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Treatment of migraine

Q: Being the wife of a doctor, I consulted ophthalmologists & few neurologists all of whom clinically dianosed my 15 years headache to be Migraine for which I have been taking Inderal (40) & Tryptomer (25) per day since 1999; but unfortunately till date I cannot discontinue these medicines. My questions are: 1) How should I proceed further? any investigation or take it as it comes; 2)Can I use Femilon as a contraceptive? 3) Any change of medicine?

A:Migraine is a recurrent, throbbing headache which is usually unilateral and may be preceded by a visual aura. Family history is generally positive and there is no cure. The treatment may be abortive (treatment of acute attack) or preventive. Conventional analgesics are helpful in many patients. Sumatriptan is of considerable value in acute attack. When migraine attacks are frequent, search should be made for provocative factors such as lack of sleep or food, stress, diet (chocolate, cheese, alcohol), travelling (especially in sun) or menses. In case of more than one attack per month, preventive therapy should be tried. You are already taking propranalol and amitriptyline for migraine prophylaxis. The dose of either may be increased and the other one may be discontinued. Acute attacks should be treated as mentioned above, and inciting factors should be identified and avoided if possible. The need for continuing preventive therapy may be reviewed at intervals of 6 months. Progesterone-only oral contraceptives may be taken as combined OCs may increase the frequency of migraine.

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