled with abortive therapy. I call this “neuroverting.” As cardiac patients with heart rhythm problems are cardioverted with medication or by shocking the heart, headache patients can be “neuroverted” out of a chronic daily headache pattern with migraine treatment.
Q: How can I prevent progression of my migraine?
A: You can prevent progression of your migraine by preventing migraine attacks. The longer you have migraine, the more likely it is to progress. It is important that your preventive therapy is effective. You need to reduce headache days to 2 a month or less; if you haven’t achieved this you need to try another preventive medication or a combination of preventive medications.
Q: Are there risk factors for disease progression in migraine?
A: Studies have shown that risk factors for migraine progression include: obesity, medication overuse headaches, and post-traumatic headaches. Aggressive treatment of these conditions will lessen the risk by decreasing the number of headaches. I believe excessive intake of carbohydrates triggers frequent migraine attacks that subsequently causes chronic migraine. Obesity and chronic migraine have a common link: excessive carbohydrates. If you decrease your carbohydrate intake you may notice a decrease in the frequency of your migraine attacks before weight loss.
Q: What do I do if my current medical treatment is not working?
A: If you are having trouble controlling your attacks, you may need to see a specialist. There are many headache treatment centers in the US. 

Long-term Effects of Medication

Q: Are there any long-term effects from taking the medications used to treat migraine?
A: No long-term effects have been reported on the use of triptans. This class of drugs, used in abortive therapy, has been on the market in Europe since 1990 and on the US market since 1992. The nonsteroidal anti-inflammatory drugs (NSAIDs) may cause stomach ulcers, gastrointestinal bleeding, and kidney disease if used in excess for long periods. Analgesics can cause medication overuse headache and drug addiction if used daily.
Q: Does this mean it is OK to take triptans every day?
A: Not exactly. Triptans or other abortive medications (such as NSAIDs) shouldn’t be used daily. Although triptans do not seem to cause long-term effects, the overuse of any abortive medications could cause medication overuse headache. In addition, overuse can make medications less effective. Abortive therapy is a very important part of migraine treatment but it cannot be your only treatment. You must also have a preventive treatment program in place. If you are using abortive therapy more than 2 days a week then preventive medication is needed.
Q: How many times in a day can I use abortive therapy?
A: Since abortive therapy needs to be effective it shouldn’t be required more than twice a day. You should ideally need it no more than once within a 24-hour period. If your migraine attack isn’t aborted within 2 hours or less and you experience relapses within the following 24 hours, then you need to change your treatment.
Q: I have been using analgesics for years for my daily headaches. How can I find help?
A: If you have used analgesics regularly for years, you will have developed medication overuse headache, which causes chronic daily headache. These conditions can be treated, but this is not easily done. You will need the expertise of a headache clinic and will need to make your treatment a priority in the same way as, say, a cancer patient does. You must become a headache survivor.
Q: Are there any long-term effects from taking medications for migraine prevention?
A: Most medications used to prevent migraine have been on the market for years. The newest preventive medication, topirimate, has been on the market since 1997. Although every drug used to prevent migraine can have side effects, there have been no reported long-term effects yet.
Q: I do not want to take medications long-term. Will there come a time when I do not need preventive medications?
A: When you have been able to decrease the frequency of your migraine attacks to less than twice a month for more than 8 months, you can try to slowly do away with preventive medications. You will need to work hard to maintain your dietary restrictions, follow your exercise and relaxation programs, and reduce stress if you are going to be successful at stopping your preventive medication.
Q: What is the best way to stop my preventive medications?
A: When you and your doctor have made a decision that your migraine is controlled enough to stop preventive medications, you need to stop the medications very slowly. If you are taking several medications, you should stop one at a time. As you decrease the dose of your daily medication every 3–4 weeks, you need to track your migraine frequency very closely. If the attacks begin to increase in frequency, you must increase the dose of your medication by a small amount. Regain migraine control for at least 4 months before you try again to lower the dose.
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