What is the best way to manage migraines in the long term?

Question

Hello Doctor,

I have been getting intense headaches about three to four times a month. They usually start on one side, throb for hours, and come with nausea and sensitivity to light. Sometimes I even see flashing lights beforehand. I think these might be migraines. How are migraines diagnosed for sure? Are there daily medications that can help reduce their frequency? I have also noticed they tend to occur during periods of high stress. Could stress be a trigger? What’s the best way to manage them in the long term?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Migraine diagnosis is primarily based on a detailed medical history and thorough physical and neurological examinations, as there are no specific blood tests or imaging studies that can definitively confirm migraines. Physicians assess symptoms, rule out other possible conditions, and may order imaging tests such as magnetic resonance imaging (MRI) or computed tomography (CT) scans to exclude structural or other neurological causes. To help reduce the frequency and severity of migraine attacks, daily preventive medications may be prescribed. These include beta-adrenergic blockers such as propranolol or Metoprolol, anticonvulsants such as Topiramate or Valproic acid, and tricyclic antidepressants such as Amitriptyline.

Newer options include calcitonin gene-related peptide (CGRP) inhibitors like Erenumab, as well as OnabotulinumtoxinA (Botox) injections, which are typically considered after other treatments have proven ineffective and may require referral to a specialist. For acute migraine attacks, medications such as triptans (for example, Sumatriptan or Rizatriptan) and CGRP receptor antagonists, also known as gepants (for example, Ubrogepant or Rimegepant) can be used. However, these should be taken no more than a few days per week to avoid medication-overuse headaches. Stress is one of the most common migraine triggers, with research suggesting it may play a role in up to 80 percent of cases. Stress can act as both a direct trigger and a contributing factor to a cycle of worsening symptoms, as the experience of managing chronic migraines can itself increase stress levels and lead to more frequent attacks.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.