Pharmaceutical approaches for migraine care can be divided into 2 categories: those medicines designed to stop a migraine and those designed to prevent them.
Medicines To Stop Migraines
For milder migraine headaches, some doctors recommend a mix of 2 types of medicines, or they may try to work with just 1. To help with inflammation in the vascular system, non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and naproxen are all options, with brand names like Bayer, Advil, and Aleve. Other over-the-counter medicines that are designed specifically for migraines combine acetaminophen, aspirin, and caffeine.
For migraines that are moderate to severe, prescription medications may be called for. Doctors might prescribe triptans, which relieve swelling in the blood vessels and can be taken as tablets. Some are also available as a nasal spray, an injection, or a dissolvable tablet. Brand names of triptans include Axert, Frova, Maxalt, Imitrex, Treximet, and Zomig. These drugs quickly relieve the sensitivity to light and noise, nausea, and vomiting that may accompany migraines.
Ergotamines also work to constrict blood vessels in the brain and can be taken as a migraine is emerging. These have been prescribed for years but may not be as effective as some of the newer medicines. Sold under the brand names Migranal, Cafergot, and Migergot, these prescription medicines are available as tablets, nasal sprays, suppositories, and injections.
With a few exceptions, most doctors will not prescribe opioids for the treatment of migraine. Opioids can be effective in the treatment of some migraine pain, but the risk of dependence and other side effects is very high and outweighs, in most cases, the benefits. A 5-year study completed by the Michigan Headache and Neurological Institute found that opioids were effective in less than 25% of patients with chronic headache, with many other patients requesting to be removed from that treatment plan shortly after beginning.
Medicine To Prevent Migraines
Patients who find that they are using medicines to stop migraines twice a week may want to start a course of preventative treatment. These prescription medicines work differently on different people, so it may take some trial and error to see which is most effective.
- Beta-blockers: This includes brand-name drugs such as Tenormin, Lopressor, Toprol, Corgard, and Inderal. These drugs relax blood vessels, but it is not clear how they prevent migraines. These drugs can reduce the number of migraines by more than half.
- Anticonvulsants: Typically used to prevent seizures, anticonvulsants such as Topamax and Depakene can help cut the number of migraines by half.
- Antidepressants: These medicines can be used to prevent migraine by helping with sleep problems (a common trigger) and by relieving pain. Tricyclic antidepressants are most commonly used for this purpose.
- Calcium channel blockers: These medicines also help constrict blood vessels in the brain, with the best evidence of usefulness surrounding verapamil.
- Botulinum toxin: Also known as Botox, some patients report migraine prevention when using this treatment. It is not clear how Botox prevents migraines.
There are many different options for migraine care, with new drugs and alternative therapies being investigated. A new blood pressure drug, candesartan, has shown promise in treating migraine, and new treatment options are still emerging. What works for one patient may not work for another, so talk to your doctor about your options.
What treatments for migraine care have you tried in the past, and what worked?
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