Notoriously tricky to treat, what works for one migraine patient will have no effect on another. Usually, various different types of migraine treatment or medication are tried before the option of surgery is considered.
Designed to stop the pain once it’s started, or abort it if you can catch it early such as in the prodrome stage, these therapies include the Triptans of which there are several different kinds. You may have to experiment a little to find one that suits you best, and your doctor will advise if a change would be beneficial.
Sometimes Triptans don’t work, so a different form of medication may be tried, including those that affect serotonin. These are administered either orally, via a nasal spray or an injection. Drugs commonly used to treat nausea may also have a beneficial effect on headaches, and these include prochlorperazine and promethazine.
Other types of drugs, such as butalbital compound or acetaminophen are habit-forming and should be used only on those occasions when other medications have no effect. Generally, over-the-counter analgesics such as aspirin or ibuprofen are most effective in sufferers whose migraine attacks are infrequent, and when they’re taken at the first sign of a headache.
Other treatments include migraine patches: battery powered devices that wrap around the arm or leg and deliver medication through the skin over a few hours. Relatively new, these are useful in patients who dislike nasal sprays or have difficulty swallowing tablets.
Some abortive medications lose their effectiveness if not taken at the first sign of approaching migraine. By the time the pain actually starts, it may be too late.
All medications come with some risk of side effects so it’s important to monitor your reactions and stay in touch with your doctor.
Migraineurs who suffer from more than one headache a week could benefit from preventive medications, most commonly beta blockers, some anti-depressants, and certain antihistamines and other allergy drugs. These medications can normally be taken daily, and are intended to reduce the severity and frequency of attacks.
Botulinum toxin (commonly known as Botox) is another therapy that’s rapidly gaining ground in the treatment of migraine. It’s also used as a part of the testing to determine whether surgery would be a good option.
Qualifying for Surgery
There are several stages and steps to go through before you or your doctor can determine if surgery is your best course of treatment. The first step is an official migraine diagnosis by a qualified doctor or neurologist. You’ll be asked lots of questions, including:
- Your family history.
- What symptoms you have.
- What medications you’ve tried.
- How effective these have been.
It helps to keep a migraine diary where you note down not just the date of the migraine, but also the time, your surroundings, activities and known triggers. By including the additional details, you could even uncover triggers you hadn’t previously spotted. You could also include notes about the types of treatments you try for each attack, and whether you experience any relief as a result. Doing this enables you to pay closer attention to causes and effects than you might do otherwise, and can provide valuable information for your doctors to work with.
Alongside the questionnaire, a physical exam helps the neurologist to build up a more complete picture of your migraine pattern, characteristics and triggers. Surgery will only be offered if it can be established that relief of nerve pressure would be beneficial.
Simulating the long-term effect of surgery is possible with a Botox injection into one or more of the trigger points. Because Botox relaxes the muscles and prevents nerve aggravation at the site, migraine is often avoided following treatment. It’s perfectly safe to have Botox treatment alongside other migraine medication. Some patients prefer regular Botox treatments to surgery, although if they are good candidates, surgery would provide more long term relief.
Following the Botox injection, the patient is expected to keep a migraine diary for a further eight weeks. By comparing the diary before and after the injections, doctor’s can more accurately assess the likely success of the migraine surgery procedure. Generally, an improvement of 50% or better is expected following Botox treatment.
The migraine surgery itself takes around an hour, and brings long-lasting relief to those patients who are suitable candidates for the procedure. Carried out under general anesthetic, it is an out-patient procedure with few risks and you can normally go home after a few hours. A certain amount of swelling is inevitable at the site of the operation, although this will subside after a few days. There are no visible scars once complete healing has taken place.
For those patients who find abortive treatment unreliable or ineffective, the possibility of migraine surgery is definitely worth investigating.