How is a migraine diagnosed?

If you think you get migraine headaches, talk with your doctor. Before your appointment, write down:

   1. how often you have headaches
   2. where the pain is
   3. how long the headaches last
   4. when the headaches happen, such as during your period
   5. other symptoms, such as nausea or blind spots
   6. any family history of migraine
   7. all medications you are taking, even those that are over-the-counter (better still, bring the medicines in their containers to the doctor)
   8. all the medicines you have taken in the past that you can recall and, if possible, the doses you took and any side effects you had

Your doctor may also do an exam and ask more questions about your health history. This could include past head injury and sinus or dental problems. Your doctor may be able to diagnose migraine just from the information you provide.

You may get a blood test or other tests, such as CT scan or MRI, if your doctor thinks that something else is causing your headaches. Work with your doctor to decide on the best tests for you.

How are migraines treated?

Migraine has no cure. But your migraines can be managed with your doctor's help. Together, you will find ways to treat migraine symptoms when they occur, as well as ways to help make your migraines less frequent and severe. Your treatment plan may include some or all of these methods:

Drugs
There are two ways to approach the treatment of migraines with drugs: stopping a migraine in progress (called "abortive" or "acute" treatment) and prevention. Many people with migraine use both forms of treatment.

Acute treatment Over-the-counter pain-relief drugs such as aspirin, acetaminophen, or NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen relieve mild migraine pain for some people. If these drugs don't work for you, your doctor might want you to try a prescription drug. Two classes of drugs that doctors often try first are:

    * Triptans, which work by balancing the chemicals in the brain. Examples include sumatriptan (Imitrex®), rizatriptan (Maxalt®), zolmitriptan (Zomig®), almotriptan (Axert®), eletriptan (Relpax®), naratriptan (Amerge®), and frovatriptan (Frova®). Triptans can come as tablets that you swallow, tablets that dissolve on your tongue, nasal sprays, and as a shot. They should not be used if you have heart disease or high blood pressure.
    * Ergot derivatives (ergotamine tartrate and dihydoergotamine), which work in the same way as triptans. They should not be used if you have heart disease or high blood pressure.

Most acute drugs for migraine work best when taken right away, when symptoms first begin. Always carry your migraine medicine with you in case of an attack. For people with extreme migraine pain, a powerful "rescue" drug might be prescribed, too. Because not everyone responds the same way to migraine drugs, you will need to work with your doctor to find the treatment that works best for you.

Beware the rebound
Women who use acute pain-relief medicine more than two or three times a week or more than 10 days out of the month can set off a cycle called rebound. As each dose of medicine wears off, the pain comes back, leading the patient to take even more. This overuse causes your medicine to stop helping your pain and actually start causing headaches. Rebound headaches can occur with both over-the-counter and prescription pain-relief medicines. They can also occur whether you take them for headache or for another type of pain. Talk to your doctor if you're caught in a rebound cycle.