Preventing Migraines by Lowering Risk

Migraines can produce debilitating pain. The key to management goes beyond medications. Managing risk factors can reduce the number of migraines. The key is identifying those triggers.

A prominent migraine specialist notes that obesity and depression increase the risk of migraines, making a preventative strategy essential.

Ask your primary care doctor about migraine prevention strategies.

David Dodick, MD, professor of neurology at Mayo Clinic in Phoenix, noted that risk factors for migraines can be treated effectively in a primary care setting. He encourages educating doctors about what they can do to help prevent migraines.

“About 40 percent of migraine patients are candidates for preventive treatments but only 10 percent receive them. Doctors just want to treat the pain because they have little time to spend with patients to explore other options," said Dr. Dodick.

"They need to start thinking about the treatment of migraine in a disease model context, in much the same way as hypertension or diabetes.”

Dr. Dodick said that individuals who are obese have a five-fold risk for developing migraines, while depression increases the risk of migraines at least three-fold.

He said other risk factors include the overuse of drugs to treat acute migraines, particularly opioids, barbiturates, analgesics and triptans, depression and other mood disorders, snoring, head trauma and excessive caffeine intake. Controlling these risk factors, he said, may prevent those who suffer from occasional migraines from becoming chronic sufferers.

The American Academy of Neurology (AAN) announced new guidelines for treating migraines just last month. The academy suggested a wide variety of medications to prevent migraines ranging from antidepressants to plant extracts.

“The new AAN guidelines illustrate that there are many treatments for which there is substantial evidence to support their safety and efficacy for the preventive treatment of migraine,” said Dr. Dodick. “Physicians should use the guidelines to individualize treatment, based on coexisting and comorbid conditions which may be present in their patients, with medications that have the highest level of evidence.”

Dr. Dodick made the comments in a recent address to the American Pain Society.