As a family physician treating people of all ages for over 30 years, I’ve cared for many individuals with migraine headaches.
Classic migraine headaches power in with visual and auditory hallucinations followed by pounding, unrelenting pain best relieved by retreating to a dark room and resting. But migraine sufferers can’t always do that.
Migraine headaches interfere with work, personal, professional and recreational activities.
The annual cost of migraine headaches reaches $78 billion annually.
Individuals with chronic migraine of 15 or more episodes per month, seek endlessly for therapies that will reduce the burden of this disorder.
Certainly, we know that avoiding triggers like foods, flashing lights, and certain smells reduce the incidence of chronic migraine.
Cognitive behavioral therapy or counseling helps certain individuals and should be a component of therapy for all who suffer from migraine headaches.
We also know that taking an effective medication at the first signal of a migraine may reduce its intensity and duration.
Surprisingly, Excedrin Migraine is FDA approved to treat migraine and is effective for many sufferers if taken immediately at the onset.
Imitrex has been used for years and is effective as well. It comes in injectable and oral forms.
The real trick is preventing migraines. The first line in prevention is 7 to 8 hours of sleep nightly, nutritious foods with emphasis on fruits and vegetables, stress reduction, mindfulness, avoiding triggers and counseling.
The old-time medication propranolol has been used for years with varying degrees of success to prevent migraine.
For those with depression, Cymbalta and other antidepressants may reduce the frequency and severity.
Studies on botulinum toxin A or Botox show efficacy for chronic migraines in many individuals, but Botox is very expensive, needs to be injected adding to its cost.
I’ve had success with Topamax also known as topiramate.
Most recently, new medications called CGRP inhibitors have been approved by the FDA for the treatment of chronic migraine. One such formulation is called Aimovig. Patients take a single pill monthly at the whopping price of $575 per month or nearly $7000 annually!
That’s enough to give just about anybody a headache. Jeez.
Reference: Amgen Novartis, 2019. Aimovig: I Am Here Online [available at]: http://bit.ly/2N9m2SM Accessed June 23, 2019.