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Migraines cause recurrent, severe headaches, often with throbbing pain on one side of the head. Some people notice visual changes, called an aura, before the headache begins, and many people also experience nausea, vomiting, and sensitivity to light or sound. Researchers believe migraines involve changes in brain activity that affect nerves and blood vessels in the head. Here’s information on some effective strategies for managing a migraine:
Rapid IV Relief Options
When migraines last longer than 24 hours and oral medications have not reduced the pain, a medical specialist may recommend IV therapy. IV treatment delivers fluids and medications directly into the bloodstream, allowing faster absorption than pills. It can also be an option for people who cannot keep oral medications down, due to nausea or other factors. A treatment may include a combination of the following:
- IV Fluids: Vomiting and reduced fluid intake during an attack can lead to dehydration. Fluids restore hydration, which helps ease some symptoms.
- Anti-nausea Medications: These target nausea and vomiting, and some may also help reduce headache pain.
- Anti-inflammatory Medications: IV nonsteroidal anti-inflammatory drugs (NSAIDs) help reduce inflammation that can contribute to migraine pain.
- Magnesium: Some research links low magnesium levels to migraines. IV magnesium may help calm overactive nerve signals.
A session usually takes one to two hours in a clinic, and your provider monitors your response throughout the infusion. Some common triggers include hormonal shifts, stress, poor sleep, skipped meals, and certain foods. An attack can last from a few hours to several days, so timely treatment is fundamental for managing headache pain.
Preventive Infusions
Preventive medications help reduce how often migraines occur and how severe they become, and many patients start with daily oral preventatives. These medications do not work for everyone. For patients who have tried oral preventatives without success, a preventive infusion may be an option. One type uses a medication that targets calcitonin gene-related peptide (CGRP), a protein involved in migraine pain signaling. Blocking CGRP may reduce migraine frequency over time for some individuals. The preventive infusion takes about 30 minutes and is usually given in a clinic once every three months.
Advanced Headache Interventions
When other treatments do not provide enough relief, specialists may recommend advanced headache interventions. Botox is approved for adults with chronic migraine, defined as 15 or more headache days per month. For this management option, a provider injects small amounts of the medication into specific head and neck muscles, helping to block the release of chemicals involved in pain signaling. Each session takes about 15 minutes, with repeat injections typically scheduled every 12 weeks.
Nerve blocks use a local anesthetic, sometimes combined with a steroid, to interrupt pain signals. An occipital nerve block targets the nerves at the back of the head. A sphenopalatine ganglion block targets a nerve cluster behind the nose; the provider applies the medication through a thin applicator placed in the nasal passage. Both procedures are performed in the office and take only a few minutes.
Transcranial magnetic stimulation (TMS) uses a handheld device to deliver brief magnetic pulses to the back of the head. These pulses interrupt abnormal brain activity associated with migraines. TMS does not require medication, and patients may use it during an attack or as part of a daily prevention routine. These advanced management options can be combined with other management options, like physical therapy, depending on your needs.
Address the Cause of Your Migraines
Migraines vary from person to person; what helps one individual may not help another. A migraine and headache specialist can evaluate your symptoms, review your treatment history, and identify possible triggers. If your migraines are frequent, long-lasting, or not responding to current medications, schedule a consultation with a headache specialist to discuss your options.
