With approximately 40 million people in the US alone living with migraine and a stunning lack of mandatory education on headache disorders in medical schools, many people with migraine remain at a loss on how to navigate preventive treatment. Visits to doctors often end up with a “one and done” attitude, not taking into account the importance of a toolbox approach. Between following up on insurance denials and guidelines for step therapy, and a devastating shortage of certified headache specialists, patients living with this disabling disease often find themselves without adequate and current information. Having a personalized, preventive care toolbox can go a long way to helping figure out how to maintain a quality of life that most people take for granted.
Increasingly, doctors who are educated on headache medicine, as well as patient advocacy organizations, look at migraine treatment from a toolbox perspective. This perspective focuses on partnering with patients to discover a personalized mix of treatment tools. Not only can this help prevent episodic migraine from getting more frequent or becoming chronic, but can even help people with chronic migraine go back to being episodic and regain more quality of life. In this blog, we’re going to look at some of the different categories you can consider for your personalized preventive care toolbox.
Thankfully the situation is no longer the same as it was for those of us who were children in the mid to late 1900s. There are many prescription medications now, including some that are finally specifically designed for migraine prevention rather than being “borrowed” from other disease spaces. Insurance companies often set up obstacles to reduce access to some of these treatments, but when patients work together with their doctors to appeal denials, treatment access is often successful, so determination and perseverance are crucial! The options include the following, but you can find a complete list in our Migraine Toolbox:
- Oral tablets or capsules—e.g., tricyclic antidepressants, anti-epileptics, beta-blockers, calcium channel blockers, and gepants (designed specifically for migraine)
- Injections—e.g., monoclonal antibody CGRP inhibitors (designed specifically for migraine for patients to use at home)
- IV infusion—e.g., monoclonal antibody CGRP inhibitor (designed specifically for migraine and administered in a doctor’s office)
- Nerve blocks—e.g., onabotulinum toxin A, occipital and trigeminal nerve blocks, SPG blocks
Non-Invasive Medical Devices
There are now 5 FDA-cleared medical devices for migraine. Three of those are already cleared for preventive treatment in addition to abortive treatment, and two are in clinical trials for the additional indication for preventive treatment.
- Cefaly®—FDA cleared for both preventive and abortive treatment
- gammaCore™—FDA cleared for both preventive and abortive treatment
- Nerivio®—FDA cleared for abortive treatment and in clinical trials for preventive
- Relivion MG®—FDA cleared for abortive treatment and in clinical trials for preventive
- SAVI DUAL™—FDA cleared for both preventive and abortive treatment
It can be challenging to make lifestyle changes when you are not feeling well, and even more so when you see other people around you not having to take the same approach. However, lifestyle changes can make a huge difference in preventive care, especially in the toolbox approach. Things to consider include:
- Getting regular sleep
- Having a healthy diet
- Making sure you are hydrated
- Getting regular exercise – note: as long as it doesn’t trigger a migraine attack!
There are few OTC supplements to consider for preventive care which show some evidence of efficacy. The most common ones recommended by doctors include the following, but for a full list see our Migraine Toolbox:
- Vitamin B2 / riboflavin
- Butterbur (PA-free)
- Anti-inflammatory supplements (e.g. turmeric, boswellia)
Integrative treatments can play a huge role in a preventive treatment toolbox, however the cost can be prohibitive, and insurance coverage can vary widely from plan to plan. However, some of the options are affordable or free, and insurance does sometimes cover those that are more expensive. Some of the things to consider include:
- Cognitive Behavioral Therapy
- Mindfulness and Meditation
- Therapeutic Massage
If you have migraine, and are considering preventive treatment or looking to adjust your preventive protocol, it’s important to talk to your doctor about which of these options are best for you. Bearing in mind, of course, that there is no way to know ahead of time which treatments will work for you specifically without first trying them, this can be a long process and one that may need to keep being adjusted. This process becomes a lifelong journey for many, that takes not only partnership with your doctor, but also perseverance, hope, and time! So don’t give up – you are not alone in this journey, and there is always hope!
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