Migraine Headaches

	Topic Overview
	Health Tools
	Cause
	Symptoms
	What Happens
	What Increases Your Risk
	When To Call a Doctor
	Exams and Tests
	Treatment Overview
	Prevention
	Home Treatment
	Medications
	Surgery
	Other Treatment
	Other Places To Get Help
	Related Information
	References
	Credits

What are migraine headaches?

Migraines are painful, throbbing headaches that last from 4 to 72 hours. When you have a migraine, it may be so painful that you are not able to follow your normal routine or do your usual activities. But even though they make you feel bad, migraines do not cause long-term damage.

Migraines are a disease. You cannot just "will them away." Talk to your doctor about your migraines. There are treatments that can help you manage them.

What causes migraines?

Experts are not sure what causes migraines. It may have something to do with the blood vessels in your brain.

Migraines run in families, but it is not clear why some people get migraines and others do not.

What are the symptoms?

The main symptom of a migraine is a throbbing headache on one side of your head. You may also feel sick to your stomach and vomit. Activity, light, noise, or odors may make the migraine worse. The pain may move from one side of your head to the other, or you may feel it on both sides at the same time. Different people have different symptoms.

Some people have an aura before the migraine begins. When you have an aura, you may first see spots, wavy lines, or flashing lights. Your hands, arms, or face may tingle or feel numb. The aura usually starts about 30 minutes before the headache. But most people do not have auras.

How are migraines diagnosed?

A doctor can usually tell if you have a migraine by asking about your symptoms and examining you. You probably will not need lab tests, but your doctor may order some if he or she thinks your symptoms are caused by another disease.

Many experts think you have migraines if:¹

• You have 5 or more headache attacks without an aura or you have 2 attacks with an aura.
• Your headache lasts from 4 to 72 hours without treatment.
• You also feel sick to your stomach and may vomit. Light and noise may make your headache worse.

How are they treated?

You can usually manage your migraines. First try an over-the-counter pain medicine, such as ibuprofen or naproxen. Brand names include Advil, Motrin, and Aleve.

If over-the-counter medicine does not work, your doctor can prescribe stronger medicine that stops the migraine as it is starting. You may not be able to use some medicines if you are pregnant or have other health problems, such as heart problems or high blood pressure.

When you feel a migraine coming on:

• Stop what you are doing, and take your medicine. Do not wait for the migraine to get worse. Take your medicine exactly as your doctor told you to.
• Take it easy. Rest in a quiet, dark room. Close your eyes, and try to relax or go to sleep. Do not watch TV or read. Put a cold pack or cool cloth on the painful area.

If the first treatment you try does not work, try something else. It may take time to find what works best for you.

Some people also use other kinds of treatments, such as acupuncture. These may help reduce the pain or the number of migraines you have. But experts need more research to see if they really work.²

Be careful when you use your migraine medicines. Taking them too often can cause you to get another headache when you stop taking the medicine. This is called a rebound headache. If you find you are taking your medicines very often, talk to your doctor before a problem starts.

Can I reduce how often I have migraines?

You may be able to reduce how often you have migraines by staying away from things that cause them. These are called "triggers." Common triggers include chocolate, red wine, cheese, MSG, strong odors, not eating, and poor sleep habits. It may be helpful for you to track and write down your triggers. You may be able to avoid the trigger and more migraines.

If you have migraines often, your doctor may prescribe medicine that helps prevent them.

Frequently Asked Questions

Health tools help you make wise health decisions or take action to improve your health.

	Decision Points focus on key medical care decisions that are important to many health problems.
	Should I take medicine to prevent migraine headaches?
	Actionsets are designed to help people take an active role in managing a health condition.
	Identifying and avoiding migraine triggers
	Managing a headache

Migraines run in families, and a genetic link has been identified.³ But it is not entirely clear why some people get migraines and others do not.

Although the cause of migraines is not well understood, it may have something to do with the blood vessels in the brain.

Migraine headache symptoms vary and may occur with or without a warning sign called an aura. People who get an aura, which usually begins within 30 minutes before the headache starts, may see spots, wavy lines, or flashing lights. Some people have numbness or a "pins-and-needles" sensation in their hands, arms, or face during the aura. However, most people do not have an aura before they get a migraine headache.

Common symptoms of migraine include:

• Throbbing or pulsating headache on one side of your head.
• Moderate to severe headache intensity.
• Your headache getting worse with routine physical activity.
• Nausea, vomiting, or both.
• Sensitivity to light and noise, and sometimes smells.

There are several types of migraine headaches, each with unique features. For example, some women get migraines before, during, or shortly after their menstrual period.

It can be difficult to distinguish migraines from other types of headaches. Sinus or tension headaches have symptoms similar to those of migraines. Unlike other headaches, however, migraines usually occur on one side of your head, although the side that is affected can shift with each new attack. Migraines are also often accompanied by sensitivity to light and noise.

Migraines may occur along with many other conditions such as asthma or depression.³ More serious conditions, such as tumors or infections, can also cause migraine-like symptoms. Headaches that are caused by more serious health problems are rare.

Symptoms before the migraine begins (prodromal)

In the day or two before a migraine starts, you may experience symptoms such as fatigue, excessive yawning, food cravings (such as for chocolate), irritability, or restlessness.³

Aura

Some people (about 1 out of 5) experience a warning sign called an aura within 30 minutes before a migraine headache develops.¹ Symptoms of an aura usually develop gradually over 5 to 20 minutes. During an aura, you may see wavy lines, flashes, sparks of light, blind spots, or distortions. You may also feel tingling or a "pins-and-needles" sensation in your hands, arms, or face.

Less commonly, you may temporarily be unable to put words in proper order or have difficulty finding the right words. You may also experience short-term weakness on one side of your body. If you have these symptoms and have not had them before, call your doctor immediately so he or she can rule out a transient ischemic attack (TIA), stroke, or other serious condition.

Onset of headache and accompanying symptoms

Usually within 30 minutes of an aura, a throbbing headache begins. Without treatment, a migraine headache lasts from 4 to 72 hours. You may experience the throbbing pain on one side of your head, often behind an eye, although the pain may shift to the other side of your head or be present on both sides. The pain from the headache may be moderate to severe, and can be disabling. Other symptoms that commonly occur with the headache include:

• Extreme sensitivity to light, noise, and smells.
• Nausea and vomiting.
• Symptoms that get worse with physical activity.

Less commonly, problems with speech; tingling in the face, arms, and shoulders; or temporary weakness on one side of the body can occur.

Symptoms after the headache (postdromal)

After the headache eases, you may experience symptoms such as muscle aches, fatigue, or even a brief period of elation. These symptoms may last up to 24 hours after your migraine headache ends.

You may be more likely to get migraines if you:¹

• Have a family history of migraines.
• Are female. Women are three times more likely to develop migraines than men.
• Are a teenager or young adult. Migraines commonly begin during these years.
• Have depression, anxiety disorder, asthma, or epilepsy.

If you have a headache or have been diagnosed with migraine headaches, use the following information to help you decide when to call your doctor.

Call 911 or other emergency services if:

• You have a very sudden, severe, "thunderclap" headache that seems to come on instantly and is unlike any headache you have had before.
• You have symptoms of a stroke, which may include:
  • Sudden numbness, paralysis, or weakness in your face, arm, or leg, especially on only one side of your body.
  • Feeling dizzy or clumsy, or having trouble walking.
  • Sudden changes in vision.
  • New and sudden problems speaking or understanding simple statements.
  • Trouble walking or standing.

Call your doctor now or go to the emergency room if:

• You develop fever and a stiff neck.
• You have new nausea and vomiting, or you cannot keep food or liquids down.
• Your headache does not get better within 24 hours.

Watch closely for changes in your health, and be sure to contact your doctor if:

• Your headache has not gotten better within 1 to 2 days or wakes you up at night.
• Your headaches get worse or happen more often.
• You develop new symptoms.
• You have any problems with your medicine.
• You are older than 50 and have new or more frequent headaches.
• Your headaches occur after physical exercise, sexual activity, coughing, or sneezing.
• Your life is disrupted by your headaches (for example, you miss work or school regularly).

Watchful Waiting

Watchful waiting is a period of time during which you and your health professional observe your symptoms or condition without using medical treatment. Watchful waiting may be appropriate if you have recently been diagnosed with migraines and are taking medicine to reduce the pain or frequency of the migraines.

Who To See

Health professionals who may diagnose and treat your migraines include:

• Family medicine physician.
• Internist.
• General practitioner.
• Nurse practitioner.
• Physician assistant.
• Neurologist.

It may be helpful to see a doctor who has considerable experience treating migraines, especially if your migraines do not respond to drugs. If your child has migraines, it may be helpful for you to locate a doctor who has experience treating migraines in children. Research on the safety of migraine drugs for children is limited.

If you think your headaches might be linked to depression or anxiety, you may want to seek additional treatment from a psychiatrist, psychologist, or a licensed mental health counselor.

To prepare for your appointment, see the topic Making the Most of Your Appointment

Your doctor will diagnose a migraine by asking you questions about your health and lifestyle and by examining you. There are no lab tests that can confirm a diagnosis. Migraines can be difficult to diagnose because symptoms resemble those of other headache conditions. For example, many people have been diagnosed with sinus headaches when they actually have migraines. As a result, migraines are underdiagnosed and undertreated.

Your doctor may use the International Headache Society's criteria to diagnose migraines. You may be diagnosed if you experience 5 or more headache attacks without an aura (or 2 attacks with an aura) that last from 4 to 72 hours without treatment and are accompanied by symptoms of nausea, vomiting, or sensitivity to light or noise.

Your doctor will check your symptoms and decide whether you need to have tests to rule out other conditions that might be causing your headaches. Tests may include:

• MRI or CT scan, which may be used to rule out tumors or bleeding in the brain.
• Lumbar puncture (also called a spinal tap), which may be done if your doctor thinks that you might have another condition such as meningitis or bleeding in the brain.
• Sedimentation rate (a blood test), which may help determine whether another condition is causing inflammation related to your headaches.

Although there is no cure for migraines, you can often reduce and possibly prevent some migraines. Drugs are available to prevent or treat migraines. There is some evidence that taking aspirin along with a drug that helps with nausea, such as metoclopramide (for example, Reglan), may help reduce migraine symptoms.⁴

You may also reduce the number of migraines you have by identifying and avoiding triggers that lead to migraines, such as drinking red wine or getting too much or too little sleep.

Initial treatment

At first you may use pain relievers that you can buy without a prescription, such as acetaminophen (for example, Tylenol), and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen sodium, to reduce migraine symptoms. Some doctors recommend that you first try an NSAID to see whether it reduces pain before trying abortive or preventive drugs, which may have more side effects.⁵

Initial treatment depends on how severe your migraine attacks are and how often they occur, but usually includes drugs to stop a headache (abortive) or drugs to prevent a headache (preventive), along with treatments that may reduce stress.

The most commonly used abortive drugs are:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, some of which you can buy without a prescription.
• Triptans (serotonin receptor agonists). These are usually the first type of prescription medicines tried to quickly stop a migraine attack.
• Ergotamine derivatives, such as Cafergot, although these medications may not be as effective as triptans for treating migraines.
• Midrin, which is a combination of the drugs isometheptene, acetaminophen, and dichloralphenazone.

The most commonly used preventive drugs—used to avoid or reduce the frequency of migraine attacks—include:

• Beta-blockers, which relax blood vessels.
• Calcium channel blockers, which reduce the amount of narrowing (constriction) of the blood vessels.
• Antidepressants, such as amitriptyline, a tricyclic antidepressant, which has been shown to be effective in preventing migraines.⁵
• Anticonvulsants, such as topiramate, which is approved by the U.S. Food and Drug Administration (FDA) for preventing migraines.

Some small studies suggest that the angiotensin-converting enzyme (ACE) inhibitor lisinopril and the angiotensin receptor blocker (ARB) candesartan reduce the frequency of migraine headaches. But more research is needed.⁶

Antinausea drugs (such as Compazine or Reglan) are sometimes prescribed along with abortive drugs to relieve symptoms of nausea and vomiting. Antinausea drugs may also be prescribed alone to treat migraine symptoms.

Complementary therapies may be added to drug treatment to reduce or prevent migraine symptoms. Be sure to ask your doctor before you try these therapies—to make sure they are safe for you.

• Acupuncture, which involves putting very thin needles into the skin at certain points on the body to produce energy flow along the body's meridians. Current evidence suggests that acupuncture can help with headaches. But more research is needed.²
• Biofeedback, a relaxation method for learning to control a body function that is not normally under conscious control, such as muscle tension.
• Relaxation techniques to reduce stress and tension.
• Feverfew, which is an herb that in the past was thought to help prevent migraines. We now have enough research to say that a benefit has not been proven. Feverfew doesn't appear to work any better than placebo at preventing migraines.⁷
• Butterbur, which is an herb that has been shown to help prevent migraines in some people.⁸
• Riboflavin (vitamin B2) and coenzyme Q10, which in small studies have both been shown to help prevent migraines.⁹

If you have recently been diagnosed with migraines, see:

Identifying and avoiding migraine triggers

You may also want to learn about drugs that can prevent migraines before they start. For more information, see:

Should I take medicine to prevent migraines?

Ongoing treatment

It is important to develop a treatment plan for ongoing migraines. This may involve finding the right drug for your type of migraine, identifying and avoiding migraine triggers, and avoiding rebound headaches that are caused by overusing migraine drugs. You and your doctor will work together to find the best treatment to relieve or prevent your migraines.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, may be helpful in reducing migraine symptoms. If NSAIDs stop your migraines, they may be your best treatment because they have fewer side effects than migraine drugs.

The most commonly used abortive drugs, used to stop a headache, are:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, some of which you can buy without a prescription.
• Triptans (serotonin receptor agonists). These are usually the first type of prescription medicines tried to quickly stop an acute migraine attack.
• Ergotamine derivatives, such as Cafergot, although these medications may not be as effective as triptans for treating migraines.
• Midrin, which is a combination of the drugs isometheptene, acetaminophen, and dichloralphenazone.

The most commonly used preventive drugs—used to avoid or reduce the frequency of migraine attacks—include:

• Beta-blockers, which relax blood vessels.
• Calcium channel blockers, which reduce the amount of narrowing (constriction) of the blood vessels.
• Antidepressants, such as amitriptyline, a tricyclic antidepressant, which has been shown to be effective in preventing migraines.⁵
• Some anticonvulsants—such as topiramate—that are approved by the U.S. Food and Drug Administration (FDA) for preventing migraines.

Some small studies suggest that the angiotensin-converting enzyme (ACE) inhibitor lisinopril and the angiotensin receptor blocker (ARB) candesartan reduce the frequency of migraine headaches. But more research is needed.⁶

Antinausea drugs (such as Compazine or Reglan) are prescribed along with abortive drugs. Antinausea drugs may also be prescribed alone to treat migraine symptoms.

Complementary therapies may be added to drug treatment to try to reduce or prevent migraine symptoms. Be sure to ask your doctor before you try these therapies—to make sure they are right for you.

• Acupuncture, which involves putting very thin needles into the skin at certain points on the body to produce energy flow along the body's meridians. Current evidence suggests that acupuncture can help with headaches. But more research is needed.²
• Biofeedback, a relaxation method for learning to control a body function that is not normally under conscious control, such as muscle tension.
• Relaxation techniques to reduce stress and tension
• Feverfew, which is an herb that in the past was thought to help prevent migraines. We now have enough research to say that a benefit has not been proven. Feverfew doesn't appear to work any better than placebo at preventing migraines.⁷
• Butterbur, which is an herb that has been shown to help prevent migraines in some people.⁸
• Riboflavin (vitamin B2) and coenzyme Q10, which have both been shown to help prevent migraines in small studies.⁹

If you have recently been diagnosed with migraines, see:

Identifying and avoiding migraine triggers

You may also want to learn about drugs that can prevent migraines before they start. For more information, see:

Should I take medicine to prevent migraines?

Treatment if the condition gets worse

If you continue to have migraines while receiving treatment, you and your doctor may want to change your abortive or preventive headache drugs or try a different type of migraine drug. If you have already tried several different types of migraine drugs, your doctor may seek additional testing (such as MRI or CT scan) to rule out other causes for your recurring headaches.

It is possible you have been misdiagnosed with migraines when you really have another type of headache. It can be difficult to distinguish migraines from other types of headaches such as sinus, tension, or cluster headaches, as symptoms can be similar or overlap. Different types of headaches require different treatment.

What To Think About

Even with treatment, you may continue to have migraines. The goal of treatment is to reduce the frequency of attacks and relieve your symptoms as quickly as possible with the fewest drug side effects. For mild to moderate migraines, you may first want to try a nonprescription pain reliever that has fewer side effects and is less expensive than other drugs. However, if this treatment is not effective or if you have frequent or severe headaches, prescription drugs may be needed.

Finding an effective medicine may require some time and patience.

Overuse of abortive headache drugs or pain relievers can cause rebound headaches. Rebound headaches are different from migraine headaches. They are usually triggered after pain medicine has worn off, prompting you to take another dose. Eventually you get a headache whenever you stop taking the drug. Be sure to take your migraine medicine only as prescribed by your doctor.

If you think your recurring headaches could be associated with depression or anxiety, be sure to let your doctor know. You may be able to eliminate or reduce some headaches with proper treatment of these conditions.

You may be able to reduce frequent migraines by avoiding triggers, such as certain foods, stress, and changes in your daily routine, although it is not clear how or why these events lead to migraines. Some common triggers of migraines include:

• Consuming certain substances such as chocolate, monosodium glutamate (MSG), red wine, and caffeine.
• Getting too much or not enough sleep.
• Fasting or skipping meals.
• Changes in the weather or barometric pressure.
• Stress or intense emotions.
• Strong odors or cigarette smoke.
• Bright lights or reflected sunlight.

For more information, see:

Identifying and avoiding migraine triggers

Your doctor may also prescribe drugs to help prevent migraine headaches.

There are many steps you can take at home to reduce the frequency of migraine attacks and treat the symptoms, such as reducing stress, taking prescription drugs, and identifying and avoiding migraine triggers.

• Find healthy ways to deal with stress. Migraine headaches seem to be more common during stressful times or right after you have "let down" after a stressful time.
• Practice relaxation techniques to reduce muscle tension and stress.
• Take preventive drugs as prescribed by your doctor.
• To help identify triggers of your headaches and determine if your headaches are becoming more severe or more frequent, keep a headache diary(What is a PDF document?).
• Seek help if you think that your migraines may be linked to depression or anxiety. Proper treatment of these conditions may reduce the frequency of your migraines.

For more information, see:

Identifying and avoiding migraine triggers

Managing your headache

Often children's headaches are related to stress about school, such as tests, athletic or social events, or peer pressure. They may also be related to lack of sleep. If your child has headaches, follow the treatment your doctor recommends. If your child has trouble managing his or her headaches with home treatment and your doctor's advice, keep a diary of the headaches and talk with your doctor.

Drugs are used to treat migraine symptoms after they have started (abortive drugs) as well as to prevent future attacks (preventive drugs). You may have to try several different drugs or types of drugs before you find the one that is right for you. Good communication with your doctor is important in this process.

Usually, your doctor will first prescribe a drug that causes the fewest side effects. Drugs may be prescribed based on the type of migraine that you experience. If your migraines are mild to moderate, you may need only a nonprescription drug to relieve your symptoms. However, if your migraines are moderate to severe and disabling, you may need a prescription migraine drug to treat your symptoms. If you experience frequent migraine attacks, your doctor may suggest a preventive drug.

Medication Choices

Abortive drugs—used to stop a migraine attack—include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, which may be tried first to reduce migraine symptoms.
• Triptans (serotonin receptor agonists). These are usually the first type of prescription medicine tried to quickly stop acute migraine attacks.
• Ergotamine derivatives, such as Cafergot, although these medications may not be as effective as triptans for treating migraines.
• Midrin, which is a combination of the drugs isometheptene, acetaminophen, and dichloralphenazone.
• Antinausea drugs (such as Compazine or Reglan) may also be prescribed alone to treat migraine symptoms.

Preventive drugs—used to avoid or reduce the frequency of migraine attacks—include:

• Beta-blockers, which relax blood vessels.
• Calcium channel blockers, which reduce the amount of narrowing (constriction) of the blood vessels.
• Antidepressants, such as amitriptyline, a tricyclic antidepressant, which has been shown to be effective in preventing migraines.⁵
• Some anticonvulsants (such as topiramate) that are approved by the U.S. Food and Drug Administration (FDA) for preventing migraines.

Some small studies suggest that the angiotensin-converting enzyme (ACE) inhibitor lisinopril and the angiotensin receptor blocker (ARB) candesartan reduce the frequency of migraine headaches. However, more research is needed.⁶

Antinausea drugs (such as Compazine or Reglan) are prescribed along with abortive drugs. Antinausea drugs may also be prescribed alone to treat migraine symptoms.

What To Think About

It may take several attempts with different drugs before the right one or combination of drugs is found. Researchers now recommend taking a nonsteroidal anti-inflammatory drug (NSAID), such as aspirin or ibuprofen, to reduce headache pain before trying a prescription migraine drug, which may have more side effects than an NSAID.⁵

Because many people who have migraines also have depression, taking prescription medicines for both problems is common. In very rare cases, when a triptan such as sumatriptan (Imitrex) for migraines is taken with an SSRI (selective serotonin reuptake inhibitor) or SNRI (selective serotonin/norepinephrine reuptake inhibitor) such as fluoxetine (Prozac) or duloxetine (Cymbalta) for depression, these medicines can cause a very rare but serious condition called serotonin syndrome. But most people take these two types of medicines together and have no problems. If you are worried about serotonin syndrome, talk to your doctor.

If you experience increased nausea or vomiting as a side effect of a migraine drug, your doctor may also prescribe an antinausea drug, such as prochlorperazine (Compazine) or metoclopramide (for example, Reglan), to reduce these symptoms.

Overuse of migraine drugs or pain relievers can cause rebound headaches. Rebound headaches are different from migraine headaches. They are usually triggered after pain medicine has worn off, prompting you to take another dose. Eventually you get a headache whenever you stop taking the drug. Be sure to take your migraine medicine only as prescribed by your doctor.

The U.S. Food and Drug Administration (FDA) has issued a warning on anticonvulsants and the risk of suicide and suicidal thoughts. The FDA does not recommend that people stop using these medicines. Instead, people who take anticonvulsant medicine should be watched closely for warning signs of suicide. People who take anticonvulsant medicine and who are worried about this side effect should talk to a doctor.

For more information, see:

Should I take medicine to prevent migraines?

There is no surgical treatment for migraine headaches.

Although drugs are usually the primary treatment for migraines, adding complementary therapies may help reduce symptoms and the frequency of your migraine attacks. You may want to try the following after discussing them with your doctor:

• Acupuncture, which involves putting very thin needles into the skin at certain points on the body to produce energy flow along the body's meridians. Current evidence suggests that acupuncture can help with headaches. But more research is needed.²
• Biofeedback, a relaxation method for learning to control a body function that is not normally under conscious control, such as muscle tension
• Relaxation techniques to reduce stress and tension
• Feverfew, which is an herb that in the past was thought to help prevent migraines. We now have enough research to say that a benefit has not been proven. Feverfew doesn't appear to work any better than placebo at preventing migraines.⁷
• Butterbur, which is an herb that has been shown to help prevent migraines in some people.⁸
• Riboflavin (vitamin B2) and coenzyme Q10, which in small studies have both been shown to help prevent migraines.⁹

Online Resource

Organizations

• Anxiety
• Cluster Headaches
• Depression
• Headaches
• Stress Management
• Tension Headaches

Citations

1. Evans RW (2006). Headache. In DC Dale, DD Federman, eds., ACP Medicine, section 11, chap. 8. New York: WebMD.

2. Melchart D, et al. (2006). Acupuncture for idiopathic headache. Cochrane Database of Systematic Reviews (4). Oxford: Update Software.

3. Evans RW (2003). Migraine. In Saunders Manual of Neurologic Practice, chap. 11, pp. 421–430. Philadelphia: Saunders.

4. Morillo LE (2006). Migraine headache, search date August 2003. Online version of Clinical Evidence (15): 1–16.

5. Snow V, et al. (2002). Pharmacologic management of acute attacks of migraine and prevention of migraine headaches. Annals of Internal Medicine, 137(10): 840–849.

6. Drugs for migraine. (2004). Treatment Guidelines From the Medical Letter on Drugs and Therapeutics, 25(2): 63–66.

7. Pittler MH, Ernst E (2006). Feverfew for preventing migraine. Cochrane Database of Systematic Reviews (4). Oxford: Update Software.

8. Lipton RB, et al. (2004). Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Neurology, 63(12): 2240–2244.

9. Sándor PS, et al. (2005). Efficacy of coenzyme Q10 in migraine prophylaxis: A randomized controlled trial. Neurology, 64(4): 713–715.

Other Works Consulted

• Diamond S (2001). A fresh look at migraine therapy. Postgraduate Medicine, 109(1): 49–60.

• Landy S, et al. (2004). Efficacy and tolerability of sumatriptan tablets administered during the mild-pain phase of menstrually associated migraine. International Journal of Clinical Practice, 10: 913–919.

• Loder E, et al. (2004). Efficacy and tolerability of oral zolmitriptan in menstrually associated migraine: A randomized, prospective, parallel-group, double-blind, placebo-controlled study. Headache, 44: 120–130.