Migraine Treatments and Therapies

People with migraine often need to make lifestyle changes or take medication to help control their migraine.  This section helps to explain more about the different types of migraine treatments available for individuals. 

Please remember that the information in this section is general, and it is important that you discuss any concerns or problems you may have with your medications and treatments, with your GP or neurologist.

The migraine treatments available are:

If you are getting more than 4 migraines a month, you may need to undertake preventative treatment. This might commonly involve a course of medication that your doctor can prescribe, though other treatments that do not involve medication may also be available. Preventative treatments are aimed at reducing the frequency and/or severity of your headaches. These sometimes take a while to show full benefit so you will probably need to try them for at least 3 - 6 months. Preventative treatments do not eliminate headaches entirely, so you may also need to take an effective acute treatment alongside it.

Beta Blockers
Drugs such as propanolol or atenolol, were originally developed to treat patients with high blood pressure, but have been found to be effective in the prevention of migraine. They are particularly helpful for migraineurs who have muscle tension, high blood pressure or suffer from stress.  Side effects can include nightmares, hallucinations, tiredness, cold hands/feet, tummy upsets and wheezing in people prone to asthma.

BOTOX®
Botox® (botulinum toxin type A) has been licensed by the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK as a preventative treatment for adults who have chronic migraine. However, unfortunately it is not generally available on the NHS but is more widely available privately.
To be eligible for this treatment, individuals need to experience headaches for 15 or more days per month, with migraine on at least 8 of these days.

read more... However, we know that doctors will also consider the impact that chronic migraine is having on your life, how disabled you are, if you are unable to work or if you suffer from other conditions that are common with chronic migraine, for example, depression, anxiety or other pain related conditions like arthritis or fibromyalgia.
It is a common misperception that BOTOX® is only used for cosmetic purposes to reduce the effects of wrinkles. However, smaller therapeutic doses can be used in the treatment of health conditions such as chronic migraine.
Over the past 15 years in the UK, BOTOX® has also been used as a therapeutic treatment in:
• Blepharospasm (uncontrolled blinking of the eyelids);
• Hemifacial spasm (a neuromuscular disorder characterised by unpredictable and involuntary twitching of facial muscles on one side of the face);
• Cervical dystonia (a muscle condition affecting the neck making it difficult to hold the head up straight);
• Severe axillary hyperhidrosis (excessive sweating) of the armpits;
• Cerebral palsy (dynamic equinus foot deformity in paediatric patients aged two years and older);
• Upper limb spasticity (wrist and hand disability associated with stroke in adults).

Click here to download the migraine and BOTOX® booklet.

Neuromodulators
Medication such as sodium valproate (Epilim), topiramate (Topamax), gabapentin (Neurontin), which were originally developed to treat epilepsy, have been found to be effective in preventing  migraine if given in low doses.  These drugs are currently not licensed for migraine prevention in the UK, with the exception of topiramate, which has recently been licensed.  For more information on these, please consult your doctor.

Antidepressants
These can be prescribed in low doses for preventing migraine, so if your doctor suggests them it does not mean you are depressed or neurotic.  Amitriptyline, is more frequently prescribed and can be helpful for migraineurs who do not sleep well.  Low doses of anti-depressant drugs have been shown to be effective in preventing migraine.

Serotonin (5HT) Agonists
These drugs reduce the severity and frequency of attacks in about one third of sufferers.  Drowsiness and increase in weight are the most common side effects. Treatment with methysergide (although rarely used in the UK) must be discontinued for at least one month in six because of the potential side effects. Drugs normally prescribed are pizotifen (Sanomigran) and methysergide (Deseril).
Click here to download the booklet on Serotonin (5HT) Agonists.

Calcium Channel Blockers
Flunarizine a drug which has the most evidence of being effective in treating migraines but it is only available on a named patient basis via some specialists in the UK. Verapamil another drug is particularly effective in treating familial hemiplegic migraine..

Acupuncture
This has been endorsed by the British Medical Association as an effective treatment for headache and migraine.  Its treatment consists of small fine sterile needles being inserted into your skin at certain points; they may be left in for just a few seconds or for several minutes.

Traditional Chinese acupuncturists will position the needles at various points along the body's energy meridians, according to their assessment of each individual (i.e. different migraineurs could have differently positioned needles).

read more...Practitioners of western acupuncture will usually be health professionals (e.g. GPs, physiotherapists, doctors and specialist nurses working in pain clinics) who have received additional training in this method of treatment. They will position the needles in certain areas determined by the condition they are treating (i.e. all migraineurs are likely to have the needles placed in similar positions). If western acupuncture has not helped you, it may still be worth considering traditional acupuncture.
Acupressure
This is a method of applying pressure at various points along the energy meridians. Although there is no published evidence from controlled trials to demonstrate its efficacy in the treatment of migraine, there is considerable anecdotal evidence which supports this kind of therapy in migraine management.

Click here to download the migraine and acupuncture booklet.

Other Therapies
Occipital Nerve Block Injection
This aims to chemically block the migraine pain pathway.  A trial to investigate the efficacy of this procedure has been carried out in the UK and the results should be available later in the year.
Occipital Nerve Block Implant
In a similar way to the injection, an implant is inserted to block the pain pathway electronically.  Very few implants have been carried out in the UK. For more information please click here.
PFO Closure
New research has linked a common, and usually harmless, defect of the heart to migraineurs. For more information on this please click here.