Migraine Treatment: Migraine Medication and More

Medication for Migraines

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Many chronic migraine sufferers take preventative medication before a migraine to curb attacks as well as abortive medication during a migraine for pain relief. Preventative medication is usually taken on a regular basis (often daily) to reduce migraine attacks. Alternatively, abortive medication tends to stop symptoms which have already begun to happen. Whether a person takes combination of the preventative and abortive medication depends on the frequency and severity of their migraines as well as their tolerance to a particular medication.

Abortive medications

Milder migraines could be treated by common over the counter pain relievers such as acetaminophen (Tylenol), Asprin or NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen. Over the counter drugs which developed to specifically treat migraines, such as Excedrin Migraine, could also be helpful for patients with mild migraines. However, over use of OTC pain relief drugs can lead to medication-overuse headaches and ulcers.

Prescription pain relievers known as triptans are mostly used as abortive medication for more severe migraines. Triptans target serotonin in the brain and many migraine sufferers report them to be effective in obstructing migraine pain. Triptan medications include:

  • Sumatriptan

  • Rizatripan

  • Naratriptan

  • Zolmitriptan

  • Eletriptan

  • Almotriptan

  • Frovatriptan

Because the side effects of triptans can include muscle weakness, nausea and dizziness, they are not recommended to be used by heart or stroke patients. Triptans can be found in the form of pills, injections as well as nasal sprays.

Although less effective than triptans, ergots, essentially ergotamine and caffeine combination drugs, are also used to thwart migraines. Like triptans, ergots can also be found in the form of nasal sprays and injections and tend to be more effective for migraines lasting more than two days.

Many migraine sufferers also take additional medication, such as anti-nausea medication, to prevent other symptoms of migraines such as nausea and vomiting. In certain cases where patients cannot take triptans and ergots to treat migraines, opioid medications, which contain narcotics are used to treat migraine pain.

Preventative Medication

Preventative medication is used by people who suffer from chronic migraines and experience migraine events that last longer than 12 hours. Preventative medication can be taken daily to curb migraine attacks and reduce their duration and severity. Anti-seizure drugs, beta blockers and anti-depressants could also be used to prevent migraines. Anti-seizure drugs such as topiramate are very popular amongst chronic migraine sufferers although their usage can often lead to side effects which include nausea, weight loss and brain fog.

Anti- depressants work in a similar manner- although depression is a common side effect of migraines, the patient need not suffer from it to take anti-depressants during a migraine. Tricyclic anti-depressants, for example amitriptyline, affect serotonin in the brain and prevent migraine attacks. Side effects of anti-depressants can include weight gain and dryness in the mouth.

Whereas beta blockers are mainly used for cardiovascular issues such as high blood pressure, they have been effective in deterring migraines for some migraine sufferers as well. Often the effect of beta blockers on migraines cannot be seen for weeks; hence it is difficult to determine right away whether beta blockers are working. Older patients or those with heart conditions are often not prescribed beta blockers for migraines.

Measuring the effectiveness of treatment plan

Many migraine sufferers take a combination of several different medications to treat their migraines and it can be difficult to decipher which medicine is the most effective. Since, migraine medication as well as other migraine treatments can be expensive, painful to administer and with several debilitating side effects, it is a good idea to understand which treatment is most effectual and eliminate those that aren’t.

Tracking migraine events and related medication intake is an efficient way of examining which medications work for a particular individual. If a person is religiously taking preventative medication, yet their migraines are not reducing in frequency, he/she can have reliable records to show their doctor this result. This allows the doctor to make informed decisions about his/her patient’s treatment plan without having to rely on the patient’s memory. If the treatment plan needs to be changed, recording the new medication and treatments and the duration, frequency and severity of the migraine can indicate whether it is successful or not.

In the case of preventative medication, it is important to take the medication as prescribed without fail. Missing medication can increase migraine attacks and if recorded, a patient can look back and see which days he/ she did not take medicine. Similarly over use of medication can also cause medication-overuse headache. Recording the quantity of medication taken can help reduce the chances of medication overuse.

Alternative procedures for migraine prevention

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OnabotulinumtoxinA or Botox, could also help in preventing migraine attacks for chronic migraine patients. Many migraine sufferers, who received Botox for other reasons, reported it to be effective in relieving migraine pain. After several phases of testing, Botox was approved by the FDA in 2010 and the NHS in 2012 for chronic migraine sufferers.

Chronic migraine sufferers usually use Botox when pain relief and preventative medications are not effective in reducing migraine attacks. Botox treatments are administered every 12 weeks and the entire treatment period is usually 15 months. Botox is injected in multiple doses into the bridge of the nose, temples, forehead, the back of the head, the neck and upper back. Many migraine patients who use Botox do not see a positive effect immediately and may not do so for months before it starts helping. The reported side effects of Botox can include neck stiffness and muscle weakness. Many insurance providers cover Botox and require a migraine diary as proof of chronic migraines.

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Sphenopalatine Ganglion Block (SPG Block)

The sphenopalatine ganglion (SPG) are nerve cells which are closely associated to the trigeminal nerve and pain signals during a migraine attack. Sphenopalatine Ganglion Block is used as an alternative treatment for reducing migraines and cluster headaches. Through this procedure, pain transmission to the nerve is blocked using anaesthesia. The anaesthesia is administered through the catheter which is inserted through the nostril to the back of the nasal cavity where it is absorbed through the bone and to the SPG. New catheters, such at the Sphenocath and Allevio have been developed to make the treatment less uncomfortable and quicker.

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Occipital Nerve stimulation

Occipital nerve stimulation can be useful to treat people with severe and chronic migraines who do not respond well to standard migraine treatment methods. Although occipital nerve stimulation has worked for some migraine sufferers there is still not enough research to prove that it is a long term relief method for migraines or that it is effective enough to be included in the standard migraine treatment methods. Occipital nerve stimulation involves implanting a device at the base of the skull near the occipital nerve. This device is then connected to a pulse generator, placed near the collarbone, which sends electrical pulses to the occipital nerve.

Devices for migraine prevention

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Cefaly is an external trigeminal nerve stimulation device, available only by prescription, which is used to prevent migraine attacks and provide relief during a migraine. It looks like a headband which is worn on the forehead with an electrode which creates contact with the forehead. Cefaly provides electric current to the skin which stimulates the trigeminal nerve. The patient usually experiences tingling or the feeling of being massaged. There have been no reported adverse side effects of Cefaly except a feeling of uneasiness during the time that the device is on, sleepiness and a headache after it is turned off. Although, it has become popular with migraine sufferers the long term effectiveness of Cefaly on migraines is yet to be seen.

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Spring TMS

Spring TMS is a portable transcranial magnetic stimulation device which is placed on the base of the skull to deliver mild currents which depolarize neurons in the brain. The device has received FDA approval in 2014 and is available by prescription. The effectiveness of the Spring TMS can vary is different patients; however it can take a few weeks before showing positive results.

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