Treatment Options for Migraine

A migraine is a type of headache that causes an intense throbbing pain on one side of the head, and is associated with nausea and/or vomiting; as well as sensitivity to light and/or noise. The pain is worsened by exertion and causes a person to avoid routine physical activity. A “migraine attack” can last from four to 72 hours. Some migraines are accompanied by a preceding “aura”, which is a collection of symptoms that warn you a migraine is coming. Often the pain can be so intense that it is impossible to function normally, and a person suffering from a migraine will most likely want to lie down in a dark, quiet room until the attack resolves. A migraine is much more than “just a headache”!

Whilst you can try and identify and avoid migraine triggers, unfortunately, there is no cure for migraines, and you have to treat each migraine headache as it comes. Treatment of a migraine involves medications, and taking other measures to help reduce the pain and severity of a migraine headache. Some people prefer non drug treatments, and this a choice for each individual to make.

Medications for migraine fall into two categories – reliever medications which are taken when a person is experiencing a migraine; and preventative medications, which need to be taken on a daily basis in an attempt to reduce the frequency of migraine attacks. There are a wide range of medications available, and the choice of medication depends on your personal situation, migraine frequency and severity, other medical conditions and other medications that you take (for any medical condition).

These may also be called “abortive” or “acute” treatments, as they are trying to stop the migraine pain once the headache has commenced.

NSAIDS – non-steroidal anti-inflammatories - are an effective class of medications for migraine pain. Drugs in this class of medication include aspirin, naproxen (Aleve), ibuprofen (Advil) and diclofenac (Voltaren) among others. These may be available over the counter or on prescription (depending on your country). It is important that you are using the correct dose needed to treat a migraine, as this may be different to the standard dosing directions listed on the packet. Check with your pharmacist or doctor for the correct therapeutic dose needed for treating migraine. Anti-inflammatories are associated with many side effects, so should only be used on an irregular basis. Some people may not be able to take them at all if they suffer from other medical conditions, such as stomach ulcers. If you are suffering from frequent migraines, talk to your doctor about preventative medication.

Acetaminophen (aka paracetamol) may be helpful for milder migraines in some people. It is generally not helpful for more severe attacks.

There are some combination drugs that contain acetaminophen and aspirin and caffeine (Excedrin Migraine) that may be helpful for mild to moderate migraine, but not as helpful for severe migraine.

Opioid medications (eg. codeine, tramadol, oxycodone) should NOT be used for migraine headaches as they can be addictive, and contribute to medication overuse headache. Use of combination analgesics (eg. codeine with acetaminophen) should also be avoided.

The triptans are a class of drug that were a breakthrough in the treatment of migraine. These drugs constrict certain blood vessels in the brain, which relieves the pain, inflammation and associated symptoms of migraines. These drugs are only available on prescription, and different people may find they respond better to a particular one. They work best when taken at the earliest sign of the migraine, rather than waiting for the headache pain to become more severe. This class of drugs includes the following:

• Sumatriptan (Imitrex)
• Rizatriptan (Maxalt)
• Almotriptan (Axert)
• Naratriptan (Amerge)
• Zolmitriptan (Zomig)
• Frovatriptan (Frova)
• Eletriptan (Relpax)

A range of different formulations are available for the triptan drugs. Whilst a tablet is the most common, in some situations an alternative to a tablet is preferred. This is particularly true if vomiting occurs, as you can’t absorb medication properly if you are vomiting. Severe nausea also delays digestion, and impairs the drug absorption process. The table shows the different formulations in which the different triptan drugs are available (this may vary in different countries).

Triptans can cause dizziness, a sensation of pins and needles (paraesthesia), a sensation of warmth, and muscle weakness. If you have a history of heart attack or coronary heart disease, or if you have had or are at risk of a stroke, you should not use triptan medication. Check with your doctor if you are unsure whether your should be taking them.

Ergots (combined with caffeine) are an older class of medications that tend to be reserved for more severe migraines unresponsive to other treatment. They are less effective than triptans, and are associated with more severe side effects. This class of medication includes:

• Ergotamine
• Dihydroergotamine – this is more effective than ergotamine, has fewer side effects, and is less likely to lead to medication overuse headache

This class of medications can cause significant side effects to the heart and circulation system, and therefore these drugs are not as widely used as they once were.

Migraine is often accompanied with nausea and vomiting, and in some cases it can be severe enough to require medication. Medications used in the treatment of nausea associated with migraine include:

• Metoclopramide (Reglan, Maxolon) and ondansetron (Zofran) – often given orally
• Chlorpromazine; Prochlorperazine (Compro, Stemetil) – often given at the doctor or emergency department via injection.

These drugs commonly cause drowsiness or dizziness so it is best to take them when you can go to sleep soon after taking them. They do not relieve migraine pain.

When you have a migraine, everyone is different and has different ways of coping. The following may be helpful in relieving the symptoms and severity of the headaches:

• Go to sleep in a dark, quiet room.
• Invest in an eye mask and a set of ear plugs if you live somewhere where it can be hard to block out light and noise.
• Talk to those around you. It is hard for others to understand how debilitating a migraine is if they have never had one. Make sure your family know when they need to have the lights dimmed or when your flatmates could help by trying to keep the noise down.
• Try putting an ice pack on your head. Ice helps to reduce inflammation. Wrap it in a tea towel and don’t put ice directly onto skin!
• Ensure you stay hydrated. Drink enough water and if necessary you may need to sip on rehydration solution if you have become dehydrated.
• Massage your temples or where your head hurts. If this causes too much pain, a neck or shoulder rub may be helpful.
• If you have nausea, try some ginger. Ginger beer may help you burp (and relieve some discomfort) or ginger biscuits may be good to nibble on to help settle the stomach.
• Be open to try a range of treatments. Many migraine sufferers have tried so many different things to try and help prevent ad relieve their headaches. It’s an ongoing battle for many. If you come across a suggestion from a friend, the internet, your doctor; be open to giving it a go, giving due consideration to the possible side effects of treatment (and financial implications).

It may be some time before a cure for migraine is found, so effectively treating and managing your migraines is important. Everyone is different, and bear in mind a treatment that doesn’t work well for someone else might be really effective for you. As you age and your body changes, your migraine cycle will most likely change as well. Be active in your migraine management and develop a good relationship with a doctor who tries to be responsive to your needs and who isn’t afraid to refer you to a specialist. Remember you are not the only one who gets migraines, even though sometimes it may feel like you are suffering in silence. For further information and support, see the links below.

General Note:

This article is of a general nature and in no way should be seen as a substitute for your own doctor’s or health professional’s advice. The author accepts no responsibility for loss occasioned to any person acting on or refraining from action as a result of the published information. Before commencing any health treatment, always consult your doctor.