New guidelines offer drug, herbal options for preventing migraine

The 35 million Americans with migraine know all too well the signs and symptoms of this debilitating condition. For the rest of you, here’s a good description by horror author Steven King, himself a migraineur, in his novel Firestarter:

“The headache would get worse until it was a smashing weight, sending red pain through his head and neck with every pulse beat. Bright lights would make his eyes water helplessly and send darts of agony into the flesh just behind his eyes. Small noises magnified, ordinary noises insupportable. The headache would worsen until it felt as if his head were being crushed inside an inquisitor’s lovecap…. He would be next to helpless.”

Migraine was once largely unpreventable and untreatable. Today there are dozens of prescription and over-the-counter medications, and even a few herbal preparations, proven to prevent migraine. Unfortunately, only about one-third of people who could benefit from a preventive therapy take one. New guidelines from the American Academy of Neurology and the American Headache Society highlight effective treatments, which should make choosing a medications easier and safer for migraine sufferers. The guidelines were published in today’s issue of the journal Neurology.

Choosing an anti-migraine medicine

Whether to take something every day to prevent migraine is a personal choice. When deciding this with your doctor, consider the following:

• The number of migraines you have each month
• The severity of your migraines—do they routinely keep you from work or school?
• Whether your migraines stop quickly if you take a medicine immediately after an aura or headache begins.

A good place to start might be with a daily herbal or over-the-counter product. According to the new guidelines, there’s good evidence that an extract of the butterbur plant is effective at preventing migraine. Other simple preventives include ibuprofen (Motrin, Advil, generic versions), naproxen (Aleve, generic versions), riboflavin (vitamin B₂), and an extract of feverfew known as MIG-99.

When it comes to prescription medicines, the guidelines recommended these as being supported by the most solid evidence for preventing migraine

•   anti-seizure medicines, specifically divalproex sodium (Depakote), sodium valproate, and topiramate (Topamax)

•   beta blockers, specifically propranolol (Inderal, generic versions), metoprolol (Lopressor, generic versions), and timolol

•   frovatriptan (Frova) for perimenstrual migraine

There is no definite first choice for any of the above. Your choice should depend upon whether you have another condition that might also be helped with the same medicine. For example, someone with arthritis and migraines might start with daily naproxen.

Be patient if the first or even second one you and your doctor choose doesn’t help. The guidelines list even more medicines that might be right for you.

Prevention important for many

Several medications are available that can stop a migraine in its tracks, or at least blunt its course. But these don’t work for many migraineurs. For them, prevention is key to avoiding novelist Joan Didion’s compelling description of her migraines in the essay “In Bed”:

“Migraine gives some people mild hallucinations, temporarily blinds others, shows up not only as a headache but as a gastrointestinal disturbance, a painful sensitivity to all sensory stimuli, an abrupt overpowering fatigue, a strokelike aphasia, and a crippling inability to make even the most routine connections. When I am in a migraine aura (for some people the aura lasts fifteen minutes, for others several hours), I will drive through red lights, lose the house keys, spill whatever I am holding, lose the ability to focus my eyes or frame coherent sentences, and generally give the appearance of being on drugs, or drunk. The actual headache, when it comes, brings with it chills, sweating, nausea, a debility that seems to stretch the very limits of endurance. That no one dies of migraine seems, to someone deep into an attack, an ambiguous blessing.”