Written By: Satata Karmakar | Published : December 26, 2023 10:36 AM IST
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Winter Migraine Management Tips: 5 Proven Ways to Stop That Persistent Headache
Migraines are defined by severe attacks of unilateral pulsing head pain that are accompanied by photophobia, phonophobia, nausea, and/or vomiting and last for 4 to 72 hours. Chronic migraine is a neurological illness that affects 1.4-2.2% of the world's population and has a significant impact on both one's lifestyle and one's socioeconomic status.
In this article, we explore the reasons why migraine pain increases during the winter, and how one can effectively bring them under control with proper care treatments. To help us understand the medical treatments better, we have with us Dr. Khushbu Goel, Consultant Neurology, Manipal Hospital, Dwarka.
Chronic migraine is defined as having headaches for at least 15 days per month for at least three months, with at least eight of these headaches satisfying the criteria of migraine headache.
Mechanism of chronic headache: the transformation from episodic to chronic migraine appears to be a complex mechanism.
Risk factors for progression include
Acute migraine treatments are primarily analgesics, nonsteroidal anti-inflammatory medications (NSAIDs), or migraine-specific medicines with vasoconstrictive effects, such as triptans and ergot derivatives.
Opioid and barbiturate-containing drugs are not advised due to a strong link between them and medication usage, headache development, and medication dependency.
For patients with migraine, preventive treatment is usually considered when headache frequency or severity increases to the point where it is significantly interfering with work, school, or social life.
For patients with chronic migraines, this is usually required, and some form of preventive medication or other intervention is almost universally indicated.
American Migraine Prevalence and Prevention study shows, however, that as many as 40% of those patients who might benefit from preventive treatment are never offered it.
To reduce adverse effects, preventive therapies are typically started at a low dose. The dose should be gradually and consistently increased until the medication begins to work. Because compliance is known to be low, it should be closely checked.
Currently, available pharmacotherapies that have demonstrated efficacy in chronic migraine prophylaxis are onabotulinumtoxinA (BoNT-A), topiramate, and newly approved CGRP-targeted monoclonal antibodies.
BoNT-A has been proven to be an effective, safe, and well-tolerated treatment for chronic migraine prevention in randomized, double-blind, placebo-controlled studies. Regardless of acute drug abuse, BoNT-A treatment was linked to a considerable reduction in the frequency and disability of headaches as well as an improvement in quality of life.
Topiramate is effective in the treatment of chronic migraines and reduces the mean monthly headache days in chronic migraineurs compared to placebo in randomized placebo-controlled trials.
Recently developed as the first fully-humanized monoclonal antibody treatments specifically for chronic migraine, fremanezumab, galcanezumab, and eptinezumab target the CGRP ligand, while erenumab targets the CGRP receptor. During migraine attacks, the trigeminal sensory nerve fibers release excessive amounts of CGRP, which is neutralized by these antibody therapies. In controlled clinical trials, these anti-CGRP monoclonal antibodies have demonstrated efficacy, tolerability, and safety as chronic migraine preventive therapies.
A potentially effective new treatment for chronic migraines that are uncontrollable or not responding to medication is neuromodulation. Transcranial magnetic stimulation, transcranial direct current stimulation, non-invasive vagus nerve stimulation, and supraorbital transcutaneous stimulation are some of the modalities available. Deep brain stimulation, occipital nerve stimulation, sphenopalatine ganglion stimulation, and implanted vagus nerve stimulation are examples of invasive techniques.
