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Home remedies are huge and all-encompassing. It is anything from just putting ice on the back of your head or the area that may hurt during a migraine attack to some of the herbal remedies that are actually recommended by American Headache Society. Those herbal remedies include things you may have heard about or read about. Those include Magnesium, Vitamin B2 (which is also called Riboflavin), Coenzyme Q10, Feverfew (which coincidentally was not found to be effective, but everybody asks me about it), Butterbur Root - a whole variety of them. I have a very specific handout that I give patients if they're interested in herbal remedies and the specific dosing and everything recommended by American Headache Society.
Home remedies are huge and all-encompassing. It is anything from just putting ice on the back of your head or the area that may hurt during a migraine attack to some of the herbal remedies that are actually recommended by American Headache Society. Those herbal remedies include things you may have heard about or read about. Those include Magnesium, Vitamin B2 (which is also called Riboflavin), Coenzyme Q10, Feverfew (which coincidentally was not found to be effective, but everybody asks me about it), Butterbur Root - a whole variety of them. I have a very specific handout that I give patients if they're interested in herbal remedies and the specific dosing and everything recommended by American Headache Society.
For patients who have migraines fairly often (let's say: once a week - often in our field, we'll look at whether or not they have 4 days a month of significant migraines that really impact the quality of their life) then for these patients, they're smarter to get on medicines that prevent the migraine as opposed to using the medicines to treat it once it's happened - to what we call abort the migraine or abortive medicine. Primary care doctors, neurologists, pain doctors - lots of doctors can help patients find medicines that might prevent the migraine. There's a variety of medicines that are used for this. One of the nice things about preventing the migraines is that it doesn't trigger these rebound headaches that can occur with the short acting abortive medicines. For the rare headache (once a month, maybe twice a month) abortive medicines are okay, but when they're used frequently, they really have the problem of developing these rebound headaches - increased vulnerability to a headache as soon as the good effects have worn off. Included in this are Tylenol, Ibuprofen, Naproxen, Aleve, Fioricet, Fiorinal, the Triptan medicines, medicines like Imitrex, etc. There are many different medicines that are short acting for the purpose of aborting the pain of a headache, and if they're used very sporadically, they too can be good, but when they're used frequently, they increase the headache problem.
Abortive medications would be Triptans - these are the kind of gold standard. Things such as Imitrex, Maxalt, Zomig, there's 9 different Triptans on the market. Even if you failed one, it doesn't mean that you would fail or have a side effect to another and it may take a while to figure out which one is the best for you. Other options: maybe nonsteroidal antiinflammatories - things you have in the cabinet: Ibuprofen, Naproxen, aspirin, things of those nature. However, you have to be careful about those medications as they can cause a bounce-back or rebound headache if you use them too often. Most commonly, I see people prescribed Fioricet or Fiorinal (the generic name is Butalbital with other ingredients along the list.) You have to be very, very cautious with this medication because it has multiple medications in it. It's the most common medication that can cause a bounce-back or rebound headache. I'm not saying that patients are addicted or dependent on this medication, but the brain gets used to having those chemicals and it can actually make the headache worse long term. Actually, so can Excedrin. Other options for treatment include physical therapy, which can be sometimes beneficial - it kind of depends on the patient and where their pain is at. I get often asked about manipulation or chiropractic treatment, which is fine, except that we don't like fast manipulation of the neck (so only gentle manipulation) and I'm very cautious about manipulation the neck whatsoever because it depends on arthritis and other conditions of the neck. I'm very cautious to ever recommend that. Fast manipulation of the neck can actually increase your risk of stroke. I also do some therapies here in the office, sometimes if you're having a very bad migraine just to try and break that headache cycle. Those can include a short burst of steroids that I may prescribe. Those may include coming into the office for an injection such as Toradol or an Imitrex injection or even a nausea medication. Those may also include coming in for nerve injections, so sometimes I'll actually give a shot in the various places that you're having pain and try and actually numb up that nerve temporarily.
One of the things that can help patients with headaches that is pretty gentle and natural is to use magnesium supplements. There are also a variety of herbal supplements - some of them are even combined with magnesium. These are reasonable things to try. Sometimes the doctors have tried the supplements, the medications and may have even tried putting the patient on a preventative medication, and we still find that they're struggling with severe headaches. In those situations, we need to go back and make sure we understand the diagnosis. Sometimes it's not just a simple migraine, but sometimes it may be a condition, for instance, called Occipital Neuralgia, where the nerve that comes from the neck up to the back of the head is being pressured or trapped by the muscles in the back of the neck. In those situations, injections sometimes make a big difference. Sometimes just abnormal tension in the muscles that surround the head, the neck, or the face are the triggers and injections, exercises, physical therapy to relax and recondition these muscles, again, can make a big difference.
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