Answer #2 - When we see patients with migraine headaches, first of all the most important thing with migraine is to make the diagnosis. There are many patients that come to their physicians and if the migraine isn’t properly diagnosed they are not treated properly and that’s the key to migraine. The key is to make a proper diagnosis. Once patients are diagnosed with migraine, then hopefully treatment is more accurate. The first step to treating migraine is diagnosis, after that we have to assess lifestyle and the thing about lifestyle is that we have to determine what triggers migraines.

It’s the ABCs of migraines. We have to determine whether patients are doing something in their life to trigger these migraines, we have to deal with triggers of migraine we have to look at patient lifestyles, we have to look at things like sleep patterns, regularity of diet, whether they are smoking, whether there is exercise that we can introduce into their lifestyle. If patients are working shifts for example, shift workers may be more prone to migraines because of irregularity of sleep cycles for example. So we therefore ask patients to keep diaries. That’s the first step to migraine treatment. Once we have addressed these issues, then we deal with pharmacological or medical and medication treatment. You are absolutely right, there are acute therapies or what we call abortive therapies and then there are preventative therapies or prophylactic therapies. The acute therapies are dealt with when patients for example have headaches that occur perhaps 2-3 times a month. And these headaches can be dealt with quite easily with abortive or acute therapies. These are simply medications that the patients will take when the headaches occur.

So if they have a headache that occurs once, twice, three times a month as soon as they feel these headaches coming on, they take these acute therapies and hopefully their headaches will resolve. Now with acute therapies, these medications can be taken immediately at the onset of a headache; we know the medications work better that way. If the medications are taken too late, they tend to work less effectively. There have been studies done that show us that there are definite advantages for treating the headache early. The patients get back to a normal functioning much earlier, the headaches resolve much earlier, they have less need for re-dosing, and the headaches tend not to come back if they treat their headaches earlier.

That’s acute therapy and there are many different types of acute therapies. For example, there are over the counter medications that they can use if their headaches are mild to moderate. Things like ibuprofen, Tylenol for example, Aspirin can be very affective in the mild migraine. When the migraine is more severe, for example if it’s moderate to severe, then we get to more specific migraine medication. Things like the Triptan medications such as Amerge, Axert, Imitrex, Zomig, Relpax, Maxalt; these are all medications that have come out in the last 15 years that we refer to as migraine specific medications and we reserve those for headache patients that have moderate to severe migraines.

If a patient comes back and their headaches are occurring more than three times a month, or if their headaches have not responded very well to acute therapy, or if for example they cannot take acute therapy for reasons such as high blood pressure that is not controlled or if they have heart disease and they cannot take these acute therapies, we then consider the preventative medications or the prophylactic medications. And these are medications that a patient will take every day in hopes of reducing their headache frequency, and intensity. Very often we will combine preventative medications with acute medication therapies.