Healthy Living and Fitness

Illness Care: Migraine

Medication

A lot of the drugs that treat acute migraine attacks work best when taken as soon as you feel a migraine coming on. These medications should not be taken more often or in higher doses than your doctor recommends. Pain relievers such as aspirin, acetaminophen, and ibuprofen are frequently recommended as initial treatments. However, if they do not relieve the pain, your physician may prescribe other drugs or drug combinations.

Non-specific (analgesic) drugs used to relieve the pain of migraine attacks:

• Non-prescription (over-the-counter) medications, such as aspirin, acetaminophen, alone or in combination with antihistamines, decongestants, or caffeine.
• Prescription analgesics, including narcotics, non-narcotics, or both. These drugs are often combined with sedatives or medications to relieve anxiety.
• Non-steroidal anti-inflammatory drugs, to relieve both pain and inflammation. Many different anti-inflammatory drugs are effective in treating migraine.
• Antinausea drugs may be given in combination with non-prescription and prescription drugs. These drugs treat the nausea caused by a migraine, improve the absorption of the antimigraine drugs, and may help relieve the pain.

Specific drugs used to stop migraine attacks:

• Ergot alkaloids, such as ergotamine and dihydroergotamine.
• Triptans are relatively new drugs developed specifically to stop migraine headaches. This family includes sumatriptan, naratriptan, zolmitriptan, and rizatriptan. These drugs have important similarities, yet they differ in routes of administration (eg, tablets, shots, nasal sprays, melt-in-your-mouth tablets), onset of action, and side effects. If one drug in this family does not work, another drug may be quite effective.
• Drugs used in hospital emergency departments to stop migraine attacks: Drugs are often given by shots in the hospital emergency department. Injectable narcotics, antiemetics (antinausea drugs), nonsteroidal anti-inflammatory drugs, corticosteroids and sumatriptan are options.

Drugs used to prevent migraine

If your migraine interferes with your life several days per month, or treatments for acute attacks do not offer adequate relief, your physician may recommend preventive therapy. While these drugs may not prevent all migraines, they often can reduce the frequency, intensity, and/or duration of attacks.

• Antidepressants (also used to treat depression) such as amitriptyline, nortriptyline, and doxepin. These drugs represent a class of antidepressants called tricyclic antidepressants. Other antidepressants called selective serotonin reuptake inhibitors or monoamine oxidase (MAO) inhibitors may also be used.
• Beta-blockers (also used to treat hypertension and angina) such as propranolol, metoprolol, timolol, nadolol, or atenolol.
• Calcium channel blockers, such as verapamil, diltiazem, or nifedipine.
• Serotonin antagonists, especially methysergide and cyproheptadine.
• Anticonvulsants, specifically divalproex.

Once your migraines are under control, your physician may advise you to gradually reduce the preventive medication. This is particularly true when you have established successful lifestyle modifications and adequate treatment of acute attacks. Sometimes your doctor may recommend a drug that can simultaneously treat your migraine and another condition, such as depression.

 

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