Introduction
Call a doctor if any of the following occur:
- A change in frequency, severity, or features of the migraine commonly experienced
- A new, progressive headache that lasts for days
- A headache brought on by coughing, sneezing, bearing down, straining while on the toilet, and so on
- Large, unintentional loss of body weight
- Weakness or paralysis that lasts after the headache
Go to a hospital emergency department if any of the following occur:
- Having the worst headache ever, especially if the headache came on very quickly
- Headache associated with trauma to the head
- Trauma to the head with loss of consciousness
- Fever or stiff neck associated with headache
- Decreased level of consciousness or confusion
- Paralysis of one side of the body
- Seizure
Self-Care at Home
Most migraineurs can manage mild-to-moderate attacks at home with the following strategies:
- Using a cold compress to the area of pain
- Resting with pillows comfortably supporting the head or neck
- Resting in a room with little or no sensory stimulation (light, sound, odors)
- Withdrawing from stressful surroundings
- Sleeping
- Drinking a moderate amount of caffeine
- Trying certain over-the-counter headache medications
- Nonsteroidal anti-inflammatory drugs (NSAIDS): These include medications like aspirin, ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve), and ketoprofen (Orudis). Stomach ulcers and bleeding are serious potential side effects. This type of medication should not be taken by anyone with a history of stomach bleeding. A doctor or pharmacist should be asked about possible medicine interactions if the migraineur is taking other drugs.
- Acetaminophen (Tylenol): Acetaminophen may be safely taken with NSAIDs for an additive effect. Taking acetaminophen by itself is usually safe, even with a history of stomach ulcers or bleeding. Acetaminophen should not be taken if the migraineur has liver problems or has 3 or more alcohol drinks a day.
- Combination medications: Some over-the-counter pain relievers have been approved for use with migraine. These include Excedrin Migraine, which contains acetaminophen and aspirin combined with caffeine. A similar effect can be achieved by taking 2 aspirin or acetaminophen tablets with a cup of black coffee.
Follow-up
Regular follow-up care with a doctor is a must. Keeping a pain journal to monitor the frequency of attacks and the medications used can be very helpful. It may take several doctor visits before an effective treatment plan is found.
Prevention
Migraine triggers should be identified and avoided. Making individual lifestyle changes is very important. Changes may include avoiding certain types of foods and certain emotional situations. If missing meals triggers headaches, the migraineur should make every effort to eat on a regular basis. In some instances, the use of biofeedback may help reduce the severity and frequency of attacks.
Outlook
After the headaches are under control, the prognosis is very good. However, patience is the key. As noted previously, it may take several attempts before an effective treatment plan is found.
Treating migraine is an art more than a science. No "cookbook" recipe is effective for every person. A drug that works well for one migraineur may not provide any relief for another. A combination of different medications is sometimes needed to treat resistant headaches.