What do do when I feel a migraine come on?

Question

I get headaches every night but have only had two doozy migraines ever (I was released from the hospital from one this morning). What do I do when one comes one? The two that I have had have woken me out of a sound sleep in the night. What do I do when they hit? I was prescribed topamax.

Answer 1

Jen,

Migraines are very complex issues, I'm not sure about the hospital giving you Topamax when you are reporting a history of only 2 headaches fitting a migraine pattern in your life.

Contrary to advice given by others, Topamax is used to prevent migraine headaches, not to abort or treat the acute symptoms of migraine. It is meant to be taken daily as instructed until your physician instructs you to stop taking the medication. Also while the normal starting dose for topiramate is 25 mg per day, it is often used at much higher doses to manage the recurrance of migraines. Topamax (topiramate) is actually a medication designed for the treatment of seizure disorders, and is thought to control the recurrance of migraines by decreasing the excitability of the neurotransmissions in the brain.

This is a good medication when patients do not experience side effects, but patients need to have a method for controlling the acute symptoms of migraines even when on preventive medications.

The largest percentage of people with migraines are able to abort the migraine with over-the counter treatments, such as acetaminophen (paracetamol), aspirin, ibuprofen or combination medication medications such as Excedrin Migraine (which contains 250 mg of Aspirin, 250 mg of Tylenol, and 65 mg of caffeine in each tablet). Aspirin has a ceiling effect at 800 mg so taking 1000 mg does not help but does increase the risk of gastric bleeding. Tylenol is generally effective at 650 mg, so if you are going to exceed the bottle directions take no more than 3 tablets at a time, any more just waste your money and risk side effects for no medical benefit.

If you are having recurrent or chronic headaches you need to see a health care provider. They can pick the proper abortive medication for the acute headache. There are numerous medications out there, but as they are prescription, and as you need to know all about the headaches to select the proper medication, that should be left to the physician, or nurse practitioners. The most effective abortive medications currently in use are a class of drugs called the triptans, and includes a medication called Imitrex. There are also the ergotomine derivitive substances. In cases with no effect from other measures, opioids are sometimes used in rare circumstances. Frequently, an injection of an anti-nausea medication can relieve a migraine, and has the side benefit of relieving the nausea often associated with the migraine.

If you feel you need to see a doctor, I recommend that you go to the following site prior to your visit:

http://www.headaches.org

In the consumer area, see the educational resources tab.

Print and fill out the headache diary as shown.

People say there are several causes for migraines, and this is not thought to be the case. The actual cause is not proven, but there is a current consensus theory. What people often say are causes are actually called triggers, they do not cause the headaches, but they can trigger the effect. There are activities and foods to be avoided, however, each person's triggers are individual. This is the purpose for the diary noted above. It helps you to discover your triggers so they can be avoided or eliminated.

You have stated that you have been awakened by the migraines on both occasions. While some patients have been awakened with migraine headaches at 3 or 4 am, it is much more common for patients with cluster headaches to be awakened at night with headache pain, and are often misdiagnosed as having migraines.

The common triggers for migraines for the most part do not apply in patients with headahce which awake them from sleep (such as bright light, caffeine etc) some food substances and sleep sdisorders can produce migraine triggers however.

See the How to talk to your headache doctor page. This will help you know what information is important to report so the doctor can properly diagnose and treat your headaches.

I also recommend the pages on analgesic rebound, and diet.

Do not take Imitrex of any one else’s migraine medication without a health care provider’s approval. I have seen patients with severe hypertensive crisis bordering stroke and cardiac problems due to taking a medication which was inappropriate for them. Also there are some types of migraine which are not recommended for the new migraine wonder drugs, ie. Hemiplegic and basilar artery migraines.

There are many non medication methods which are beneficial also, such as biofeedback, and acupuncture. I also feel that chiropractic can be beneficial for some forms of migraine, but in some forms it can cause permanent disability and possibly death. I advise you have a diagnosis of the type of migraine and be clear to try chiropractic before trying any alternative techniques.

Until you can be seen the best methods for managing migraines without medication abortives, are cold compresses, relaxation, dark quiet areas, sleep.

You can try an accupressure technique.

For acute pain find a painful point 3-6 mm behind your thumb nail and press it, the headache should disappear or decrease within 30 seconds. For forehead pain the points are in front of nails on the finger tips or 3-7 mm below

Seek the assistance of your primary care clinic and if no improvement a specialist in headaches.

As a fellow migraine sufferer, I wish you the best.

Answer 2

When you feel a migraine coming on, take your Topamax! I suggest keeping a food diary - a lot of migraines can be triggered by foods (chocolate, wine, cheeses, etc). Try and find what your trigger is. Do you get migraines from sitting in front of the computer? Bright lights? Fluorescent lights? Stress? or just out of nowhere? I am a longtime migraine sufferer, and I know how debilitating they can be. Sometimes just lying in the dark with it very quiet, and a cold washrag on my head, can help. If you get nauseous with the migraines, have you ever tried Dramamine? it is for motion sickness, but is also used as an antiemetic med (anti nausea). If you find the headaches are from stress, try doing yoga or learning some other relaxing techniques. Good luck, I truly sympathize!!

Answer 3

Just to be 100% sure, your headaches ARE on just one side of the face, right? When a migraine comes on, the first thing you should do is take your Topamax. Then go lie down in a quiet, dark room.
I've seen one woman have to try 3 different meds before she found the right one. So don't be discouraged if the
Topamax doesn't work. There are dozens of others. I wish you the best of luck, and don't be afraid to tell the doc if the Topamax doesn't work. Just try another one. If you'd like the list of migraine meds, feel free to E-mail me.

Good luck, hon! :)

Answer 4

I thought there was a prescription drug you could get from your doctor?? Do you drink plenty of water, headaches can originate from dehydration.