I have migraines. How to prevent its frequent episodes?

Question

Hello doctor,

I have migraine headaches. I am a 34-year-old woman who has been getting severe, throbbing headaches on one side of my head about three to four times per month that completely disable me for six to 24 hours.

The pain is accompanied by nausea, vomiting, and extreme sensitivity to light and sound. I have to lie in a dark, quiet room until it passes. Sometimes I see flashing lights or blind spots in my vision about 20 minutes before the headache starts, which my coworker says sounds like an aura.

These headaches are affecting my work performance and family life, and over-the-counter pain medications do not help. I think these might be migraines since my mother had similar headaches.

What preventive treatments are available to reduce the frequency and severity of these debilitating episodes?

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

From your description, these are very typical features of migraine with aura. The disabling one-sided throbbing pain, nausea or vomiting, light and sound sensitivity, and visual changes before the attack all fit well.

Since attacks are frequent (three to four per month) and severe enough to disturb work and family life, you would benefit from preventive therapy, not just painkillers.

Some migraine preventive options include:

Lifestyle changes such as maintaining regular sleep, meals, hydration, and exercise; avoiding known triggers (fasting, stress, certain foods, hormonal changes).
Supplements that can help you are magnesium, riboflavin (B2), or coenzyme Q10, which may help in some people.
Daily preventive medicines to take are Beta-blockers like Propranolol, antiepileptics such as Topiramate and valproate (though valproate is avoided in women of childbearing age), and antidepressants like Amitriptyline and Venlafaxine.
Newer targeted treatments include CGRP (calcitonin gene-related peptide) monoclonal antibodies (Erenumab, Fremanezumab, Galcanezumab), which are very effective for frequent, disabling migraines.
Botulinum toxin (Botox) injections are considered if headaches are chronic (more than 15 headache days per month).
For acute attacks, triptans like Sumatriptan or Rizatriptan are more effective than over-the-counter medicines.

These drugs can sometimes be combined with anti-nausea drugs to improve the efficacy of the medication.

I hope you find this response helpful.

For more queries, feel free to reach out to me anytime. I am here to help you.

Thank you.