New Approaches to Preventing Migraine Headaches

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Taking a shower hurts. Shaving hurts. Even your brain perceives the trigger, it begins a cascade of events. The headache will start developing within two hours or two days. In the beginning, blood vessels in your forehead start to swell up. This causes nerve fibers, which are coiled around the blood vessels, to release chemicals causing pain and inflammation.

A vicious cycle develops: The inflammation makes the blood vessels enlarge even more, making the pain only worse. When this chain-reaction process goes on for an hour or two, it achieves a new threshold.

“It’s called ‘central sensitization,’ and it tends to perpetuate the headache,” explains Seymour Solomon, MD, director of the Montefiore Headache Unit at Albert Einstein College of Medicine in the Bronx, N.Y. At that point, the chain-reaction of pain begins traveling along nerve pathways throughout the head, to the base of the neck and to the spine.

That’s when everything starts hurting, Solomon tells WebMD. The pain-nerve cells are stuck in the “on” position. The slightest touch or movement hurts. Even the pulse of blood in your types of migraines, not just menstrual headaches.

It’s an exciting finding. If altitude changes are your nemesis, then taking a long-acting triptan drug twice a day on the day before you go skiing in Utah and continuing it for a week may nip your migraine from starting at all.

New migraine drugs are also on the horizon. “A lot of drugs are coming down the pipeline, drugs that work by different mechanisms,” says Silberstein. One is a class of enzyme-blocker drugs, such as feverfew. Coenzyme Q10, which the body produces naturally, has also been shown to cut migraine attacks, but it’s pricier than the others, she adds.

You have to take magnesium for three months to get a benefit, says DeRossett. “People sometimes give up on it too soon.” Taking the correct dosage is important as well: 500 mg magnesium, 400 mg riboflavin (vitamin B-2), and 150 mg coenzyme Q10.

The herb butterbur can also help prevent migraine attacks, she adds. A recent study found that a daily 75 mg butterbur supplement cut migraine frequency by more than 50%.

“Our patients are on all kinds of high-powered migraine headache medications,” DeRossett tells WebMD. “These [magnesium, etc.] aren’t in the same ballpark as Depakote or Topamax. But for some people, magnesium might be enough. For others, it might provide added benefit in terms of relief.”