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Reader's Mail: Headache Treatment Requires Individualized Approach

Q. I get three to four migraines per month, sometimes with aura, sometimes without. I find that my biggest triggers are my menstrual cycle and stress. Given this, which medication is more effective for migraine prevention: beta blockers or calcium channel blockers?

A. There is no single answer to that question as these medications are selected on an individualized basis. I think most headache specialists, myself included, would probably select a beta blocker before the calcium channel blocker unless there are issues such as heart failure, asthma, or other diagnoses that would be contraindicated with one of these drugs. Personally, I consider these medications second-line or “helper” drugs to add benefits to more commonly used first-line agents, such as amitriptyline or nortriptyline or the anti-epilepsy agents (e.g., topiramate or valproate) and others.

Since you mention a relatively small number of headaches per month, a straight abortive plan (using triptans) may fit your needs especially if you can eliminate some of your triggers—rather than using a daily preventive medication. Stress and the decline of estrogen levels at the end of a menstrual cycle will make migraines more likely to occur. Stress reduction techniques such as meditation, auto-relaxation, and yoga are very helpful. Others find counseling for stress management or coping skills helpful.

In extreme menstrual headache situations, gynecologists can offer non-estrogen strategies for eliminating menstrual cycles. Remember, the treatment of headache does not only involve medication; lifestyle and other factors must also be managed.

Edmund Messina M.D., F.A.H.S.
Medical Director Michigan Headache Clinic
East Lansing, Michigan

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