How to effectively manage frequent migraine episodes?

Question

Hello doctor,

I am a 29-year-old, and my life is being destroyed by migraines. I am experiencing them three to four times a week now, with intense pain that starts at my temples and radiates to the back of my skull. It is so bad that I can hardly look at my computer screen without feeling like my head is going to explode. The nausea is severe, and I have thrown up in my office bathroom twice this month. I have identified chocolate and lack of sleep as triggers, but avoiding them has not helped much. My productivity at work has dropped significantly, and I am terrified of losing my job. I have tried Sumatriptan, but it makes my chest feel tight and uncomfortable. The pain is usually worse on my right side, and sometimes I experience strange numbness in my face.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your symptoms are typical of migraine with aura, but to rule out other potential conditions, a magnetic resonance imaging (MRI) scan of the brain and skull (possibly with contrast) should be done. Other conditions to consider include trigeminal neuralgia, stroke mimic, and hemiplegic migraine. Given the high frequency of your attacks, you need preventive treatment.

I recommend starting with Topiramate 25 milligrams once daily, along with Propranolol (Inderal) 10 milligrams twice a day for at least 6 weeks.

For acute pain relief, try Naproxen sodium 550 milligrams as needed, or Lasmiditan 50 milligrams or 100 milligrams as needed.

To help reduce attacks, avoid triggers by making slight adjustments to your work habits:

Reduce screen time.
Take regular breaks during work.
Use anti-glare glasses.
Stay hydrated.
Additionally, you can consider B2 (Riboflavin) supplements, 400 mg per day.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.