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Reader's Mail: Other Ideas for Treating Migraine

Q. I have had migraines for over 20 years. For many years now I have been on a beta-blocker for preventive therapy as I failed to tolerate Imitrex® or Topamax®. My headaches usually begin after excessive stress and fatigue, but can occur anytime. In spite of having a very healthy lifestyle, I still have migraines at least twice a month, which unfailingly last three days. Do you have any other ideas for me?

A. For acute pain control, you might use Midrin®, dosing two caps at the start of a headache and one every 45 minutes for up to three more doses. Liquid ibuprofen can be effective, too, as can the gel cap form of sodium naproxen. I have not been impressed with the tablet form of either ibuprofen or naproxen, probably due to relatively slow breakdown and absorption in the setting of nausea. A small amount of Fioricet® could be combined with the ibuprofen or the naproxen.

For prevention of migraines at a frequency of two per month, I recommend magnesium aspartate, 500 to 1000 mg. at night (kidney function needs checking prior to starting this), and/or vitamin B2 (riboflavin) 200 mg. twice a day with meals. The magnesium in this formulation is well absorbed and well tolerated. It should not be taken at the same time of the day as iron, calcium or zinc as they will interfere with the absorption of the magnesium. The B2 will turn the urine a bright yellow which is normal. A medication for prevention that would not seem to be contraindicated in your case is gabapentin, taken at night in doses of up to 900 mg.

Biofeedback training is great for stress management and can be viewed as a life skill that is always available to you, much like yoga and meditation. For people with migraine, prevention really rests on excellent self care, including a good diet, hydration, rest, exercise and stress management.

Douglas Mann, M.D.
Professor of Neurology
University of North Carolina
Chapel Hill, NC

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