{"id":1658,"date":"2023-06-10T19:39:53","date_gmt":"2023-06-10T19:39:53","guid":{"rendered":"https:\/\/dorsethead.uk\/?page_id=1658"},"modified":"2025-05-21T12:27:17","modified_gmt":"2025-05-21T12:27:17","slug":"migraine-treatment","status":"publish","type":"page","link":"https:\/\/dorsethead.uk\/index.php\/home\/migraine-treatment\/","title":{"rendered":"Migraine Treatment"},"content":{"rendered":"\t\t
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Lifestyle modifications<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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More information about lifestyle factors can be found on the Migraine Trust website<\/a>.<\/p>

Sleep<\/b>\u00a0in sufficient quantity is important for all headaches. Migraine can also be brought on by sleeping too much, e.g. on weekends. Insomnia should be managed by behavioural change rather than by medication, amitriptyline can however be helpful as an addition.<\/p>

Diet <\/b>can affect headaches, primarily as skipping meals can bring on a headache. Some patients with migraine have specific triggers such as citrus or cheese but they are usually well aware of this and there’s not need to go on an extreme diet.<\/p>

Drinking<\/b>\u00a0too much alcohol brings on a headache. In particular, red wine is often a trigger for migraine. Caffeinated drinks can help relieve a headache in the short term but then cause a rebound headache, similar to medication overuse headaches, and it’s therefore often best to avoid caffeine especially in the evenings.\u00a0<\/p>

Smoking <\/b>can make all headaches worse. When patients with cluster headache smokes, this will prevent them from having oxygen treatment.<\/p>

Exercise<\/b>\u00a0can improve headaches. We recommend exercise intense enough to cause shortness of breath at least a couple of times a week, and also regular relaxation exercises such as yoga \/ tai chi to prevent muscle tension can also be helpful.<\/p>

Mindfulness <\/b>has been shown to be helpful in all types of chronic pain.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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Rescue medication<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Pain killers are sufficient treatment for most persons with headache. It’s important not to use pain killers too often, but it’s also important to use pain killers early enough and in high enough doses when needed. If one treatment hasn’t worked on 2-3 occasions, try another combination or increase the dose. The goal is to become pain free within an hour.<\/p>\n

Paracetamol <\/b>is typically only helpful for mild headaches.<\/p>\n

NSAID <\/b>are usually helpful for headaches. Ibuprofen up to 600mg, Naproxen up to 500mg, and Aspirin up to 900mg is often needed for migraine. Naproxen is more long-lasting than ibuprofen, and Aspirin might be more effective for migraines than the other two. These medications can cause stomach ulcer. Most persons with asthma can use them.<\/p>\n

Triptans <\/span>are the most effective pain killers for migraine. Start with sumatriptan 50mg. If not effective, combine with NSAID or try 100mg next time. If still not effective, try another triptan. There are four triptans on the Dorset formulary: sumatriptan, zolmitriptan, rizatriptan, frovatriptan. The first three are similar but frovatriptan has slower onset and longer duration. Sumatriptan and Zolmitriptan exist as nasal spray which is useful if the headaches are quick onset or come with severe nausea – in these cases sumatriptan injection is also an option. On the BNF, there are also naratriptan, eletriptan, and almotriptan.<\/b><\/p>\n

Rimegepant <\/b>is an alternative for patients who cannot take triptans, or where two triptans have tried and are ineffective. It has slow onset, but the effect lasts up to two days.<\/p>\n

Anti-nausea medication<\/b> reduce nausea and can also improve the uptake of the pain killers. Three options commonly used in migraine are prochlorperazine, domperidone, and metoclopramide. They can all cause tiredness. Domperidone can also cause arrhythmia. Metoclopramide, and to a lesser extent prochlorperazine, can cause neurological side effects.<\/p>\n

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More about Triptans<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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How many?<\/div>\n\t\t\t\t\t\t\t\t\t
Interactions?<\/div>\n\t\t\t\t\t\t\t\t\t
Pregnancy?<\/div>\n\t\t\t\t\t\t\t\t\t
Vascular disease?<\/div>\n\t\t\t\t\t\t\t\t\t
Old age?<\/div>\n\t\t\t\t\t\t\t\t\t
Hemiplegic migraine?<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t
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How many?<\/div>\n\t\t\t\t\t