Collection of lab or imaging studies to rule out conditions apart from migraine headache depends upon the individual demonstration (eg, erythrocyte sedimentation rate and C-reactive protein levels might be proper to exclude temple/giant cell arteritis). Neuroimaging isn’t essential in patients having a history of recurrent migraine head aches as well as a standard neurologic assessment.
The American Headache Society released a set of 5 generally performed tests or processes which aren’t necessarily required in treating migraine and headache, within the American Board of Internal Medicine (ABIM) Foundation’s Selecting Wisely effort. The recommendations contain[2,3]:
* Do Not perform neuroimaging studies in patients with steady head aches that satisfy standards for migraine.
* Do Not perform computed tomography imaging for head ache when magnetic resonance imaging is accessible, except in crisis settings.
* Do Not advocate operative deactivation of migraine cause points outside of a clinical trial.
* Do Not prescribe opioid or butalbital-including drugs as first-line treatment for recurrent headache ailments.
* Do Not urge lengthy or regular use of over the counter pain medications for headache.
Pharmacologic agents useful for treating migraine may be categorized as abortive (ie, for relieving the acute phase) or prophylactic (ie, preventive).
Acute treatment intends to invert, or at least stop the progression of, a head ache. It’s best when given within 15 minutes of pain start and when pain is light.
Abortive drugs range from the following:
* Selective serotonin receptor (5-hydroxytryptamine1, or 5HT1) agonists (triptans)
* Mix products
The following may be considered indicators for prophylactic migraine treatment:
* Duration of individual episodes is longer than 24 hours
* The head aches cause major disruptions in the individual ‘s lifestyle, with critical impairment that lasts 3 or more days
* Abortive treatment fails or is overused
* Symptomatic drugs are contraindicated or ineffective
* Use of abortive drugs more than two times a week
* Migraine forms like hemiplegic migraine or infrequent headache episodes creating deep disruption or threat of long-term neurologic injury
Prophylactic drugs contain the following:
* Serotonin antagonists
* Botulinum toxin
Treatment of migraine might likewise incorporate the following:
* Decrease of migraine causes (eg, insufficient sleep, tiredness, anxiety, certain foods)
* Nonpharmacologic treatment (eg, biofeedback, cognitive-behavioral treatment)