Migraine
Fact sheet
Step 1 - Education
Four stages of migraine 1) prodrome 2) aura 3) headache and then 4) postdrome
75% of people have a prodrome with yawning, euphoria, depression, irritability, food cravings, constipation, or neck stiffness occurring 1 to 2 days before the headache
25% of people have an aura lasting 5 to 60 minutes which may have positive symptoms (seeing bright lights, ringing in ears, tingling in skin, muscle twitches) or negative symptoms (loss of vision, hearing, feeling or movement)
Step 2 - Lifestyle factors that help
Regular sleep schedule
Limit variations in blood glucose (regular meals, avoid high sugar foods)
Stay hydrated (1.5 to 2 L of water per day)
Limit caffeine (1 to 2 cups daily)
Regular exercise (30 minutes 5 times a week) - walking is a good option, exercise that involves jumping or running may trigger migraines
Good workplace setup (optimal desk height, screening brightness, room lighting) with regular breaks (to stretch and rest eyes)
Regular relaxation (meditation, mindfulness, yoga, breathing techniques)
Step 3 - Avoid known triggers
Emotional stress (self reported in 80% of migraine sufferers)
Hormones changes in women (65%)
Not eating (57%)
Weather (53%)
Sleep disturbances (50%)
Odours (44%)
Neck pain (38%)
Lights (38%)
Alcohol (38%)
Smoke (36%)
Sleeping late (32%)
Heat (30%)
Food (27%)
Exercise (22%)
Sexual activity (5%)
Step 4 - Supplements
Evidence is not strong but a 3 month trial of any of these supplements can be tried separately or in combination
Magnesium (elemental) - 400 to 650mg orally once daily
Riboflavin - 200mg orally twice daily
Coenzyme Q10 - 300mg once daily
Step 5 - Acute general measures
Cold pack over the forehead or back of the head
Hot pack over the neck and shoulders
Neck stretches and gentle range of movement exercises
Resting in a quiet dark room
Step 6 - Acute migraine attack medication
Aspirin 600 to 900 mg orally (2 to 3 tablets). Not safe for children OR
Ibuprofen 400 to 600 mg orally (2 to 3 tablets) OR
Paracetamol 1000 to 1500 mg orally (2 to 3 tablets)
Can combine and do Paracetamol and either Aspirin or Ibuprofen together
Step 7 - If nausea you can add
Metoclopramide (Maxalon) - 10 mg orally OR
Domperidone (Motilium) - 10 to 20 mg orally OR
Ondanestron (Zofran) - 4 to 8 mg orally OR
Prochlorperazine (Stemetil) - 5 to 10 mg orally
Step 8 - If simple analgesia is not enough, you can add a Triptan
Eletriptan (Relpax) - 40 to 80 mg orally OR
Rizatriptan (Maxalt) - 10 mg orally OR
Sumatriptan (Imigran) - 50 to 100 mg orally
If needed, can repeat dose but should wait at least 2 hours
Step 9 - Consider long-term prophylaxis medication if frequent migraines
Propranolol (Inderal) - Blood pressure medication known as a Beta Blocker
Start with 20 mg orally at night. Increase dose by 20 mg at intervals of at least 1 week up to effect. Maximum daily dose 160 mg in 2 or 3 divided doses. Side effects may include worsening asthma, low blood pressure, tiredness
Amitriptyline (Endep) - Tricyclic antidepressant used for nerve pain
10mg orally at night. Increase daily dose by 10 mg at intervals of at least 1 week up to effect. Maximum daily dose 75 mg. Side effects include sleepy, dry mouth
Candesartan (Atacand) - Blood pressure medication known as an ARB
4mg orally daily. Increase daily dose by 4mg at intervals of at least 1 week up to effect. Maximum daily dose 32mg.
All medications take 8 to 12 weeks at maximum tolerated dose to assess if effective
Step 10 - Other options
Neurologist doctors are the experts and can help if simple measure fail
Regular Botox injections into the back of the neck is an effective option
Long-term use of simple analgesia and Triptans can lead to a medication overuse headache. Limit simple analgesia to less than 15 days per month and Triptans to less than 10 days per month
Menstrual migraines can be treated with Ibuprofen, Naproxen or Naratriptan starting 2 to 3 days prior to your period or through period suppression