Managing migraines and the new treatments available

Migraines are more than just your average headache, and can be debilitating to those who suffer them. Hence, finding a way to manage the pain and preventing them is key to treating those who have them. Dr Stefan Schumacher, a leading neurologist, explains how patients can manage their migraines, from controlling their diet, to medications, to new treatments being used.

How can I manage my migraines?

The management of migraines can be very different and with every patient it is very individual. A lot of our patients watch their diet, which makes sense as a healthy diet does help. Patients, for instance, with gluten or other intolerances to food have to watch their diet very carefully because if they don’t follow the guidelines with their diet then that also triggers migraines. Daily stress in work or other stresses including stress from bereavement, for instance, also induces migraines.

Additionally, the daily management of migraines means taking medication. Patients who suffer from migraines must go and see their specialist or GP who you should have good contact with so that they can keep a watchful eye on you and ensuring you are leading a normal, healthy life. What does that mean though? That means that you sleep enough, at least six hours per night, that you have a regular pattern of sleep, that you preferably do not smoke, that you do not take any drugs and that you don’t drink too much alcohol.

What medications are there for migraines?

We have different treatment strategies for migraines. The first one is tackling the acute pain and the best medication for this are the so-called triptans. We use, for instance, sumatriptan (the brand name is Imigran) in a dosage of fifty or one hundred milligrams, either as tablets, as nasal spray or as a subcutaneous injection into the skin which the patient can administer themselves.

Then we use so-called preventative drugs, which are established drugs used for other conditions such as depression and epilepsy. These preventative medications include beta blockers, amitriptyline, topiramate, zonisamide, gabapentin and others. These drugs are given in a daily dosage and patients need to take them for at least eight to twelve weeks to see if they are effective. Sometimes patients find it a bit irritating taking these drugs because they also have to take them when they haven’t got headaches, but it is very important and they are often very beneficial.

What new medication is available for treating migraines?

An interesting and relatively new drug being used just for treating chronic migraines is Botox. Botox A (this is the proper brand name) is a medication which consists of a certain protein coming from a bacteria and there is a special chemical way to transform this protein which we then administer in injections. Since 2012 Botox has been licensed by NICE (National Institute of Clinical Excellence) guidelines here in the UK and in many other countries by their own authorities. There are a good number of patients suffering from chronic migraines who benefit from Botox injections. When neurologists are administering these treatments, we inject the Botox with a very fine needle into the head in two sessions within three months. This might sound frightening – thirty-one injections into the head – however, it is a very fine needle, like an insulin syringe and it is normally tolerated very well.

My personal experience with this drug is that it works very well for many patients. The criteria are that patients have to have at least fifteen headaches per month, nine of them migraines, and they must have tried or treated with three different preventative drugs, not being effective. Hence, the criteria are quite strict and a number of our patients who we treat for migraines do not fulfil the criteria, but these patients who have chronic migraine often find Botox injections enormously helpful and I am very happy that we have this new treatment and hopefully we shall move forward with Botox as a treatment for chronic migraine.

If you suffer from migraines, make an appointment with an expert to discuss your treatment options.