Many medications are available to treat migraines. Generally, migraine medications fall into two categories: medicines that treat a migraine attack (e.g. acetylsalicylate, eventually triptans as a second choice) and medicines that help prevent a migraine from occurring (e.g. beta-blockers).
Treating the acute attack
Preventing the attack
Treating the acute attack
Over-the-counter medications
These are effective for some people with migraines. The main ingredients in pain-relieving medications are ibuprofen, aspirin, acetaminophen (paracetamol) and caffeine. Be cautious when taking over-the-counter pain-relieving medications because sometimes they can contribute to a headache, or the overuse of them can cause chronic daily headaches or rebound headaches. If you are taking any over-the-counter medications more than three times a week or daily, it’s time to see your doctor. S/he can suggest prescription medications that may be more effective.
Prescription medications
When over-the-counter medications - even at high doses - fail to treat your migraine attacks, your doctor will suggest more specific anti-migraine medication. Regular pain killers can be combined with codein, a weak opioid, which makes them far more potent. Tablets, suppositories or injections with alkaloid
drugs, like ergotamine, are also a very effective treatment for acute migraine attacks, although many people suffer from severe side effects, like nausea and dizziness. Medication, containing ergotamine
or its derivatives, should never be used simultaneously with triptans, as this may provoke even more serious side effects.
Triptans
The medications specifically developed for acute treatment of migraine attacks are a class of medications known as ‘triptans’. These medications work by constricting the blood vessels in the brain, bringing them back to normal, and relieving the throbbing pain. They also are effective in the treatment of symptoms that accompany migraines, such as nausea and light sensitivity. ‘Acute medications’ like triptans should be taken as soon as the migraine attack begins. This will produce better and longer-lasting pain relief.
Anti-nausea medicines
Your doctor can prescribe medication to relieve nausea that often accompanies migraines.
Non-pharmacological methods
These remedies, such as cold compresses, or lying down in a dark room, often help to alleviate migraine symptoms.
Preventing the attack
The frequency of migraine attacks can be reduced by identifying and then avoiding migraine triggers. You can keep track of your headache patterns and identify headache triggers by keeping a ‘headache diary’.
Recalling what was eaten prior to an attack may help you to identify chemical triggers and make the necessary dietary changes to avoid these triggers in the future. Stress management and coping techniques, along with relaxation training, can help prevent or reduce the severity of the migraine attacks. Women who often get migraines around their menstrual period can take preventive therapy when they know their period is due.
Migraine sufferers also seem to have fewer attacks when they schedule regular mealtimes and get adequate rest. Regular exercise - in moderation - also can help to prevent migraines.
Biofeedback helps people to learn to recognise stressful situations that bring on migraines. If the migraine begins slowly, many people can use biofeedback to stop the attack before it becomes full blown.
Some medications can help preventing migraines to occur or migraine attacks to be less severe or less frequent. Your doctor could consider prescribing prophylactic medication when:
- the headaches are severe
- migraine attacks occur more than two or three times a month
- headaches are interfering significantly with normal activities
- 'acute' medication is ineffective or causes unacceptable side effects
Preventive medications reduce the frequency, severity and duration of the headaches and are generally taken on a regular, daily basis. As such, they may reduce the need for taking acute medications or improve the way patients respond to their acute treatments.
Many different types of medication are used for migraine prevention. Possible options are:
- blood-pressure-lowering medication, like propranolol and metoprolol
- antidepressants, like amitriptyline
- high-dose vitamin B2
- pizotifene
- flunarizine
- anti-convulsants, like topiramate
You should always consult your doctor to determine if preventive medicines are right for you.
