Sep 23, 2013
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
No navigator to find my way home. Unladen, empty, and turned to stone. A soul in tension that's learning to fly. Condition: grounded - determined to try. Can't keep my eyes from the circling skies. Tongue-tied and twisted; just an earth-bound misfit, I. Those Pink Floyd lyrics from Learning to Fly kept circling through my head as I watched this incredible YouTube video of an eagle flying. What made the video incredible was the camera was somehow mounted to the eagles back. I felt like I was the one flying above those mountains and trees. I felt as if I was flying like an eagle. Perhaps the opposite of flying like an eagle is being grounded by a migraine. Migraine headaches come and go in sufferers lives. Each episode can last 4 to 72 hours and can drastically affect quality of life. Although there are many medications to treat the migraine when it occurs, this time we are going to focus on preventing migraines from happening.
When should we give people medication to prevent or reduce future migraines? It can be useful for anyone who gets migraine headaches, but usually doctors will start talking about adding preventative medications when a person has migraines more than 2 days per week. We hope that the preventative medication will reduce the number of migraines a person gets by half. We also hope they will have less pain when they get a headache and that their migraine treatment medication will work better. Migraine prevention medications do not act quickly. We hope they can reduce the number of migraines a person gets after 6 to 8 weeks.
The medication that is chosen the most often to prevent migraine headaches is propranolol. It is a beta-blocker and is often used as a heart and blood pressure pill because it slows down the heart. So propranolol is a good choice in a patient who has migraines and high blood pressure. It is a bad choice if the person has migraines and asthma. Propranolol can make asthma worse and make asthma medications not work as well.
Amitriptyline is often chosen next after propranolol. It is a tricyclic antidepressant and so it can be a good choice if the migraine patient also has depression or sleeping problems. Amitriptyline can also be effective for tension headaches. It does have some side effects, though. Those include dry mouth, constipation, heart problems and confusion. Sometimes we use propranolol and amitriptyline together to prevent migraines.
Topiramate is an anti-seizure medication. It is also effective at preventing migraines. It is not used that often as it has more side effects than amitriptyline or propranolol and it is much more expensive. It can cause glaucoma, kidney stones, and swelling of the brain.
The migraine prevention technique I found most surprising was weight loss. I just never thought about the link between weight and migraines. In the September 2013 issue of Neurology, Peterlin et. al published an interesting survey. They interviewed 3862 people to find if episodic migraines were influenced by obesity, age, sex and race. They defined episodic migraines as having less than 14 migraines per month. Only 188 of the people met the criteria of having episodic migraines, but the researchers found that people who were obese were more likely have migraines than normal weight people. This relationship between obesity and migraines was strongest in white females under the age of 50. The researchers said the reason for the link between obesity and migraines is unknown.
There was another small study published by Varkey et. al. in July 2011 Cephalagia that took 90 people with migraines and divided them into an exercise group, a relaxation group and a topiramate group. The exercise group exercised for 40 minutes three times per week. The relaxation group was given a recorded self relaxation program to follow. All three groups had less migraines than at baseline. This study was so small that it is tough to draw too many conclusions, but it is interesting that exercise may be able to prevent migraines at a similar rate to topiramate.
A last tiny study published by Bond et. al. in March 2011 Neurology looked at the migraines of very overweight people who had gastric surgery to lose weight. There were only 24 people in this study and they were mostly women. The participants were interviewed about their migraines, then had surgery and lost a lot of weight. Then 6 months later they were interviewed about their migraines again. Again, this tiny skewed sample makes it hard to generalize, but the participants had fewer migraines after their surgery and weight loss.
Above the planet on a wing and a prayer. My grubby halo, a vapour trail in the empty air. Across the clouds I see my shadow fly
out of the corner of my watering eye. I know that learning to fly is an unattainable dream for me. But the dream of reducing the frequency or even eliminating migraines doesnt need to be. We have medications you can talk to your doctor about to help prevent migraines. And there might be weight loss and exercise. These three studies are a long way from saying definitely that being overweight causes or contributes to migraines. We also cant say definitely that losing weight and exercise will prevent migraines. But with all the other benefits we know that go with weight loss and exercise, if you have migraines talking to your doctor about an exercise and weight loss program might not be a bad idea.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
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As always if you have any questions or concerns about these products, ask your pharmacist.
Pink Floyd Learning to Fly - http://www.youtube.com/watch?v=En_JVlpXodM
POV Eagle Video - http://www.youtube.com/watch?v=t1xpIcZeVws