Q: My doctor has prescribed medication that seems to relieve the pain when I have a migraine headache, but lately attacks have occurred with increased frequency and are more severe. Do you have any suggestions that might help?
A: The management of migraine headaches involves two distinctly different goals. The first is to prevent attacks; the second is to treat headaches when prophylactic measures fail.
The initial step in the prevention of attacks is to try to recognize and avoid factors that may trigger your attacks. Foods that may provoke migraine include chocolate, ripened cheese, citrus fruits, sauerkraut, sausages, yeast and meat extracts, monosodium glutamate, excessive coffee use and alcoholic beverages, especially red wines. It is not necessary to eliminate all of these foods from your diet, but rather to assess whether consuming any of them seems to provoke attacks. Many other factors may initiate migraine headaches in some people. Among these are sensitivity to particular odors like cigarette or cigar smoke, gasoline fumes, paint, perfumes, after-shave lotions and fragrances added to various toiletries. Attacks may also be provoked by psychological stress, irregular or inadequate amounts of sleep, exposure to bright light and the use of some common medications.
You should also ask your doctor about the possible use of one of the following types of medication that can be effective in decreasing the frequency and severity of migraine attacks: beta-adrenergic blockers, calcium-channel blockers, tricyclic anti-depressants, monoamine oxidase inhibitors, serotonin antagonists and aspirin. Some experts begin with a daily aspirin in all patients with migraine and add one of the other medications listed above if the aspirin alone is ineffective. Because migraine attacks occur irregularly, it may be difficult to tell when one of these drugs is effective. For that reason, you should give any drug your doctor selects a trial of several months and keep a record of the timing and severity of your attacks during that period. Even if you do not respond to the selected drug, one of the others has a good chance of helping you.
When these preventive measures fail, many different medications can alleviate the severity of migraine attacks, particularly if taken at the onset of symptoms.
Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.