While a regular yoga practice and diligent effort to avoid triggers can stave off many a headache, sometimes it's useful to try other treatments. Prescription-only preventative medicines can reduce the number and intensity of attacks, drugs called acute or abortive therapies can stop a headache attack in its tracks, and several natural remedies may offer relief. Though over-the-counter medications such as acetaminophen and ibuprofen often reduce the pain if they're taken at the onset of an attack, they can make headaches worse if overused, and they are not effective for everyone.
Many preventative medicines were developed as treatments for other medical conditions but have proved beneficial in relieving headaches. Certain antidepressants, for example, can help prevent migraines by regulating serotonin levels in the brain. Beta blockers and calcium-channel blockers are typically used to treat people with heart disease but can help stave off headaches by improving blood flow in the brain. And anticonvulsants, long used to treat epileptic seizures, are also used to avert migraines. (It is thought that epilepsy and migraine may share common mechanisms.)
Abortive medicines are many people's silver bullet against migraine pain, offering relief in about an hour when taken early in an attack. Triptans, a class of drugs that may reduce migraine symptoms by constricting certain blood vessels in the brain and by affecting pain receptors, are considered the most effective of these. (Imitrex, approved by the Food and Drug Administration in 1992, is the best known.)
Magnesium and riboflavin supplements may also help. A 2002 study of women suffering from menstrual migraines found that 45 to 50 percent had low levels of the mineral magnesium. Although some experts advocate levels of 500 milligrams of magnesium daily (well above the National Institute of Medicine Food and Nutrition Board's dietary reference intake of 320 mg a day for women 25 and older), those with kidney stones or low calcium levels should talk with their doctor before taking magnesium in supplement form. Those under care for any condition should also let their doctor know.
Riboflavin, or vitamin B2, may assist nerve cells in the production of energy. High doses of riboflavin are thought to reverse energy loss in cells during migraine attacks: In a Belgian study released in 1998, migraine sufferers taking 400 mg a day of riboflavin reported improvement in the severity and frequency of their attacks within one to three months of starting supplements. (Though the Food and Nutrition Board's recommended dietary allowance for riboflavin is just 1.3 mg a day for females ages 25 to 50 and 1.2 mg a day for women 51 and older, higher levels are generally considered safe, as this vitamin is water-soluble and excess amounts are flushed from the body.)
If you're looking for an herbal remedy, you might consider feverfew capsules. Numerous clinical trials have been conducted with feverfew, and although the outcomes have varied, some experts believe it shows promise as a means of reducing both the frequency and severity of attacks. To keep side effects to a minimum, the suggested dose is 50 to 100 mg. (Note: Most people need to take feverfew for several months before deriving its full benefit.)
And many headache sufferers find relief through biofeedback, which can teach sufferers to control the body's unconscious and automatic responses to stress, such as blood pressure changes, muscle tension, and changes in heart rate. Though some health care practitioners question biofeedback's value, a five-year retrospective study by the Diamond Headache Clinic in Chicago found that 85 percent of adult participants who learned biofeedback techniques showed significant symptom reduction in severity, duration, and frequency of headaches.