There are two approaches to preventative treatment. One entails reducing the sensitivity of the migraine generator by means of drugs, and the other focuses on reducing the number of impulses reaching the migraine generator.
All drugs have side effects and this approach is only recommended if all else fails. In addition, the drugs used to prevent primary headaches are often not effective.
It is preferable to make every effort to diagnose where abnormally high numbers of impulses are coming from and why, and to treat the cause or causes. In most primary headache sufferers, it is possible to achieve effective prevention without the use of drugs.
The best way to get to the root of the problem is by a “multidisciplinary” approach. There are so many different structures in the head and neck, all of which can be involved in the headache process, that no single specialist can have all the knowledge necessary to make a comprehensive assessment and diagnosis.
For this reason, the expertise of different specialists who would normally treat headache patients in isolation, is combined and integrated into a single more comprehensive body of knowledge. This makes it possible to provide a coordinated treatment plan, so that all the contributing factors are addressed.
There are several common-sense courses of action that may well prevent headaches by removing the triggering factors: A change in lifestyle that reduces stress may be enough – although for the majority of people, changing one’s lifestyle is in practice impossible.
Some sufferers notice that certain situations or habitual patterns of behaviour are likely to trigger headache. Avoiding certain trigger foods and chemical compounds (perfumes, smoke) may be helpful in the management of migraine.
Getting regular exercise, avoiding excessive caffeine and alcohol, stopping smoking and ensuring adequate hydration may also be helpful in some individuals – and these steps have many other benefits.
Prophylactic medications are taken daily and are directed towards preventing the headache from developing in the first place. They are not pain medications.
Causes of headaches
Reviewed by Dr Elliot Shevel, BDS, Dip MFOS, MB, BCh, Maxillo-facial and Oral Surgeon and Medical Director, The Headache Clinic, Johannesburg and Cape Town, February 2015.
Previously reviewed by Dr Andrew Rose-Innes, MD, Department of Neurology, Yale University School of Medicine, New Haven