# migraine treatment | Symptoms, Causes, Tests and Treatment | OSANG > Migraine treatment consists of two axes: acute treatment and preventive treatment. In the acute phase, anti-inflammatory analgesics or triptan-based drugs are used, and… - Official page: https://osns.co.kr/en/encyclopedia/migraine-treatment - Organization: OSANG Neurosurgery ## Page content Headache ## migraine treatment Migraine Treatment · G43 Migraine treatment is divided into acute treatment, which quickly reduces pain during an attack, and preventive treatment, which reduces the number and intensity of attacks. Treatment methods have recently become more diverse with the advent of new targeted treatments and neuromodulation treatments. ## At a glance Migraine treatment consists of two axes: acute treatment and preventive treatment. In the acute phase, anti-inflammatory analgesics or triptan-based drugs are used, and preventive treatment is initiated if attacks recur more than four times a month. In addition to existing oral medications, preventive treatments include CGRP-targeted injections, Botox injections, and transcranial magnetic stimulation. Combining drug treatment with lifestyle management can reduce the number of attacks by more than half. - 01definition - 02acute care - 03preventive care - 04Neuromodulation treatment - 05life management - 06Precautions ## definition Migraine treatment includes acute treatment and It is divided into preventive treatment. Acute treatment treats pain and accompanying symptoms when a attack occurs. The goal is to relieve it quickly. Preventive treatment reduces the number, intensity, and duration of attacks. The goal is to reduce acute drug use. Approximately 38% of migraine patients are eligible for preventive treatment, The rate of actually receiving preventive treatment is only about 13%. Since 2018, new targeted treatments and As non-invasive neuromodulation devices become widespread, The direction of migraine treatment is changing rapidly. ## acute care ### anti-inflammatory painkiller The first line of treatment for mild migraine attacks is These are anti-inflammatory drugs (NSAIDs). Ibuprofen (400~600mg), Naproxen (500~750mg), Aspirin (900-1000 mg) has been used in clinical studies. The effect has been confirmed. If nausea occurs, anti-vomiting medication Metoclopramide (10mg) or domperidone (10mg) Take them together. Antiemetics reduce nausea while also Helps absorption of painkillers. ### triptan Triptan is an acute treatment drug specifically for migraine. Reduces dilated cerebral blood vessels, By suppressing the secretion of pain signaling substances Blocks migraine headaches. Currently, 7 types of triptans are available, Representative examples include sumatriptan, zolmitriptan, and rizatriptan. When taking sumatriptan 100mg orally The headache disappearance rate within 2 hours is about 32%, The pain relief rate is approximately 59%. Even if one type doesn't work Because it can react to different types, It is recommended to try at least 2-3 types. ### Gepant Gepant blocks the CGRP receptor. It is a new acute treatment drug. Unlike triptans, they do not have a vasoconstrictive effect. It can also be used in patients with cardiovascular disease. Ubrogepant is in clinical trials. Headache disappearance rate within 2 hours compared to placebo It was significantly higher (21.8% vs 14.3%, p=0.01). Rimegepant is used for acute treatment and preventive treatment. It is the first migraine medication that can be used for everyone. ## preventive care ### When starting preventive treatment The American Headache Society (AHS) recommends that in the following situations: It is recommended to start preventive treatment: - When you have migraine attacks more than 4 days a month - When acute medications are ineffective or difficult to use - When there is a risk of medication overuse headache due to overuse of painkillers - When migraines severely interfere with daily life The criteria for determining the effectiveness of preventive treatment are: Migraine frequency is reduced by more than 50%. The effectiveness is usually determined after taking the drug for 2 to 3 months at the appropriate dose. ### Conventional preventive medications Existing oral medications proven to be effective in migraine prevention include: - Blood pressure medication class: Propranolol (40-240 mg/day), - Metoprolol (50-200 mg/day) - Anticonvulsants: topiramate (50-200 mg/day); - Valproic acid (500-1500 mg/day) - Antidepressants: Amitriptyline (10-75 mg/day) - Vasodilators: flunarizine (5-10 mg/day) These drugs were originally used for other diseases, but The effectiveness of migraine prevention has been confirmed through long-term research. ### CGRP targeted preventive treatment CGRP (calcitonin gene-related peptide) It is a substance that plays a key role in the occurrence of migraines. Injectable drugs that block this substance or its receptor It has been introduced for migraine preventive treatment since 2018. erenumab blocks the CGRP receptor. As an injection, inject subcutaneously once a month. Number of migraine days per month compared to placebo in clinical study It was further reduced by an average of 1.4 to 1.9 days. galcanezumab and Fremanezumab is It is an injection that blocks the CGRP substance itself. Inject once a month or once every three months. The advantage of these injections is their mechanism specialized for migraine, Convenience of dosing once a month or quarterly, And there are fewer side effects. In addition to injection site reactions in clinical studies, Serious side effects were rare. ### botox injections Botox (botulinum toxin type A) It is an approved preventative treatment for chronic migraine. Chronic migraine refers to having headaches more than 15 days a month. Inject at 31 locations around the head and neck at 12-week intervals. In a large clinical study (PREEMPT) After 24 weeks, the number of headache days per month decreased by an average of 8.4 days, The proportion of patients who improved more than half was approximately 47.1%. ## Neuromodulation treatment When it comes to non-invasive neuromodulation devices, there are concerns about drug side effects. In patients who have difficulty taking medication It is used as an alternative or adjunctive treatment. Transcranial magnetic stimulation (TMS) is Apply magnetic stimulation on the scalp It is a treatment that suppresses the neural activity of migraine. In clinical studies, the rate of headache disappearance within 2 hours after stimulation was It was significantly higher than placebo (39% vs 22%, p=0.018). Non-invasive vagus nerve stimulation (VNS) is a External electrical stimulation is applied to the vagus nerve in the neck area. It is a treatment that modulates pain signal transmission. ## life management Lifestyle adjustments in migraine management are It is as important as drug treatment. - Regular sleep: going to bed and waking up at the same time every day, - Maintain 7 to 8 hours of sleep. - Regular meals: Do not skip meals. - Aerobic exercise: 3-5 times a week, more than 30 minutes - Walking, swimming, and cycling are recommended. - Water intake: Drink 1.5 to 2 liters of water per day. - Limit caffeine: Reduce to less than 200mg per day. - Keep a headache diary: record attack dates, intensity, and triggers. - Keeping records can help you identify individual triggers. ## Precautions - If you take painkillers more than 10 days a month - Medication overuse headaches may occur. - Medications must be adjusted under specialist consultation. - Triptan use is restricted in people with cardiovascular disease or uncontrolled hypertension, - Use is limited in patients with a history of stroke. - Do not stop taking preventive medications arbitrarily. - It should be reduced gradually in consultation with a specialist. - Because migraine is a chronic disease, - A long-term management plan is needed rather than short-term treatment. - New headache patterns appear or - If the existing migraine pattern changes significantly, - Be sure to seek medical attention from a specialist. ## Frequently asked questions ### Q01What medicine should I take when I have a migraine attack? For mild attacks, you can first try anti-inflammatory painkillers such as ibuprofen or naproxen. For moderate to severe attacks, triptan drugs are recommended. The key is to take it quickly at the beginning of the attack. If you have severe nausea, you may take an anti-vomiting medication. However, if you take painkillers too often, headaches may become more frequent, so please consult a specialist about the frequency of taking painkillers. ### Q02What kind of drug is a triptan? Triptan is a treatment specifically used for migraines. It relieves migraine headaches by reducing dilation of cerebral blood vessels and blocking pain signals. There are several types, including sumatriptan and zolmitriptan, and even if one type does not work well, other types often work well, so it is recommended to try 2 to 3 types. ### Q03What is CGRP targeted therapy? CGRP (Calcitonin Gene-Related Peptide) is a substance that plays a key role in the occurrence of migraines. This is a treatment to prevent migraine attacks in advance by taking an injection that blocks this substance once a month or once every three months. Clinical studies have shown that it reduces the number of migraine days per month by an average of 3 to 5 days. ### Q04When should migraine preventive treatment begin? If you have migraines more than 4 days a month, do not respond well to acute medications, take painkillers frequently, or have severe attacks that interfere with your daily life, you will begin preventive treatment. The goal of preventive treatment is to reduce the number of migraines by more than half. ### Q05Can Botox treat migraines? Yes, Botox (botulinum toxin type A) is an approved treatment for preventing chronic migraine (headaches more than 15 days per month). It is injected at 31 locations around the head and neck at 12-week intervals, and studies have shown the effect of reducing headache days by an average of 8 to 9 days per month. However, its effectiveness has not been proven for intermittent migraines, so it is a suitable treatment for chronic migraine patients. ### Q06Can migraines be reduced without medication? Yes, regular aerobic exercise, relaxation training, and cognitive behavioral therapy are non-drug treatments with scientific evidence. Non-invasive neuromodulation treatments such as transcranial magnetic stimulation and vagus nerve stimulation are also gradually accumulating evidence. You can expect better results if you combine drug and non-drug treatments together. ### Q07Are there any lifestyle habits that are good for migraines? Regular sleep (7-8 hours) and meals are basic. It is recommended to do moderate-intensity aerobic exercise for at least 30 minutes, 3 to 5 times a week. Reduce caffeine and drink plenty of water. Keeping a headache diary can help you identify your own triggers and help reduce the number of attacks. ### Q08How long does it take to treat a migraine? The effectiveness of preventive drugs is usually determined after taking them for 2 to 3 months. If it is effective, you can maintain it for 6 to 12 months and then gradually reduce it. CGRP injections are evaluated after 3 to 6 months of use. Since migraine is a disease that needs to be managed over a long period of time, we recommend that you continue treatment by consulting a specialist. Migraine is a chronic disease, so consistent management and regular consultation with a specialist are important. ## Related articles - giant cell arteritis - Hemicrania continua - Hypnic Headache - Idiopathic intracranial hypertension This article provides general medical information and does not replace an individual diagnosis or treatment plan. Please seek a medical assessment if symptoms persist. ## Important notice This Markdown alternative helps search and AI tools understand the public page accurately. 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