Treatment

There is no cure for migraine, and the purpose of its treatment is to reduce or terminate headache attacks, relieve accompanying symptoms, and prevent headache recurrence. Treatment measures include drug therapy and non-drug therapy. Drug treatment is divided into attack treatment and preventive treatment. Non-drug treatment is mainly to strengthen publicity and education, help patients establish scientific and correct prevention concepts and goals, maintain a healthy lifestyle, find and avoid various migraine triggers; non-drug intervention methods include acupuncture, massage, physical therapy, biofeedback therapy, Cognitive Behavioral Therapy etc.

Medical treatment

Due to large individual differences, there is no absolute best, fastest, or most effective medication. Except for commonly used over-the-counter drugs, you should choose the most appropriate drug based on your personal situation under the guidance of a doctor.

Clinical treatment of migraines usually involves taking medication as soon as symptoms begin. Treatment includes nonspecific analgesics (eg, NSAIDs, opioids) and specific drugs (eg, ergots, triptans). Drug selection should be based on comprehensive consideration of headache severity, accompanying symptoms, and previous medications, and individualized treatment should be carried out.

Mild to moderate headache

Single use of non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, naproxen, ibuprofen, diclofenac, etc. is effective;

Opioids such as meperidine are also effective for acute migraine attacks, but their routine use is not recommended due to their addictive properties;

For cases where ergot preparations or triptans are contraindicated, such as heart disease, peripheral vascular disease or migraine during pregnancy, pethidine can be given to terminate the acute attack of migraine.

Moderate to severe headache

For severe attacks, migraine-specific therapeutic drugs can be directly used to improve symptoms as soon as possible. Although some patients have severe headaches but have responded well to NSAIDs in previous attacks, NSAIDs can still be used.

Ergot preparations are suitable for patients with long-lasting attacks, and compound preparations such as ergotamine-caffeine mixture can treat some moderate-severe migraine attacks.

Note: Adverse reactions of ergots and triptans include nausea, vomiting, palpitations, irritability, anxiety, and peripheral vasoconstriction. Long-term use of large amounts can cause high blood pressure and ischemic necrosis of limbs. Because of its strong vasoconstriction, it is contraindicated in patients with severe hypertension, heart disease and pregnant women. In addition, frequent use of ergots and triptans can cause overdose headaches, so it is recommended not to exceed 2 to 3 days per week.

Concomitant symptomatic treatment

Nausea and vomiting must be combined with antiemetics (such as metoclopramide 10 mg intramuscular injection), and severe vomiting can be given a small dose of chlorpromazine. Benzodiazepines may be given to sedation and sleep in patients with irritability.