A multi-component approach in migraine and other primary headaches that includes reducing triggers, treating attacks, and providing preventive treatment for those with frequent attacks. The type of treatment is selected according to the frequency and severity of attacks.
Indication
- Recurrent throbbing, usually one-sided headache attacks (suspected migraine)
- Patients diagnosed with migraine, with or without aura
- 4 or more attacks per month or headaches severe enough to disrupt daily life
- Medication overuse headache caused by frequent acute medication use (analgesic-dependent headache)
- Other primary headaches such as tension-type headache and cluster headache
- Chronic headache in which secondary causes (tumor, hypertension, sinusitis) have been excluded
- Headaches during pregnancy or breastfeeding requiring a special treatment plan
Preparation
- Keep a headache diary for at least 4 weeks including the duration, severity, and triggers of your attacks
- List all current prescription/over-the-counter medications, herbal products, and their doses
- Bring along previous brain MRI/CT reports and blood test results
- Inform your physician especially about visual aura, speech disturbance, or sudden and very severe ('the worst headache of my life') headache
- Note triggers related to caffeine, alcohol, sleep patterns, stress, and hormonal cycles
How it's performed
- The physician distinguishes primary from secondary headache through detailed history and neurological examination
- If deemed necessary, blood tests, brain MRI, or other investigations are planned
- For acute treatment, simple analgesics, NSAIDs, triptans, or, if needed, new-generation (gepant) medications are evaluated
- Preventive treatment is started in those with frequent attacks; beta-blockers, certain epilepsy medications, antidepressants, and CGRP-targeted therapies are among the options
- In selected chronic migraine cases, onabotulinum toxin injection may be an option
- Lifestyle adjustments (sleep, nutrition, hydration, exercise) and behavioral approaches are an integral part of treatment
Post-procedure
- The response to newly started treatment is generally evaluated within 8-12 weeks
- Use of acute medications more than 10 days per month may lead to medication overuse headache; usage frequency is monitored regularly
- If preventive treatment provides a meaningful reduction in attack frequency and severity, it is continued for certain periods and then re-evaluated
- The headache diary should be continued both to monitor treatment response and to adjust dosing
- If new neurological signs or unusual headache develop, urgent evaluation is needed
Risks
- Triptans have vasoconstrictive effects, so they are used cautiously in uncontrolled hypertension and cardiovascular disease
- Preventive medications (beta-blockers, antidepressants, antiepileptics) may cause side effects such as fatigue, weight changes, and changes in sleep-mood
- Frequent acute medication use may paradoxically cause medication overuse headache
- CGRP-targeted therapies (monoclonal antibodies and gepants) are relatively new treatments; long-term observation is ongoing, and efficacy and cost may vary by patient and treatment
- Treatment selection differs in pregnancy, breastfeeding, childhood, and old age; individual risk-benefit assessment is required
FAQ
Can migraine be completely cured?
Migraine is mostly a chronic, predisposition-based neurological condition. A 'definitive cure' cannot be guaranteed; however, with proper treatment, trigger management, and lifestyle adjustment, the frequency and severity of attacks can be substantially reduced in most patients.
Are CGRP antagonists and antibodies suitable for everyone?
No. CGRP-targeted new therapies are generally considered in patients with chronic/frequent migraine who have an inadequate response to several conventional preventive treatments or cannot tolerate them. Their use is restricted in special situations such as pregnancy; the decision is made individually with the physician.
Can I take my acute medication for every headache?
No. Use of acute medications such as triptans more than 10 days per month, or simple analgesics more than 15 days per month, may cause medication overuse headache. If you have frequent attacks, preventive treatment may be needed; plan this with your physician.
When should I go to the emergency department for a headache?
Go to the emergency department for a sudden-onset headache described as 'the worst of my life,' headaches accompanied by speech disturbance, weakness, vision loss, change in consciousness, high fever, neck stiffness, or after head trauma.
Related Information
Related Medical Services
Other services in the same specialty or with similar indications you may want to explore.
Electroencephalography
Neurology
Electroencephalography (EEG) — painless surface recording of the brain's electrical activity.
Neurological Examination and Assessment
Neurology
Neurological examination and assessment — a systematic clinical evaluation of the brain, spinal cord, nerves, and muscle system.
Botulinum Toxin Injection (Neurological)
Neurology
Botulinum toxin injection (neurological) — muscle/nerve treatment for dystonia, spasticity, and chronic migraine.
Vertigo Treatment
Neurology
Vertigo treatment — identification of the cause of dizziness and management with maneuvers, medication and rehabilitation.
Electromyography
Neurology
Electromyography (EMG) — a test that measures the electrical activity of muscles and nerves.
Nerve Conduction Study
Neurology
Nerve conduction study — non-invasive measurement of conduction velocity and signal amplitude in peripheral nerves.
Epilepsy Diagnosis and Treatment
Neurology
Epilepsy diagnosis and treatment — determining the seizure type and managing antiepileptic medications.
Stroke assessment
Neurology
Stroke (cerebrovascular accident) emergency assessment — critical 4.5-hour window for tPA, 24-hour window for thrombectomy.