Chronic Migraine
There are medications available. Choice of treatment is determined by a number of factors, such as your age, asthma triggers, and your symptoms. For quick-relief of an asthma attack, the physician will prescribe a bronchodilator( inhaler) which will rapidly open your swollen airways to allow easy breathing. The drugs are administered with the use of a hand-held inhaler or a nebulizer which is a machine that converts the asthma medications to a fine mist. With a nebulizer, the medication will be inhaled through a face mask or mouthpiece. These medications should be taken at the first sign of symptoms. For children, the inhaler should always be available and it is important to establish dialogue with care-givers, teachers, and principals to advise them of the child’ s condition and need for quick intervention.
These“ rescue” medications include short-acting beta agonists which act within minutes to relieve the symptoms of the asthma attack. Albuterol and levalbuterol are examples of these inhaled drugs. Another bronchodilator, ipratropium, may be considered. Oral and intravenous corticosteroids, such as prednisone and methylprednisolone, are effective in relieving airway inflammation. Because long-term use of these agents can cause serious side effects, they should only be used for brief intervals.
If the inhaler is being used two or more times per week, your physician may consider preventive medications which control the asthma symptoms on a daily basis. These medications may also be administered by an inhaler and include corticosteroids( fluticasone, bedesonide, flunisolide, ciclesonide, beclomethasone, mometasone, and fluticasone). These medications are the preferred agents for long-term therapy, and may require several weeks of treatment to achieve maximum benefit. Their action reduces the inflammation and swelling of the airways as you respond to known triggers. Unlike oral corticosteroids, these drugs have a low side-effect profile and are usually safe for long-term therapy. However, your physician will follow you closely to lower your risk of prolonged effects from this form of treatment.
Another type of drug – leukotriene modifiers – are taken orally, and include montlukast, zafirlukast, and zileuton. These drugs aid in blocking the response that causes inflammation of the airways. There are potential risks to these agents and include psychological symptoms such as depression, agitation, hallucinations, aggression, and suicidal thinking. It is vital that you contact your physician for any untoward signs.
The beta agonists will be prescribed in combination with a corticosteroid inhaled agent as they may precipitate a severe asthma attack. Salmeterol and formoterol are types of these inhaled drugs which open the inflamed airways. The beta agonists should never be used alone or for an acute asthma attack. There are combination agents available which include a corticosteroid inhaler as well as a long-acting beta agonist. These include combination products such as fluticasone-salmetrol, budesonide-formoterol, and formoterol-mometasone. Again, with the addition of the beta agonist, the risk of a severe asthma attack is possible.
Theophylline, another brochodilator, is used as a daily pill to help maintain open airways and by relaxing the muscles around the airways. It is not prescribed as often as it was previously.
Certain drugs that are used for the prevention of migraine, are contraindicated for patients with respiratory problems. Propranolol, a beta blocker which has been approved for migraine prophylaxis since 1977, is contraindicated for patients with concurrent asthma. If you have migraine and asthma, other therapies are available.
Chronic Migraine
Chronic Migraine is defined as the occurrence of a headache( tension-type like and / or migraine-like) on 15 or more days per month, for at least 3 months. Patients with chronic migraine typically report a history of episodic migraine headaches. In chronic migraine, there is little recovery or no complete recovery between the migraine attacks. Treatment of chronic migraine is complex, and appropriate diagnosis must be established. Many of these patients have failed standard migraine preventive therapies and may also be experiencing medication-overuse headaches. These patients may also be experiencing other conditions( Table 3). Asthma has been identified as one of these coexisting disorders.
TABLE 3 Coexisting Conditions Associated with Chronic Migraine
Allergies Anxiety Arthritis Asthma Bronchitis Chronic pain Depression Fibromyalgia High cholesterol High blood pressure Obesity Sinusitis
20 HeadWise ® | Volume 6, Issue 2 • 2016