SN: As you should know, being a chronic neurological pathology, and there are almost as many forms of migraine as there are patients. Some have two or three attacks per year that they manage well. Others suffer from headaches several days a month resulting in a poor quality of life. So, what have your general practitioner (GP) been advising you to take?

P: Paracetamol and Profens as I’m allergic to Ergotamines, and Triptans make me sick.

SN: Your GP knows that Paracetamol may be sufficient in the case of tension headache. Unilateral or tilting headaches, pulsating headaches, often with nausea or vomiting and/or aggravation by noise, light or smells are characteristic of a migraine. The desire to go to bed in the dark, or headaches that wake you up at night are also very suggestive of a migraine attack. So, it’s not always easy to know what drug you should take. Therefore, can you tell me exactly how your migraine comes, and what associated symptoms it triggers?

P: My headaches usually come throbbing on the left side. Sometimes it feels like my heart is beating in my ears, well, in my head. At times, painkillers have no effect and migraine wakes me up at night. Sometimes I wake up with a headache in the morning. And when it’s there, it can last a day, a few days or even several weeks almost daily, with a strange feeling of discomfort. In all cases, I feel like I’m exhausted or groggy during and after crises.

SN: Nonsteroidal anti-inflammatory drugs (NSAIDs) don’t always relieve migraines per se. And since you seem to be allergic to Ergotamines, a good option here may be to associate Ketoprofens to Paracetamol. In all cases, ideally, migraine drugs should be taken within an hour of the onset of the migraine, or even at the same time if the attack is intense. However, the doctor will tell you if you can use the Triptans again, but then they must be taken at least 3 months at the effective dose, i.e., after the initial increase in dosage, to be able to judge their action and manage some side effects that can be uncomfortable.

P: But then how should I know which treatment is most appropriate?

SN: Here you should keep a crisis agenda, that is a record of migraines. For example, 8 days of migraine spaced out in a month encourage the initiation of a background treatment regimen. If the 8 days of migraine headaches occur in two prolonged attacks, this is more indicative of incorrect management of the attack treatments. It is essential for the physician to have this information in order to be able to adapt the treatment. And you should know that we have a new protocol for special injection drugs for migraines.

P: However, I heard that there are alternative treatments, I mean nonpharmaceutical!

SN: For people with anxiety, it may be interesting to refer them to a cognitive-behavioral therapy or to a psychotherapy program for stress management. But let’s say that completely avoiding the factors that contribute to the attacks is impossible and can negatively affect the quality of life. But certain lifestyles like practicing an aerobic physical activity that appeals to the patient, for example brisk walking, swimming or cycling, having a regular sleep and meal patterns and avoiding stimulants, can have a favorable impact.