Biomedical Treatments for Migraine

The biomedical treatment of migraine is a three-pronged approach: avoidance of recognized triggers, prompt treatment of acute attacks, and preventive antimigraine therapy.

 Triggers are tracked using a migraine diary. The diary lists possible triggers such as weather, stress, menstruation, and diet.

Pharmaceuticals treat acute migraine. The drugs of choice for the past 20 years have been triptans (sumatriptan, naratriptan, zolmitriptan, eletriptan, almotriptan, frovatriptan, and avitriptan). All seven triptans are available in the form of pill, injection, nasal spray, and dissolving oral tablets.

Triptans leave the patient clear-headed while reversing nausea and pain. The side effects of triptans include tingling; flushing; and sensations of warmth, heaviness, pressure, or tightness in different parts of the body including the chest and neck. These drugs provide headache relief in 75% of patients.

Acupuncture provides a nonpharmacological treatment for migraine pain. Positron emission tomography (PET) and magnetic resonance imaging (MRI) scans have demonstrated how acupuncture modulates brain structures. Acupuncture affects the mechanisms of pain by its vasodilatory effect on the radial artery diameter. Acupuncture also affects cell secretion and signaling and afferent sensory input and the activity of norepinephrine,  angiotensin II, serotonin, enkephalin, beta-endorphin, and glutamate.

Acupuncture has a strong analgesic effect and should be used in migraine treatment.

Acupuncture has been found to be more effective than both control treatment and preventive migraine pharmaceuticals. A prospective randomized trial documented the prophylactic benefit of acupuncture in migraine.

 The research demonstrated that after a 12-week treatment protocol, the acupuncture group experienced larger decreases in monthly moderate-to-severe headaches compared to the topiramate group.

Traditional Chinese medicine (TCM) theory classifies migraine as an external invasion or an internal disruption. The qi and blood of the six bowels and five viscera all ascend to the head. The three hand yang channels, the three foot yang channels, and the liver channel all meet at the head. Stagnation of qi and blood is often present with migraine. The excess type of migraine, typically short in duration, is from external forces such as wind, cold, dampness, or heat. Wind is the most common external element.

Persistent migraine is caused by internal disruption concerning the liver, spleen, and kidney. These organs exhibit signs of deficiency in addition to signs of liver yang rising. Deficiency patterns generally present with observable excesses, such as phlegm and blood stasis.

Other factors include weather, emotions, sexual activity, diet, posture, menstruation, and hypertension. Damp phlegm accumulation due to eating fatty, greasy, or sweet food or dairy products initiates migraine. Drinking alcohol or eating pungent food can cause flare-ups of stomach or liver fire.

A headache that worsens with pressure is usually due to an excess condition.

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