The mainstay of treatment for migraine headache and atypical migraine symptoms is trigger identification and avoidance . This requires education about migraine triggers and the use of a migraine diary in which the patient is asked to record their symptoms and the probable trigger for that particular episode . Unlike many environmental and physiologic triggers , dietary triggers can be avoided . In general , an attempt to improve lifestyle by reducing stress , improving sleep habits , and adding regular exercise are beneficial . When done maximally , many patients will obtain near complete freedom from their migraines with this treatment alone .
At times , symptoms may be so constant that individual events and their triggers cannot be easily identified . In these cases , it may be helpful to give medications to elevate the threshold above which migraine triggering in the brain occurs . These may be medications originally used for blood pressure control , depression , or seizures , which have been found to be easily tolerated and very good at preventing frequent migraine , attacks . When this is successful , the breakthrough attacks , which do occur , are usually easily attributed to some particular trigger or aggravating factor , which can then be avoided . It may take 6- 8 weeks to respond to a medication , and it is common for a patient to have to try more than one medication . Patients requiring medications to elevate migraine threshold can realistically expect a 50-80 % reduction in symptom intensity and frequency .
If after maximizing the benefits of trigger identification and avoidance and medications to elevate the threshold of migraine , breakthrough headaches are still occurring , medications to abort acute attacks may be prescribed . There are now excellent medications that can help improve migraine symptoms both deep in the brain and those painful symptoms associated with sensitized blood vessels around the brain . These new medications are called triptans . Because they can cause rebound , they should not be used more than a few times a month . Doctors ’ opinions may vary on this .
Some patients will have occasional severe headaches , which can be aborted effectively with triptans without the risk of rebound . These patients should always be on the lookout for an increase in headache frequency and intensity that are the first signs of rebound . Long-term treatment of acute headaches with narcotics generally leads to increasing medication needs and must be considered very cautiously , especially in patients with histories of chemical dependency .
Migraine and Meniere ’ s Disease
There is increasing interest among ENT physicians in the connection between migraine and Meniere ’ s disease . Meniere ’ s disease is a disorder of the inner ear characterized by episodic fullness , tinnitus ( ringing ), hearing loss , and vertigo whose