Everything is based on the patient’s preferences. For example, yesterday I saw a patient who told me I didn’t want to take medication. Can you give me a preventative and rescue approach that is not a cure? “I also see some patients who are open to the usual medications and the possibility of non-medication. Therefore, I try to have a nice balance of both things in my practice, treatment without medication and treatment with medication.
Common treatments have a wealth of evidence for the treatment of migraine and they are being intensively studied. These include migraine preventative medications, seizure medications, antidepressants, blood pressure medications, and botox to prevent migraines. To save migraines, we use anti-inflammatory drugs called triptans, gepantes and ditans.
Other common treatments include devices such as the CEFALY device, which has also been rigorously studied in randomized false control trials. I always talk about these migraine devices with patients as well, because they have a large amount of evidence and have been studied in clinical trials.
Some patients want to add an integrative medical approach to their usual treatment. We could talk about vitamins or physical therapy, acupuncture and psychological approaches, such as cognitive behavioral therapy and biofeedback, because we know that many people who have migraines – almost half of them – also have anxiety.