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Treating migraine early during the first two hours of the attack can improve outcomes. A number of migraine patients develop allodynia, in which usually nonpainful sensory stimuli such as wearing a hat or a hairband can become painful. After allodynia has developed, headaches are less responsive to treatment. So treating early in the course of an attack can maximize response rates. Both prescription medications such as triptans and OTC NSAIDs such as aspirin or acetaminophen are often more effective when given early. When appropriate, combining a prescription medication such as a triptan with an OTC medicine can improve response rates as well as the duration of response to treatment.


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Mind-body therapies such as yoga, tai chi, and approaches such as mindfulness-based stress reduction can all be of substantial value for both headaches and overall well-being. One study compared six months of yoga practice to topirimate for the prevention of migraine and found similar excellent reduction in headache rates in both groups as well as improvement in anxiety and depression scores in the yoga group.4


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Biofeedback can be a valuable tool in the treatment of migraine. Many types have been used successfully, including respiratory-rate biofeedback, heart rate-variability biofeedback, electromyography biofeedback, thermal biofeedback, and neurofeedback. Patients treated with thermal biofeedback who raised the temperature of their fingers to 92° F to 93° F had substantial reductions in headache. This represents a higher response rate than typically achieved with prophylactic mediation. Neurofeedback for headache often involves about 20 sessions and generally is not covered by most insurance plans, though flexible spending and health savings accounts could potentially be used.



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Successful headache care often requires a spectrum of therapies. By understanding the array of effective OTC, herbal, supplement, and nonpharmacologic approaches, we can empower our patients to control their headaches and lead healthier, happier and more productive lives. 


Although functional MRI data show activation of different brain centers during different phases of migraine, the current diagnosis of migraine is based on clinical criteria. Adult patients need to have five or more attacks without aura or two more attacks with aura lasting 4 to 72 hours that meet specific criteria to be diagnosed with migraine.


Dawn Kaderabek, APRN, CDP, specializes in family medicine at the Mayo Clinic Department of Family Medicine in Rochester, Minn.


References


  1. Zagami AS, Goddard SL. Practical neurology part 7—recurrent headaches with visual disturbance. Med J Aust. 2012;196(3):178-183. 

  2. International Headache Society. The International Classification of Headache Disorders, 3rd ed. (beta version). Cephalalgia. 2013;33(9):629-808.

  3. Boes CJ, Capobianco DJ. Chronic migraine and medication-overuse headache through the ages. Cephalalgia. 2005;25(5):378-390.

  4. John, PJ, Sharma N, Sharma C, Kankane A. Effectiveness of yoga therapy in the treatment of migraine without aura: a randomized controlled trial. Headache. 2007;47:654-661.