Treatment of Migraines


Treatment of migraines is possible to stop symptoms and prevent future attacks.

September 21, 2017

Treatment of migraines is possible to stop symptoms and prevent future attacks. Medications used to reduce migraines are divided into two broad categories:

Pain-relieving medications:

This is also known as acute or abortive treatment. These types of medicines are taken during migraine attacks to stop the symptoms.

Preventive medications:

These types of medicines are taken on a daily basis to reduce the severity or frequency of migraines.
Your treatment plan depends on the frequency and severity of your headaches, how long it last, its effects and your other medical conditions.

Pain-relieving medications:

For best results take pain-relieving medicines as soon as you experience signs or symptoms of a migraine.
Medications include:

Pain relievers:

Aspirin, ibuprofen or acetaminophen may help relieve mild migraines. Combination of acetaminophen, aspirin and caffeine may ease moderate migraine pain.
These medications can lead to gastrointestinal bleeding,ulcers and medication-overuse headaches if taken too often or for long periods of time.
Indomethacin is a prescription pain reliever which help relieve nausea if you have migrains.

Triptans :

Triptans make blood vessels  narrower, especially by encircling pressure and block pain pathways in the brain. Hence  relieves the pain and other symptoms that are associated with migraines. Triptans are available in pill, nasal spray and injection form.
Sumatriptan , rizatriptan, almotriptan, naratriptan, zolmitriptan, frovatriptan and eletriptan are some of the triptan medications. A combination of sumatriptan and naproxen sodium are more effective in relieving migraine symptoms then used alone. Nausea, dizziness, drowsiness, muscle weakness and reactions at the injection site are some of the side effects of triptans.
These medications are not recommended for people who are at risk of strokes and heart attacks.

Ergots:

Ergots are most effective when taken soon after migraine symptoms start and for those whose pain lasts for more than 48 hours. Migergot and Cafergot are available in combination of ergotamine and caffeine. Nausea, vomiting and medication-overuse headaches are the side effects of ergotamine.
D.H.E. 45 and migranal are dihydroergotamine a substitute for ergotamine which have less side effects. These are available as nasal spray and in injection form.

Opioid medications:

People who can not take triptans or ergots, opioid medications containing narcotics, codeine are sometimes used to treat migraine pain.

Glucocorticoids:

Glucocorticoids such as prednisone and dexamethasone cab be used with other medications to improve pain relief. To avoid side effects, glucocorticoids should not be used frequently.

Anti-nausea medications:

Chlorpromazine, metoclopramide or prochlorperazine are some of the  prescribed medications for nausea can be used in combination of other medications.

Preventive medications:

You can have preventive medications and therapy if

  • the attacks last more than 12 hours
  • you have four or more attacks a month
  • pain-relieving medications are not helping
  • your migraine signs and symptoms include a prolonged aura or numbness and weakness

Preventive medications are prescribed on a regular basis or only when a predictable trigger such as menstruation, is approaching. Preventive medications can reduce the severity, frequency and length of migraines. Although these medications does not always stop headaches completely, may help increase the effectiveness of symptom-relieving medicines used during migraine attacks.
Your doctor may recommend tapering off the medication to see if your migraines return without it, if your migraines are well-controlled by using these medications.
The most common preventive medications include:

Cardiovascular Medications:

The beta blockers propranolol, metoprolol tartrate and timolol which are commonly used to treat high blood pressure and coronary artery disease may reduce the frequency and severity of migraines.
Calcium channel blocker such as verapamil used  to treat high blood pressure may help prevent migraines with aura.
The angiotensin-converting enzyme inhibitor lisinopril may be useful in reducing the length and severity of migraines.

Antidepressants:

Amitriptyline is the only tricyclic antidepressant which effectively prevent migraines by affecting the level of serotonin and other brain chemicals. Sleepiness, dry mouth, constipation and weight gain are some of the side effects of this medication.

Anti-seizure drugs:

Valproate and topiramate are some of the anti-seizure drugs that can be used to reduce the frequency of migraines. Nausea, tremor, weight gain, hair loss and dizziness are some common side effects of valproate where as topiramate may cause diarrhea, nausea, weight loss, memory difficulties and concentration problems if taken in high dose.
Valproate products should not be used in pregnant women or women who may become pregnant.

OnabotulinumtoxinA or Botox:

Botox is helpful in treating chronic migraines in adults. OnabotulinumtoxinA is injected into the muscles of the forehead and neck during this procedure. The treatment usually needs to be repeated every 12 weeks to make it effective.

Pain relievers:

Taking nonsteroidal anti-inflammatory drugs such as naproxen (Naprosyn), may help prevent migraines and reduce symptoms.