Dr. Jacqueline Gerhart: Awful Migraines Can Be Managed

UW Health Family Medicine physician Dr. Jacqueline GerhartMadison, Wisconsin - UW Health Family Medicine physician Jacqueline Gerhart writes a column that appears Tuesdays on madison.com and in the Wisconsin State Journal. Columns are re-published here with permission.



Dear Dr. Gerhart: I've been using Excedrin for my migraines, but I get migraines at night, and I think the medicine has caffeine in it, which I think is making me stay up at night. Would I be better off just trying to sleep with the headache? I'm trying to avoid medications.


Dear Reader: Migraines can be awful and debilitating. The exact cause of migraines is unknown. One theory is that inflammation in the blood vessels of the brain causes swelling and pressure on the nerves of the brain, which then causes pain. Others believe genetics has a major role, with genes signaling the brain to act in different ways.


Regardless of the underlying cause, there are three main ways to manage migraines: decrease triggers, start either acute or chronic medications and use non-medication prevention and treatment strategies.


First, determine if your headache is indeed a migraine. Migraines tend to be one-sided (unilateral) and are often accompanied by nausea and sensitivity to light. Sometimes they start at the base of the neck and travel or radiate over the top of the head, then center behind one eye.


Often, people will have an aura, which is a change in vision, smell, taste, or the feeling of numbness or tingling just before the onset of the headache. This is to be distinguished from a tension headache, which often feels like a band around the entire forehead. Some people describe it as if their whole head is in a vice.


There also are cluster headaches, which tend to cause the eyes to form tears and happen at the same time each day. Finally, there are common headaches, which tend to involve the entire head with a dull ache that often goes away within hours.


Next, keep a diary of your headaches. Do they happen when work projects are due? When the weather changes? When you don't have your daily cup of coffee?


Often, migraine sufferers will find that stress, anxiety, weather changes, caffeine changes, alcohol use, change in sleep patterns, hormonal changes, medications and skipped meals can trigger migraines. The first step in managing migraines is identifying the triggers, and then minimizing these triggers as much as possible.


On your headache diary, list what you have tried and what works. Bring this to your health care provider to discuss a strategy plan that may or may not include medications.


For daily chronic headache management, we recommend decreasing your triggers. If you are a woman with migraines around her period, you could consider a birth control pill to control your hormone levels.


If you are in a high-stress deadline-driven job, you could work on dividing tasks into small parts, and working on them before deadlines. You can also try decreasing your stress with yoga, tai chi, herbal teas, massage, acupuncture, mind-body exercises, biofeedback and meditation. These tend to be best for long-term treatment, rather than treatment to abort an active headache.


For acute management of migraines, the first line is over-the-counter anti-inflammatories such as acetaminophen, ibuprofen and naproxen. Next would be meds like Excedrin, which is a combination of aspirin, acetaminophen and caffeine. As you mention, meds with caffeine in them shouldn't be used at night.


Some other headache therapies focus on improving nausea and inducing sleep. Supplements such as vitamin B2, magnesium, feverfew, CoEnzyme Q-10, and butterbur also may be beneficial.


Before trying the above strategies, speak with your physician to determine how to mix these different strategies for optimal results. Your physician may determine that you need a prescription-strength medication to augment your headache treatment plan, or that lifestyle changes alone may do the trick.


I hope you feel better!


This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Gerhart to people submitting questions.

Date Published: 05/22/2012

News tag(s):  jacqueline l gerhart

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