Patients, Don’t Just Suffer. Migraines Can Be Treated and Even Prevented

PHILADELPHIA -- (November 19, 2002) Migraine headaches can be successfully treated and in many cases prevented, say new joint clinical guidelines from the nation’s two largest groups of primary care physicians. The American College of Physicians-American Society of Internal Medicine (ACP-ASIM) and the American Academy of Family Physicians (AAFP) say the first line of treatment for migraines are non-steroidal, anti-inflammatory drugs (NSAIDs), followed by prescription drugs called triptans and DHE nasal spray for more severe headaches. The guidelines are published in the Nov. 19, 2002, issue of Annals of Internal Medicine.

Migraines are severe recurring headaches that can disable sufferers for hours up to several days. In addition to throbbing head pain, symptoms can include nausea, vomiting, and sensitivity to light, noise and odors.

The first line NSAIDs proven to work are the familiar, inexpensive, over-the-counter, medications aspirin and ibuprofen as well as naproxen sodium and a combination of acetaminophen plus aspirin and caffeine. Acetaminophen alone has been proven not to work for migraines. If NSAIDs don’t work, physicians should prescribe drugs called triptans. The guidelines advise treating migraines immediately and also treating the nausea and vomiting that accompany some migraines with specific remedies for these symptoms. The recommended medications were deemed effective in at least two double-blind, placebo-controlled trials.

“Migraine patients should know that migraines can and should be treated at once,” said Kevin B. Weiss, MD, chairman of the ACP-ASIM Clinical Efficacy Assessment Subcommittee that helped develop the guidelines. “We physicians don’t want patients suffering longer than needed. We want to help them get on their feet and functioning.”

“Another goal is to reduce use of back-up and rescue medications,” Weiss said. “Patients should know that more isn’t necessarily better when treating migraines. And medication overuse can actually lead to more headaches, sometimes called rebound headaches.”

“Headaches are the seventh leading reason patients in the United States visit their physician,” said Eric M. Wall, MD, MPH, the AAFP member of the joint committee that developed the guidelines. “It is important that physicians know the evidence supporting migraine headache treatments that are currently available and discuss treatment options with patients who have migraine headaches."

The guidelines point out that the most successful treatment results from the patient’s active involvement in charting the migraines and identifying and avoiding headache triggers. Commonly reported triggers include alcohol, chocolate, caffeine, red wine, foods containing additives (such as monosodium glutamate, tyramine or nitrates), sleep loss, stress, skipped meals, weather changes, perfumes or fumes.

About 28 million people in the United States suffer from migraines, or 18 percent of all women and 6.5 percent of all men. Migraines are said to be a significant cause of employee absences and lowered productivity.

Migraines can sometimes be prevented or attacks made less frequent. Likely candidates for preventive therapy are patients who have two or more attacks a month producing disability lasting three or more days per month and/or who have tried many NSAIDs, triptans and other medications unsuccessfully.

Preventive therapy can include drugs such as beta-blockers, antidepressants, anticonvulsants or NSAIDs. The guidelines outline the strengths and side effects of specific drugs and caution that although many drugs are available, only a few have proven effective in preventing or mitigating migraines. In general, prevention begins with the lowest effective dose. The goal is to give each treatment an adequate trial, avoid interfering medications and create a formal management plan with the patient.

The guidelines note that migraines or other headaches are not symptoms of brain tumors, but patients with neurological symptoms such as tingling, and facial weakness or drooping should tell their internist or family physician.

For more information on migraines see www.doctorsforadults.com. The Doctors for Adults Web site is a public service developed by the American College of Physicians-American Society of Internal Medicine.