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.
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.
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.”

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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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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