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Migraine is Not Just a Bad Headache

“There is no condition of such magnitude – yet so shrouded in myth, misinformation, and mistreatment – as migraine.”

Joel R. Saper, MD, Chair, Migraine Research Foundation Medical Advisory Board

Migraine is an extremely debilitating collection of neurological symptoms with severe recurring intense throbbing pain on one side of the head, although in about 1/3 of attacks, both sides are affected.
Attacks are often accompanied by one or more of the following: visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound, light, touch and smell, and tingling or numbness in the extremities or face.
In 15-20% of attacks, other neurological symptoms occur before the actual head pain.
Attacks usually last between 4 and 72 hours.

Migraine remains a poorly understood condition that is frequently undertreated. Migraine affects nearly 1 in 4 U.S. households and the majority of migraine sufferers do not seek medical care for their pain. Nearly half of all migraine sufferers are never diagnosed. Even with the correct diagnosis, treating migraine can be very challenging. Combinations of various medications and other modalities are often the most effective therapy.

Our compounding professionals will work together with patients and their health care providers to customize the most appropriate medication for each individual.

Researchers previously believed that dilation and constriction of blood vessels in the head were the primary source of migraine pain, and this was the focus of early medical therapy. Researchers now believe that migraine is a disorder involving nerve pathways and neurotransmitters.

Estrogen adversely influences the brain receptors that play a role in migraine development. About half of affected women have more than one attack each month, and a quarter experience 4 or more severe attacks per month. More severe and more frequent attacks often result from fluctuations in estrogen levels. 10-14% of American women get menstrual migraine. The vast majority of these women also have migraine at other times of the month. Menstrual migraine is an attack that occurs up to 2 days before and up to 3 days after menstrual onset. It is usually more severe and harder to control than other types of migraine.

Migraine triggers include alteration of sleep-wake cycle; missing or delaying a meal; medications that cause vasodilation; medication overuse (which contributes to the progression from episodic migraine to chronic migraine); bright lights, sunlight, fluorescent lights, TV and movie viewing; certain foods; and excessive noise. Stress and/or underlying depression are important trigger factors that can be diagnosed and treated adequately.

Approximately one-fifth of migraine sufferers experience aura, the warning associated with migraine, prior to the headache pain. Visual disturbances such as wavy lines, dots or flashing lights and blind spots begin from twenty minutes to one hour before the actual onset of migraine. Some people will have tingling in their arm or face or difficulty speaking. Aura was once thought to be caused by constriction of small arteries supplying specific areas of the brain. Now we know that aura is due to transient changes in the activity of specific nerve cells.

If patients have frequent migraine attacks and do not respond consistently to migraine specific acute treatments, or if specific migraine medications are ineffective or contraindicated because of other medical problems, then preventive medications should be taken to reduce migraine frequency and improve response to acute therapy.

Management of migraine involves elimination of triggers, preventive (prophylactic) therapy, and pharmacologic or complementary therapy that should begin at the first sign or symptom of a migraine. For optimal therapy, the following factors must be considered:

  • Severity of the migraine
  • Side effects
  • Efficacy
  • Most appropriate route of administration (For example, oral meds would not be best for someone with symptoms of nausea and vomiting; sublingual and nasal preparations have a faster onset than oral meds.)

The goal of acute therapy is to stop or reduce the pain and other symptoms associated with the migraine while minimizing adverse drug effects and ultimately restoring the patient’s ability to function normally. Compounded medications and nutritional supplements such riboflavin, coenzyme Q10, cyanocobalamin, folate, and pyridoxine may help to prevent or improve migraine with minimal side effects.

Ask us for more information about therapies for migraine. Our compounding pharmacy can customize medications and also has many unique delivery systems that can enhance patient compliance.

References Accessed 4/24/13
Int’l J of Pharm. Compounding. July/Aug 2012; 16(4):270-4
Int’l J of Pharm. Compounding. Sep/Oct 2006; 10(5):344-350
Pharmacotherapy: A Pathophysiologic Approach. 5th ed. McGraw-Hill; 2002:1119-1135. Accessed 4/24/13 _treating_a_migraine_attack_000097_7.htm#ixzz2RQaHKVsc
Cephalalgia 1994 Oct:14(5):317
Neurology March 1997; 48:A86-A87
Continuum (Minneap Minn). 2012 Aug;18(4):796-806.
Vitam Horm. 2004;69:297-312.
Headache. 2012 Oct;52 Suppl 2:81-7.
J Assoc Physicians India. 2011 Aug;59:494-7.

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