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Adrian asked...

Tags: diet , headache

I suffer from migraines (for over 15 years) about 5 to 8 times per month, lasting about 4 to 8 hours each time. I take sumatriptan which mostly helps ease the pain. I have had a head scan (all okay) and tried non-diary, no wheat, no oranges, chocolate etc diets. I don't drink any tea, coffee or alcohol. I have also tried acupuncture, chiropractics, reflexology, massage and 10mg propranolol per day, none of which has helped - any ideas or suggestions. I'd prefer not to try topiramate due to the side effects. Thanks for your consideration.

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The Answer

Part of migraine management is identifying possible triggers which isn’t always straightforward. Likely triggers include:

  • Stress
  • Relaxation after stress, so-called 'weekend migraine'
  • Strong smells
  • Bright light
  • Dehydration and missed meals
  • Jet lag
  • Strenuous exercise is thought to trigger migraine in those unaccustomed to it, however regular exercise may help to prevent migraine.

A trigger can be identified using a ‘migraine diary’ which involves documenting: The frequency, duration, and severity of headaches, any associated symptoms, All prescribed and over-the-counter medications taken to relieve headaches and their effect and possible triggers. According to evidence based data 20% of sufferers can avoid attacks by identifying and avoiding triggers.

Possible options for migraine management include:

  • Combination therapy with an oral triptan and an anti-inflammatory ( ibuprofen, tolfenamic acid, naproxen and diclofenac), or an oral triptan and paracetamol.
  • Addition of anti-emetics e.g. metoclopramide, domperidone, or prochlorperazine) even in the absence of nausea and vomiting
  • Combination painkillers with anti-emetics e.g. MigraMax® (lysine acetylsalicylate and metoclopramide) and Paramax® (paracetamol and metoclopramide)
  • Metoclopramide
  • Domperidone

According to guideline development group, failure to respond to a particular triptan (Sumatriptan) may not mean that another triptan will not work, so it is worth speaking to your prescriber about considering an alternative triptan if there is no response to the first one.

Possible reasons for a poor response to triptans in a person with migraine include:

  • If used too little or too late in the attack, or, conversely, medication overuse.
  • Failure to use adjunctive medication, such as analgesics (anti -inflammatories / paracetamol) or anti-emetics.

Riboflavin (400 mg once a day) may be effective in reducing migraine frequency and intensity for some people.

Preventative treatment for migraine include:

  • Propranolol
  • Topiramate
  • Gabapentin
  • Amitriptyline

If your symptoms worsen having tired all of the above, it would be prudent to speak to your Gp for further assessment.

Answered by the Health at Hand nurses  

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