Migraine Headache Treatments

Migraine headaches are less common than tension headaches. About 6% of all men and 18% of all women experience a migraine headache at some time. Migraine headache occurs on one or both sides of the head. The pain is typically pulsating or throbbing in nature. Nausea, with or without vomiting, as well as sensitivity to light and sound often accompany migraines. Migraines are made worse by activity, bright lights and bright noises. In most cases, migraine attacks are occasional, or sometimes as often as once or twice a week, but not daily. Women who have migraines often find that their headaches occur or worsen around the time of their menstrual periods.

One unique feature of migraines is an unusual sensation that a migraine is about to occur. This sensation is called a prodrome. Prodrome symptoms can include fatigue, hunger and nervousness. Not all people who get migraines have prodromes.

An aura is a complex of neurological symptoms that occur just before or at the onset of migraine headache. An aura involves a disturbance in vision that may consist of brightly colored or blinking lights in a pattern that moves across the field of vision. Most patients with migraine have attacks without aura. About one in five migraine sufferers experiences an aura.

Treatment

How your migraines are treated will depend on the frequency and severity of attacks. People who have a headache several times per year often respond well to nonprescription pain relievers. There are two types of medications to treat migraines:

• Abortive medications - drugs that are taken when a headache starts
• Preventive medications - drugs that are taken every day to prevent migraines

Abortive Medications

Migraine-specific abortive medications usually are necessary for moderate to severe migraine headaches. When possible, an abortive medication should be taken immediately after an aura or migraine headache starts. However overusing abortive medications can lead to chronic headaches, that occur day after day without a specific cause or diagnosis. Several prescription and nonprescription pain medications are used as abortive drugs: aspirin, ibuprofen (Advil, Apsifen, Motrin, Nuprin and other brand names) or naproxen (Aleve, Anaprox, Naprosyn)

Effective agents available by prescription include:

• Triptans - sumatriptan (Imitrex), naratriptan (Amerge), zolmitriptan (Zomig) and rizatriptan (Maxalt). Triptan drugs are effective in 60% to 65% of patients, completely or significantly relieving migraine pain and associated symptoms within 2 hours of administration. Triptans reduce inflammation and constrict the blood vessels. The triptan with the longest history of use is sumatriptan (Imitrex).
• Ergots - sublingual ergotamine (Ergomar) and dihydroergotamine (Migranal). Ergots cause constriction of blood vessels, but ergots tend to cause more constriction of vessels in the heart and other parts of the body than the triptans, and their effects on the heart are more prolonged than the triptans. Ergots are not as safe as the triptans.
• Midrin. It is a combination of isometheptene (a blood vessel constrictor), acetaminophen (a pain reliever), and dichloralphenazone (a mild sedative)

Preventive Medications

Preventive medication are prescribed when migraine attacks that don't respond well to abortive medications or adverse reactions to abortive medications occur, migraine attacks occur too often, complicated migraines. Many drugs are listed as potentially useful to prevent recurrent migraine attacks. The drugs in the following classes are useful to prevent recurrent migraine attacks:

• Beta-blockers. Propranolol (Inderal) and nadolol (Corgard) have a good track record of being safe and effective. Metoprolol (Lopressor) and atenolol (Tenormin) are reasonable alternatives. Beta-blockers have been used for many years to prevent migraine headaches. It is not known how beta-blockers prevent migraine headaches.
• Tricyclic antidepressants. These medications are very effective, but often have troublesome side effects such as sedation, blurred vision, dry mouth and constipation. The first choice is often amitriptyline (Elavil). Nortriptyline (Pamelor, Aventyl), doxepin (Sinequan), imipramine (Tofranil) also can be tried.
• Anticonvulsants. Of the drugs in this class, valproate (Depakote, Epival) has the best evidence to support using it for prevention. Gabapentin (Neurontin) and topiramate (Topamax) also are effective. It is not known how anticonvulsants work to prevent migraine headaches.
• Serotonin antagonists. Methysergide (Sansert) has been available for many years and is very effective. Methysergide prevents migraine headaches by constricting blood vessels and reducing inflammation of the blood vessels. However, this medication has side effects that are potentially very serious and therefore is not widely used.