Migraine headaches and medicine
Medical management of migraine involves 4 distinct phases. These include:
- Prevention of migraine headache
- Trigger management of migraine headache
- Stopping a migraine headache attack
- General pain management
Prevention of migraine headache
The first line of medical management for migraine headache is the use of preventive, or prophylactic, medications in order to prevent or reduce the frequency of migraine episodes in patients who experience frequent migraine headaches. Patience who experience frequent migraines typically have two or more per month.
While these medications do not work immediately, over time they may prevent blood-vessel swelling; however, they do not treat other migraine-associated symptoms, and are non-selective, meaning that they may affect the blood vessels in other regions of the body besides the head, and this affect is not always desirable.
Many migraine headache sufferers using preventive treatments will still need to take pain-relieving medications to alleviate the pain and other symptoms associated with migraine headache in addition to the preventative medications. A few of the most commonly prescribed preventative migraine headache medications includes:
- Beta-blockers - the most commonly prescribed prophylactic treatment for Migraine and are considered to be an effective preventive treatment. Medication includes propranolol, which works by blocking certain nerve receptors that can trigger migraine headache.
- Antidepressants – these are believed to have a possible effect on serotonin or possible analgesic effects. Abnormal serotonin regulation is observed in some migraine headache patients.
- Calcium channel blockers –these may decrease the frequency of migraine attacks by regulating blood vessel constriction.
- Methysergide – may block the inflammatory and vessel-constricting effects of serotonin. Because of the potential side-effects, methysergide is generally used only on select patients. This medication also requires a four to six week drug hiatus every six months.
- Divalproex Sodium –This is a newer, preventative medicine for migraine used to treat epilepsy, a disease often referred to as a sister disorder to migraine, and is prescribed in much smaller doses when used to prevent migraine headache, thus lessening the mild side effects.
Neurogastroenterologists, physicians who study the connection between certain neaurological disorders and the digestive system, such as migraine headaches, have also discovered a link between the abnormality in migraine brain chemistry and the digestive system. This very new medical approach is being scientifically studied with highly favorable, evidence-based outcomes in preliminary testing results
Trigger management of migraine headache
Trigger management is important in preventing migraine headache attacks. The triggering factors that may cause migraine headache, when recognized and/or avoided, may forestall an impending migraine attack. Triggers vary from person to person, and amongst persons. What may be a trigger one day, may not be a trigger on another day. While this mechanism isn’t well understood, fluctuations in hormones, sleep, diet, and emotional factors are thought to play a role in the migraine sufferer’s sensitivity to triggers.
Examples of triggers acknowledged by the medical community include changes in weather or air-pressure, bright sunlight, glare, fluorescent lights, chemical fumes, menstrual cycles, and certain foods such as processed meats, red wine, beer, dried fish, broad beans, fermented cheeses, aspartame, and MSG.
Examples of what aren’t triggers according to medicine include lifestyle, stress, anxiety, worry, emotion, excitement, depressions, and caffeine. Since caffeine alleviates/ and or prevents migraine for some individuals, some health care providers do not believe that caffeine is migraine headache trigger. Other neuro-transmitter-altering chemicals in commonly caffeinated beverages and foods such as chocolate, tea and coffee may be the culprit, rather than the caffeine. Preliminary research studies support these findings.
Read more on migraine triggers on the page Migraine Headache Causes
Stopping a migraine headache attack
Migraine stopping medications are used to relieve the severity and/or duration of migraine headache pain and associated symptoms. In general, most attack-stopping medications should be taken as early as possible in an attack. Many Migraine sufferers learn to recognize their prodrome, or early migraine-onset warning signs, while others can use their aura as early warning systems to implement their migraine attack-stopping treatment of choice for an early intervention approach, and in many cases avoid a severe and painful prolonged migraine headache attack.
Certain medicines that regulate the blood vessels in the brain are designed specifically for alleviating the pain and associated symptoms of migraine headache. They may be administered by subcutaneously through the skin, orally, rectally, or by intramuscular means. These medications include ergotamine tartrate, dihydroergotamine (Migranal®, DHE45®), sumatriptan (Imitrex®), naratriptan (Amerge®), rizatriptan (Maxalt®), zolmitripan (Zomig®), Electriptan (Relpax®), frovatriptan (FROVA®) and isometheptene mucate (Midrin®). Maxalt® and Zomig® both come in a melting tablet version you can take with out water, which is very convenient for early intervention for a oncoming severe attack when you may not be able to make it to a restroom, such as during air travel, in class or while having a meeting.
An excellent non-vascular migraine-stopping medicine is butorphanol tartrate (Stadol NS), offered as a patient-administered injection and a nasal spray. In an emergency room environment, narcotic injections are usually taken with promenthazine (Phenergan) or hydroxyzine (Vistril) for nausea, and can offer a migraine-relieving option when all of the above fail to ease the symptoms, or are not appropriate, such as in heart disease or when other limiting medical conditions exist.
General pain management for Migraine Headaches
There are several types of medication offered for general pain management for migraine headaches.
- Narcotic Analgesics such as Fiorinal® with codeine, codeine, Percodan®, Demerol®, Tylox®, or methadone.
- Non-narcotic pain releivers that are very effective too, such as Midrin® or Fiorinal®.
- NSAIDs (non-steroidal anti-inflammatory drugs) such as Naproxen, Ibuprofen and Ketorolac.
- Simple analgesics such as acetaminophen and aspirin, and Excedrin® Migraine, available over-the-counter (OTC)
Effect of NSAIDs on Migraine Headache
Since NSAIDs are not specific to the blood vessels of the brain, and do not treat associated Migraine symptoms, and they can cause gastrointestinal disturbances, they are less frequently...
Read more about Migraine Headache and NSAIDs.
Effect of Narcotic Analgesics on Migraine Headache
Narcotic analgesics provide general pain management. They act on the central nervous system, and alter the patient's perception of pain. While these medicines may effectively relieve pain, because...
Read more about Migraine Headache and Narcotic Analgesics.
Effect of Analgesics on Migraine Headache
Analgesics relieve pain by acting on peripheral pain receptors and may also have anti-inflammatory effects. Though readily available, they are generally not strong enough to relieve migraine pain and...
Read more about Migraine Headache and Analgesics.
Magnum. 2003-2006. (Online) http://www.migraines.org/treatment/treatctm.htm accessed 03.01.2010
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