Migraine Medications

The physician analyzes your migraine history to devise an appropriate treatment program. The goals of treatment are to prevent or reduce the number of migraines (called prophylactic treatment) and to ease symptoms and shorten the duration of the migraine (called abortive treatment).

PROPHYLACTIC TREATMENT

The goal behind daily preventive treatment is to decrease the frequency and severity of migraine. Prophylactic medications are usually reserved for patients who have frequent headaches, and for patients who have headaches that do not respond to symptomatic treatment. These medications often help make the situation tolerable, without eliminating migraines. Some patients may require treatment with more than one preventive medication.
This is tried only after the use of single medications has been exhausted. If the headaches become well controlled, most physicians recommend tapering the dosages, or discontinuing the medication, if possible.

Beta blockers
This is the preferred medication. They work on the central nervous system as well as on serotonin systems. Beta blockers have been used for high blood pressure, heart disease, and heart arrhythmias for years. If your doctor prescribes this category of medication, it should be taken daily. He or she will probably start you on the lowest dosage possible.
Beta blockers should not be used in patients with asthma, in some patients with specific abnormalities within the heart, and in patients with diabetes.
Side effects include drowsiness, lightheadedness, gastrointestinal upset, insomnia, low blood pressure (hypotension), slowed heart rate (bradycardia), and sexual dysfunction. Some beta blockers pass into breast milk and may cause problems in nursing infants

Anti-seizure medication
This category of medication may be effective in the treatment of migraines in some patients. Side effects include nausea, diarrhea, hair loss, weight gain, gastrointestinal upset, sedation, liver damage, and tremors.

Calcium channel blockers
These medications inhibit artery dilation and block the release of serotonin. They should not be taken by patients with heart failure or heart block.
Side effects include lightheadedness, drowsiness, constipation, flushing, low blood pressure, rash, and nausea.

Antidepressants
These medications can treat migraine through their action on serotonin systems.

Tricyclic antidepressants (TCA)
These are the most commonly used antidepressants.
Patients are given the lowest possible to start. The medication is usually taken once a day, at bedtime because the cause drowsiness TCAs block serotonin reabsorption and take two to three weeks to be effective.
Side effects include:

• Constipation
• Dry mouth
• Low blood pressure (hypotension)
• Increased heart rate (tachycardia)
• Urinary retention
• Sexual dysfunction
• Weight gain

High doses of TCAs have been connected to seizures, stroke, and heart attack in some patients. Abrupt discontinuation of these medications may cause headache, nausea, and malaise, and may intensify side effects.

Selective serotonin reuptake inhibitors (SSRI)
Some patients may have a response to the newer antidepressants.
They are a part of the class of drugs known as selective serotonin reuptake inhibitors (SSRI). Although they are usually better tolerated than the tricyclic antidepressants, they tend not to be as effective in treatment.
Side effects include nausea, insomnia, sexual dysfunction, and loss of appetite.

Methysergide maleate
This medication may be prescribed for patients with frequent, severe migraines.
Side effects include insomnia, drowsiness, lightheadedness, and hair loss. This drug should not be used by patients with coronary artery disease and must be discontinued for three to four weeks after four to six months of use because it can cause retroperitoneal fibrosis, a condition in which the blood vessels in the abdomen thicken, which reduces blood flow to organs.

ABORTIVE TREATMENT

Mild, infrequent migraines may be relieved using over-the-counter medication. Severe headaches with accompanying symptoms may require prescription medication.
During a migraine, people often prefer to rest or sleep alone in a dark, quiet room. Applying cold packs to the head or pressing on the bulging artery in front of the ear on the painful side of the head may provide temporary pain relief.

Analgesics
It is important to use these medications as early as possible in a migraine attack. They are aimed at treating the severity and duration of an attack and can help the migraine sufferer return to normal activity as soon as possible. This form of therapy without preventive therapy is useful in patients with relatively infrequent migraines. It is often necessary to use some symptomatic treatment in patients who still have migraine headaches despite using prophylactic drugs.
Frequent use of analgesics (i.e., more than 4 times a week) can cause rebound headaches and may interfere with prophylactic treatment.
Side effects caused by aspirin and ibuprofen (Advil, Motrin) include gastrointestinal upset and bleeding.
These drugs should be taken with food and used with caution. Ibuprofen is available in suppository form, which can be useful if the migraine is accompanied by severe nausea and vomiting.
Narcotics are often use as a palliative pain relieving medication for migraine surfers but this is often times not the optimal medicine. Continued use of narcotics can build up a tolerance in patients sometimes requiring more and more narcotics each time a person gets a migraine. Other times migraines can again be triggered to occur as the effects of narcotics wear off, creating a vicious cycle of pain, narcotics, more pain and more narcotics. Rebound Headaches are sometimes seen with narcotic (opioid) use. Narcotics are often used in emergency situations but the ability of these to relieve migraine symptoms is mixed.
Another strategy doctors employ is to use a combination of medications. This combination of IV or oral medications has a synergistic effect. Meaning that the medications when given together have a better effect than the predicted relief that each one would achieve if giving separately.

Serotonin receptors
These are fast acting, usually well-tolerated medications that treat migraine by acting on inflammation and cerebral blood vessels. They are available in oral, injectable, and nasal spray forms and can be taken any time during the headache.
Side effects include flushing, discomfort, tingling, and nausea.

Ergots
For many years, this class of medication has been used to treat migraines. They block blood vessel dilation, prevent inflammation, and act on serotonin systems. This medication should be taken at the first sign of a migraine and may not be effective if the headache has moved into the throbbing stage.
Side effects include gastrointestinal upset, dizziness, stroke, and high blood pressure (hypertension). Ergots should not be taken by patients with heart, vascular, liver, or kidney disease.

PREVENTING MIGRAINE

Avoiding triggers, managing stress, and taking prophylactic medications can help prevent migraines. Keeping a Migraine Diary can help identify triggers and evaluate the effectiveness of preventive measures. Patients should monitor the following:

• Activities
• Emotional factors (stressful situations)
• Environmental factors (weather, altitude changes)
• Foods and beverages
• Medications (over-the-counter and prescription)
• Migraine characteristics (severity, length)
• Physical factors (illness, fatigue)
• Sleep patterns

Stress management techniques (biofeedback, hypnosis) and stress-reducing activities (meditation, yoga, exercise) can also help prevent migraines.