The goal of migraine treatment is to reduce the frequency of attacks, alleviate acute symptoms, and improve the quality of life for patients. Physicians typically develop personalized plans based on the severity of the condition, combining both pharmacological and non-pharmacological strategies. Effective treatment requires close collaboration between the patient and the physician, with regular assessments of treatment efficacy and adjustments to the plan.
Treatment strategies are divided into two main directions: acute symptom control and preventive management. Acute treatment aims to relieve pain and associated symptoms, while preventive treatment targets patients with frequent attacks to reduce the risk of occurrence. In recent years, new discoveries in the neurobiology of migraines have also driven innovations in treatment methods.
Modern medicine offers various treatment avenues, including:
Physicians will choose appropriate options based on the patient's age, symptom severity, and complications. Some patients may require a combination of multiple treatment methods, such as using medications during acute attacks while also engaging in long-term preventive treatment.
Acute treatment medications should be used at the onset of headaches to maximize effectiveness. Trigeminal vascular system modulators like sumatriptan can constrict dilated blood vessels and block inflammatory substances. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin are commonly used as first-line options, but long-term use requires caution regarding gastrointestinal side effects.
New CGRP antibody medications (such as erenumab) target the neurotransmission pathways of migraine attacks and can effectively block pain signal transmission. Spray or subcutaneous injection forms provide rapid absorption routes, suitable for patients with movement disorders. Physicians will select the appropriate formulation based on the intensity of pain and symptom characteristics.
Patients experiencing more than four attacks per month typically require preventive medications. β-blockers (such as propranolol) can stabilize neuronal excitability, and anticonvulsants like sodium valproate are also widely used. The antidepressant amitriptyline is utilized as a low-dose preventive treatment due to its neuromodulatory properties.
New monoclonal antibody medications like galcanezumab are administered via subcutaneous injection once a month and can significantly reduce the frequency of attacks. Physicians will regularly assess the effectiveness of the medication and reevaluate whether to adjust the dosage or type of medication after two to three months of treatment.
Transcutaneous electrical nerve stimulation (TENS) and magnetic stimulation therapy (sTMS) can modulate brain excitability. Unilateral stimulators (such as Cefaly) deliver stimulation through forehead electrodes to interrupt attacks by targeting the trigeminal nerve. These methods are suitable for patients who cannot use medications or wish to reduce their dependence on them.
Repetitive transcranial magnetic stimulation (rTMS) has been approved by the FDA for the treatment of chronic migraines, with weekly treatments capable of long-term modulation of the brain's pain networks. These techniques offer non-invasive alternatives with fewer side effects.
Cognitive behavioral therapy (CBT) helps patients identify and adjust thought patterns that trigger stress, and combined with relaxation training, it can reduce symptom severity. Mindfulness meditation and progressive muscle relaxation training have been shown to decrease the frequency of attacks.
Biofeedback devices assist patients in becoming aware of and controlling autonomic nervous responses, and through breathing training and heart rate variability adjustments, long-term use can improve symptom management capabilities.
Regular routines and dietary patterns are crucial for controlling migraines. Establishing a consistent sleep cycle can reduce the frequency of attacks by over 50% in patients, with recommendations for 7-8 hours of sleep per night and avoiding weekend oversleeping. Specific foods containing tyramine and nitrites should be avoided, and some patients may need to track triggers through a food diary.
Regular exercise promotes endorphin release and regulates stress hormones, with aerobic activities such as swimming and jogging recommended three times a week to reduce symptom intensity. However, vigorous exercise should be avoided as it can trigger exercise-induced migraines, and starting with low-intensity training is advised.
Gene therapy and precision medicine are hot research topics, with customized treatments targeting specific genetic markers currently in clinical trial phases. Vagus nerve stimulators and deep brain stimulation devices have shown therapeutic potential and may develop into implantable treatment options for chronic patients in the future.
Artificial intelligence-assisted diagnostic systems can analyze patient biomarkers and treatment responses to predict the best drug combinations. Minimally invasive drug delivery systems, such as transdermal patches and nasal sprays, can enhance drug absorption efficiency and reduce side effects.
Immediate medical attention should be sought when symptoms meet the following criteria: more than four attacks per month, diminished effectiveness of current medications, symptoms affecting daily functioning, or changes in aura symptoms. Sudden worsening of headaches or accompanying neurological symptoms (such as limb weakness) require urgent evaluation.
Adjustments to treatment plans should be evaluated every 3-6 months, with physicians adjusting medication types or dosages based on changes in symptoms. Patients should actively maintain a "headache diary" to track triggers and treatment responses, which is crucial for developing a personalized treatment plan.
In addition to medication, resting in a quiet, dark environment, applying an ice pack to the head or neck, or practicing deep breathing relaxation exercises can provide immediate relief. Some patients find relief through acupuncture or head massage; it is recommended to avoid light and sound stimulation during acute phases and maintain a relaxed posture.
Do preventive medications need to be taken long-term? What are the potential risks?Preventive medications typically need to be taken regularly for 4 to 6 weeks before assessing effectiveness; if effective, they may need to be continued for over 6 months. Common medications such as β-blockers or anti-anxiety medications may cause side effects like fatigue and gastrointestinal discomfort, requiring regular evaluation of risks and benefits with a physician, as well as monitoring liver and kidney function.
How can I determine migraine triggers? What details should I note in my daily records?It is recommended to use a diary to track the timing, intensity, duration of attacks, as well as daily diet, sleep, and stress levels. For example, recording caffeine intake, weather changes, or specific foods (like cheese or processed foods) can be helpful. After accumulating data, analysis with a physician can assist in identifying personalized triggers.
Can migraine patients exercise? What is the relationship between exercise and attacks?Regular aerobic exercise (such as jogging or swimming) can reduce the frequency of attacks, but excessive fatigue or vigorous exercise should be avoided. It is advised to pause exercise during attack periods, and after the acute phase, to start with low-intensity activities while ensuring hydration and avoiding triggers like low blood sugar or cold environments.
Why do migraines occur with nausea or photophobia? How can these symptoms be alleviated?The neuroinflammatory response in migraines may lead to autonomic nervous symptoms such as nausea, vomiting, and sensitivity to light or sound. Relief can be achieved through medications containing anti-nausea components, or by wearing eye masks and earplugs to block stimuli, while maintaining a side-lying position and replenishing small amounts of fluids.
%201.svg)
Copyright © 2025 MedFrontiers. All Rights Reserved.
