From the Guidelines
Migraine management guidelines recommend a comprehensive approach including both acute and preventive treatments, with a focus on lifestyle modifications, trigger avoidance, and pharmacologic interventions as needed. When managing migraines, it is essential to take a detailed history and make a specific headache diagnosis [ 1 ]. The guidelines suggest advising patients and families on lifestyle factors, migraine triggers, and avoidance of acute medication overuse [ 1 ]. For acute treatment, ibuprofen is recommended to treat pain in children and adolescents, while adolescents may also consider sumatriptan, naproxen oral, zolmitriptan nasal, sumatriptan nasal, rizatriptan ODT, or almotriptan oral [ 1 ]. Some key points to consider in migraine management include:
- Counseling patients to treat acute migraine early in the attack [ 1 ]
- Trying another triptan or a non-steroidal anti-inflammatory drug-triptan combination if one triptan is ineffective [ 1 ]
- Using a non-oral triptan if headache pain spikes quickly or if nausea/vomiting occurs [ 1 ]
- Considering preventive treatments in children/adolescents with frequent or disabling headaches or medication overuse [ 1 ]
- Discussing the evidence for and side effects of amitriptyline combined with cognitive behavioral therapy, topiramate, and propranolol for migraine prevention [ 1 ]. It is crucial to discuss the potential teratogenic effects of topiramate and valproate with patients and advise them to use effective birth control methods and take folate [ 1 ]. Overall, a comprehensive approach to migraine management, including lifestyle modifications, trigger avoidance, and pharmacologic interventions as needed, can help improve quality of life and reduce morbidity and mortality associated with migraines.
From the FDA Drug Label
to prevent headaches in adults with chronic migraine who have 15 or more days each month with headache lasting 4 or more hours each day.
Guidelines for Migraine Management:
- OnabotulinumtoxinA (BOTOX) is used to prevent headaches in adults with chronic migraine who have 15 or more days each month with headache lasting 4 or more hours each day.
- The use of BOTOX for episodic migraine (14 or fewer headache days each month) is not established 2.
From the Research
Migraine Management Guidelines
The guidelines for migraine management involve a combination of pharmacological and non-pharmacological approaches.
- Non-pharmacological recommendations include identifying and managing triggers such as environmental factors, sleep pattern changes, diet, physical activity, stress and anxiety, some medications, and hormonal changes 3.
- Patients should learn skills to cope with trigger factors that are difficult to avoid, and weight control, management of migraine comorbidities, lifestyle modification, behavioral treatment, and biofeedback are recommended as part of migraine management 3.
- The use of neuromodulation techniques, dietary supplements such as riboflavin, coenzyme Q10, and magnesium, and acupuncture can also be helpful 3.
Pharmacological Options
Pharmacological options for the treatment of chronic migraine pain include:
- Anticonvulsants
- Antidepressants
- Beta blockers
- Calcium channel blockers
- Botulinum toxins
- NSAIDs
- Riboflavin
- Magnesium 4
- Patients may also benefit from adjunct non-pharmacological options, such as cognitive behavior therapy, relaxation therapies, biofeedback, lifestyle guidance, and education 4.
Treatment Strategies
Treatment strategies for migraine include:
- Stratified care, which provides significantly better clinical outcomes than step care strategies within or across attacks, as measured by headache response and disability time 5.
- Step care, which involves escalating treatment after first-line medications fail 5.
- Taking medication early in an attack and using a stratified treatment approach can help ensure that migraine treatment is cost-effective 6.
Lifestyle Modifications
Lifestyle modifications play a crucial role in migraine management, including:
- Physical activity
- Management of obesity
- A healthy diet
- Adequate sleep
- Avoidance of drug abuse
- These factors can significantly contribute to reducing the frequency and severity of attacks 7.