Chronic Migraine
There are medications available . Choice of treatment is determined by a number of factors , such as your age , asthma triggers , and your symptoms . For quick-relief of an asthma attack , the physician will prescribe a bronchodilator ( inhaler ) which will rapidly open your swollen airways to allow easy breathing . The drugs are administered with the use of a hand-held inhaler or a nebulizer which is a machine that converts the asthma medications to a fine mist . With a nebulizer , the medication will be inhaled through a face mask or mouthpiece . These medications should be taken at the first sign of symptoms . For children , the inhaler should always be available and it is important to establish dialogue with care-givers , teachers , and principals to advise them of the child ’ s condition and need for quick intervention .
These “ rescue ” medications include short-acting beta agonists which act within minutes to relieve the symptoms of the asthma attack . Albuterol and levalbuterol are examples of these inhaled drugs . Another bronchodilator , ipratropium , may be considered . Oral and intravenous corticosteroids , such as prednisone and methylprednisolone , are effective in relieving airway inflammation . Because long-term use of these agents can cause serious side effects , they should only be used for brief intervals .
If the inhaler is being used two or more times per week , your physician may consider preventive medications which control the asthma symptoms on a daily basis . These medications may also be administered by an inhaler and include corticosteroids ( fluticasone , bedesonide , flunisolide , ciclesonide , beclomethasone , mometasone , and fluticasone ). These medications are the preferred agents for long-term therapy , and may require several weeks of treatment to achieve maximum benefit . Their action reduces the inflammation and swelling of the airways as you respond to known triggers . Unlike oral corticosteroids , these drugs have a low side-effect profile and are usually safe for long-term therapy . However , your physician will follow you closely to lower your risk of prolonged effects from this form of treatment .
Another type of drug – leukotriene modifiers – are taken orally , and include montlukast , zafirlukast , and zileuton . These drugs aid in blocking the response that causes inflammation of the airways . There are potential risks to these agents and include psychological symptoms such as depression , agitation , hallucinations , aggression , and suicidal thinking . It is vital that you contact your physician for any untoward signs .
The beta agonists will be prescribed in combination with a corticosteroid inhaled agent as they may precipitate a severe asthma attack . Salmeterol and formoterol are types of these inhaled drugs which open the inflamed airways . The beta agonists should never be used alone or for an acute asthma attack . There are combination agents available which include a corticosteroid inhaler as well as a long-acting beta agonist . These include combination products such as fluticasone-salmetrol , budesonide-formoterol , and formoterol-mometasone . Again , with the addition of the beta agonist , the risk of a severe asthma attack is possible .
Theophylline , another brochodilator , is used as a daily pill to help maintain open airways and by relaxing the muscles around the airways . It is not prescribed as often as it was previously .
Certain drugs that are used for the prevention of migraine , are contraindicated for patients with respiratory problems . Propranolol , a beta blocker which has been approved for migraine prophylaxis since 1977 , is contraindicated for patients with concurrent asthma . If you have migraine and asthma , other therapies are available .
Chronic Migraine
Chronic Migraine is defined as the occurrence of a headache ( tension-type like and / or migraine-like ) on 15 or more days per month , for at least 3 months . Patients with chronic migraine typically report a history of episodic migraine headaches . In chronic migraine , there is little recovery or no complete recovery between the migraine attacks . Treatment of chronic migraine is complex , and appropriate diagnosis must be established . Many of these patients have failed standard migraine preventive therapies and may also be experiencing medication-overuse headaches . These patients may also be experiencing other conditions ( Table 3 ). Asthma has been identified as one of these coexisting disorders .
TABLE 3 Coexisting Conditions Associated with Chronic Migraine
Allergies Anxiety Arthritis Asthma Bronchitis Chronic pain Depression Fibromyalgia High cholesterol High blood pressure Obesity Sinusitis
20 HeadWise ® | Volume 6 , Issue 2 • 2016