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How Do I Know I Have It?

There is no specific test to diagnose a migraine headache. If you seek help from your healthcare provider for recurring headaches, you may be asked to keep a headache diary in which you record information about symptoms leading up to a headache, symptoms of the actual headache, and possible triggers that may have provoked the episode.

Your healthcare provider will want to take a careful history to determine any patterns to your headaches, and to learn whether such headaches run in your family. He or she will also perform a careful physical examination to make sure you don't have any other symptoms or signs that point to another problem as the source of your headaches.

What Are the Treatments?

There are two main approaches to migraine treatment. The first is stopping (aborting) an acute attack, if possible, or at least controlling the pain and nausea. The second approach is preventing future attacks.

Conventional Medicine
In abortive therapy, it's important to take medication as early as possible in the course of the headache. So, if you have an aura or other prodrome (early symptom before headache onset), take the medicine then. Many drugs can help, but the leading ones are called triptans. They include sumatriptan (including recently available nasal spray) (Imitrex), zolmitriptan (Zomig), rizatriptan (Maxalt), and others. People respond differently, and one of these drugs may work better for you than others.

Ergot alkaloids are another class of drug that can be used to abort a migraine. The most popular one is dihydroergotamine (DHE). It is available as a nasal spray or an injection. NSAIDs (nonsteroidal anti-inflammatory drugs), such as ketoprophen and ibuprofen, may also abort a migraine attack. Often, doctors recommend taking antinausea drugs such as Reglan or Phenergan.

If these medications don't work for you, there are a variety of others available, including Midrin, Fioricet, and opioid analgesics such as Stadol Nasal Spray, Vicodan, and Actiq.

Prophylactic treatment is usually recommended if you have more than two or three migraines per month. Medications intended to head off a migraine episode, so that it never fully develops, include:

• Tricyclic antidepressants, such as amitriptyline, nortriptyline, or doxepin.
• Beta-blocking agents (also used to treat high blood pressure), such as propanolol, metoprolol, timolol, nadolol, and atenolol
• Calcium-channel blockers (also used to treat high blood pressure), such as verapamil and nifedipine
• Antiseizure medications including Depakote, Neurontin, and Topamax
• Methysergide
• Vitamin B-2 (riboflavin)
• Botox injections

During an acute episode of migraine headache, you'll probably be most comfortable lying down in a darkened, quiet room and trying to sleep. A cold pack on your head may feel comforting. If you are unable to take medications by mouth, you may need to go to a hospital emergency room or be admitted to a hospital for treatment.

Alternative Medicine Mind/Body Medicine

Biofeedback can train you to control your pulse, blood pressure, and temperature. Usually thought of as involuntary processes, they are related to stress responses, which may contribute to migraines.

Electromyographic or EMG training helps you learn to recognize tension as it builds up in your muscles, and teaches you to relax those muscles that can contribute to migraine pain, including the muscles in the face, head, neck, shoulders, and back.

Relaxation techniques may be used alone or in conjunction with biofeedback. These techniques include yoga, progressive relaxation, guided imagery, and various forms of meditation. They may help you to better handle the stresses in your life that can trigger migraine headaches.

Cognitive behavioral therapy helps you become conscious of the interplay between your life's stressors and your emotional reactions. This awareness may help you interrupt the cycles that trigger or reinforce the development of migraine headaches.

Herbs and Supplements

Many migraine sufferers have a magnesium deficiency and may benefit from taking a supplement or increasing the amount of magnesium in their diet.

Feverfew, a flower in the daisy family, has been used for decades to help relieve migraines. There is lack of scientific evidence for this benefit but feverfew is probably not harmful. Do not take it, however, if you are pregnant or taking anticoagulants, because it thins the blood. It can also have some serious side effects, including mouth ulcers, anxiety, and upset stomach, and may actually induce headaches.