Migraine prophylaxis, or migraine prevention, may aid in the reduction or avoidance of migraine attacks. Medication, integrative therapies such as acupuncture and behavioral therapy, or a combination of the two may be used in prophylaxis.
Migraine prophylaxis may help to minimize the frequency and severity of migraine headaches, as well as enhance the overall quality of life. There is evidence that there are effective migraine prevention strategies.
There are a variety of drugs as well as integrative treatments available that may be beneficial.
The varieties of migraine drugs, integrative therapy alternatives, and the outlook for migraine prevention are discussed in this article.
Prophylaxis
According to a 2019 report in American Family Physician, prophylactic drugs would benefit 38 percent of people with episodic migraine headaches, yet only 13 percent use them.
According to the article, prophylaxis can help with:
- reduce migraine attack frequency and severity
- reduce related distress
- improve quality of life
- prevent conversion to chronic migraine
People with the following conditions may benefit from prophylaxis:
- four or more migraine headaches each month
- debilitating migraine headaches
- medication-overuse headaches
- hemiplegic migraine
- basilar migraine
- migraine with prolonged aura
- fatigue
- nausea
- dizziness
- reduced tolerance for exercise
- depression
If someone has an underlying heart condition, they may consider taking other beta-blockers such as:
- timolol
- atenolol
- metoprolol
Beta-blockers may not be suitable for people with the following conditions:
- severe asthma
- peripheral vascular disease
- severe bradycardia
- heart blocks
Anticonvulsants
First-line medications for migraine prevention include the following anticonvulsants:
- divalproex (Depakote)
- sodium valproate
- topiramate (Topamax)
Common side effects of Depakote and sodium valproate include:
- nausea
- drowsiness
- hair loss
- tremors
- raised ammonia levels
Depakote with sodium valproate may be particularly beneficial in the treatment of unusual and chronic migraine headaches. People with serious liver illness or pancreatitis should avoid them. Furthermore, Topamax and sodium valproate should not be used during pregnancy.
For migraine prevention, topamax is just as effective as propranolol. People should begin with 25 mg twice a day and work their way up to 100 mg twice a day. It can take 2–3 months for a person to know whether or not treatment is working.
The following are some of the most common Topamax side effects:
- problems with memory and concentration
- pins and needles
- fatigue
- nausea
- anorexia
Other side effects may include:
- metabolic acidosis, where there is too much acid in the body
- kidney stones
- acute myopia
- angle-closure glaucoma
Antidepressants
In the treatment of mixed migraine-tension headaches, the antidepressant amitriptyline may be more beneficial than propranolol.
Amitriptyline works faster than beta-blockers, and people can see results in as little as four weeks. Each day, people can take 20–75 mg. The following are possible side effects:
- blurred vision
- constipation
- dry mouth
- low blood pressure when standing from sitting or lying down
- increased risk of seizures
- changes in heart rhythm or heart rate
- sedation
- urinary retention
Venlafaxine may be as effective in preventing migraine as amitriptyline. People can take 150 mg each day. Side effects can include:
- dry mouth
- high blood pressure
- insomnia
- dilated pupils
- nausea
- nervousness
- seizures
Other migraine preventive treatments
Other migraine prevention therapies include:
Acupuncture
For some people, acupuncture may help to reduce the frequency and pain of migraines.
A 2017 study looked at the effects of acupuncture on 249 migraine people who had no aura. The participants were divided into three groups: actual acupuncture, sham acupuncture, and those on the waiting list for acupuncture.
Over the course of four weeks, participants in the real and sham acupuncture groups received 20 sessions of acupuncture.
When comparing the actual acupuncture group to the sham and waiting list groups, researchers discovered that true acupuncture provided considerable benefits.
True acupuncture reduced migraine frequency and intensity for at least 24 weeks and was helpful in migraine prevention.
Massage
Massage may help people manage migraine symptoms, according to the American Massage Therapy Association. Massage’s advantages for migraines have received little research. Massage may, however, assist to lessen the frequency and intensity of migraine attacks, as well as the frequency and perceived pain of tension-type headaches, according to certain research.
Cognitive behavioral therapy
CBT (cognitive behavioral therapy) is a psychological strategy that can help people cope with migraine discomfort and distress.
Migraine and tension-type headaches may benefit from CBT to reduce their severity and frequency. According to studies, CBT and relaxation strategies can lower headache activity by 30–60%.
The effects of CBT on migraine in 18 adolescents were studied in a 2020 study. Participants took part in eight CBT sessions per week. Researchers used MRI images to see if there were any changes in the brain before and after the trial.
After 8 weeks, headache frequency decreased, and brain scans revealed improvements in brain function and activity, suggesting that CBT may be beneficial for migraine prevention.
Biofeedback techniques
Biofeedback devices track body reactions like muscular tension and skin temperature.
The device will provide feedback as people change their people, such as relieving tension in a specific body part. To provide feedback, a device could use a sound or light system.
People who use biofeedback will develop an awareness of their responses over time and will be able to release tension or stress in their bodies without the use of the device. Migraine headaches can be prevented or reduced by learning this skill.
Transcutaneous electrical nerve stimulation
A TENS machine is a small device with pads that people place on their skin’s surface. The equipment then sends low-voltage electrical current pulses to the nerves, which stimulate them and alter pain signals to the brain.
TENS may be an effective and well-tolerated migraine treatment, according to a 2018 meta-analysis of four studies. It may help you have fewer headache days and require fewer pain relievers.
However, more information is needed before researchers can come to a final decision.
Recognizing and avoiding triggers
Keeping track of migraine headaches may assist people in identifying their triggers.
The following are some of the most common migraine triggers:
- missed or delayed meals
- stress
- menstruation
- changes in weather
- alcohol
- certain smells
- chocolate
- soft cheese
- red wine
- artificial sweeteners and additives
A healthcare expert can help people figure out how to avoid or manage their triggers.
Stress management, avoiding particular foods, adhering to regular mealtimes, and developing excellent sleep patterns may all be beneficial.
Outlook
Migraine prophylaxis will not cure migraine but may help to:
- decrease frequency of migraine attacks
- decrease severity and duration of migraine attacks
- increase response to migraine therapy
- improve quality of life
According to research, the first-line medications effective for migraine prophylaxis are:
- divalproex
- topiramate
- metoprolol
- propranolol
- timolol
Second-line therapy options include the drugs listed below. They are most likely useful in migraine prevention:
- amitriptyline
- venlafaxine
- atenolol
- nadolol
Other migraine prophylaxis drugs may have insufficient proof of efficacy, be inadequate treatments, or lack sufficient study.
Non-pharmacologic migraine treatments, according to the study, may be beneficial, including:
- relaxation training
- biofeedback techniques
- CBT
For migraine prevention, a variety of strategies may be useful. Acupuncture, in combination with symptom management, may reduce headache frequency and be as effective as medicine.
Conclusion
Migraine prophylaxis may help to lessen the frequency, intensity, and duration of migraine attacks.
Migraine prophylaxis may include medications, relaxation, biofeedback, CBT, and acupuncture.
Sources
- https://americanmigrainefoundation.org/resource-library/biofeedback-and-relaxation-training/
- https://www.amtamassage.org/publications/massage-therapy-journal/tackling-migraines-head-on/
- https://www.aafp.org/afp/2019/0101/p17.html
- https://www.medicalnewstoday.com/articles/migraine-prophylaxis
- https://www.ncbi.nlm.nih.gov/books/NBK507873/
- https://headachejournal.onlinelibrary.wiley.com/doi/full/10.1111/head.13814
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5975046/
- https://www.migrainedisorders.org/why-try-cognitive-behavioral-therapy-for-migraine/
- https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2603492
