Posted on Feb 23, 2009

A migraine is a very painful type of headache. People who get migraines often describe the pain as pulsing or throbbing in one area of the head. During migraines, people are very sensitive to light and sound. They may also become nauseated and vomit. Migraine is three times more common in women than in men. Some people can tell when they are about to have a migraine because they see flashing lights or zigzag lines or they temporarily lose their vision. A migraine can be disabling — with symptoms so severe, all you can think about is finding a dark, quiet place to lie down. Up to 17 percent of women and 6 percent of men have experienced a migraine. In some cases, these painful headaches are preceded or accompanied by a sensory warning sign (aura), such as flashes of light, blind spots or tingling in your arm or leg. A migraine is also often accompanied by other signs and symptoms, such as nausea, vomiting, and extreme sensitivity to light and sound. Migraine pain can be excruciating and may incapacitate you for hours or even days. Fortunately, management of migraine pain has improved dramatically in the last decade. If you've seen a doctor in the past and had no success, it's time to make another appointment. Although there's still no cure, medications can help reduce the frequency of migraine and stop the pain once it has started. The right medicines combined with self-help remedies and changes in lifestyle may make a tremendous difference for you. Migraine Treatment and Drugs There are 2 types of migraine treatments. Some treatments are used to relieve the headache pain. Most of these treatments should be started as soon as you think you're getting a migraine. The other type includes treatments that are used to prevent headaches before they occur.Medications used to combat migraines fall into two broad categories: Pain-relieving medications. Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms that have already begun. Preventive medications. These types of drugs are taken regularly, often on a daily basis, to reduce the severity or frequency of migraines. Pain-relieving medications For best results, take pain-relieving drugs as soon as you experience signs or symptoms of a migraine. It may help if you rest or sleep in a dark room after taking them: Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications, such as ibuprofen (Advil, Motrin, others) or aspirin, may help relieve mild migraines. Drugs marketed specifically for migraine, such as the combination of acetaminophen, aspirin and caffeine (Excedrin Migraine), also may ease moderate migraines, but aren't effective alone for severe migraines. If over-the-counter medications don't help, your doctor may suggest a stronger, prescription-only version of the same drug. If taken too often or for long periods of time, NSAIDs can lead to ulcers, gastrointestinal bleeding and rebound headaches. Triptans. For many people with severe migraine attacks, triptans are the drug of choice. They are effective in relieving the pain, nausea and sensitivity to light and sound that are associated with migraines. Sumatriptan (Imitrex) was the first drug specifically developed to treat migraines. Related medications include rizatriptan (Maxalt), naratriptan (Amerge), zolmitriptan (Zomig), almotriptan (Axert), frovatriptan (Frova) and eletriptan (Relpax). Side effects of triptans include nausea, dizziness, muscle weakness and, rarely, stroke and heart attack. In recent studies, a single-tablet combination of sumatriptan and naproxen sodium relieved migraine symptoms more effectively than did either individual medication. This combination tablet will likely be marketed soon. Ergots. Ergotamine (Ergomar) has been in use for more than 60 years and was a common prescription for migraine before triptans were introduced. Ergotamine is much less expensive, but also less effective, than triptans. Dihydroergotamine is an ergot derivative that is more effective and has fewer side effects than ergotamine. Anti-nausea medications. Since migraine attacks are often accompanied by nausea with or without vomiting, medication for treatment of these symptoms is appropriate and is usually combined with other medications. Frequently prescribed medications are metoclopramide (oral) or prochlorperazine (oral or rectal suppository). Butalbital combinations. Medications that combine the sedative butalbital with aspirin or acetaminophen are sometimes used to treat migraine attacks. Some combinations also include caffeine or codeine. These medications, however, have a high risk of rebound headaches and withdrawal symptoms and accordingly should be used infrequently. Opiates. Medications containing narcotics, particularly codeine, are sometimes used to treat migraine pain when people can't take triptans or ergots. These drugs are habit-forming and are usually used only as a last resort. Preventive medications Preventive medications can reduce the frequency, severity and length of migraines and may increase the effectiveness of symptom-relieving medicines used during migraine attacks. Your doctor may recommend that you take preventive medications daily, or only when a predictable trigger, such as menstruation, is approaching. In most cases, preventive medications don't eliminate headaches completely, and some can have serious side effects. For best results, take these medications as your doctor recommends: Cardiovascular drugs. Beta blockers — which are commonly used to treat high blood pressure and coronary artery disease — can reduce the frequency and severity of migraines. These drugs are considered among first-line treatment agents. Calcium channel blockers, another class of cardiovascular drugs, especially verapamil (Calan, Isoptin), also may be helpful. In addition, the antihypertensive medications lisinopril (Prinivil, Zestril) and candesartan (Atacand) are useful migraine prevention medications. Researchers don't understand exactly why all of these cardiovascular drugs prevent migraines. Side effects can include dizziness, drowsiness or lightheadedness. Antidepressants. Certain antidepressants are good at helping prevent all types of headaches, including migraines. Most effective are tricyclic antidepressants, such as amitriptyline, nortriptyline (Pamelor) and protriptyline (Vivactil). These medications are considered among first-line treatment agents and may reduce migraines by affecting the level of serotonin and other brain chemicals. You don't have to have depression to benefit from these drugs. Newer antidepressants, however, generally aren't as effective for migraine prevention. Anti-seizure drugs. Although the reason is unclear, some anti-seizure drugs, such as divalproex sodium (Depakote) and topiramate (Topamax), which are used to treat epilepsy and bipolar disease, seem to prevent migraines. Gabapentin (Neurontin), another anti-seizure medication, is considered a second-line treatment agent. In high doses, however, these anti-seizure drugs may cause side effects, such as nausea and vomiting, diarrhea, cramps, hair loss and dizziness. Cyproheptadine. This antihistamine specifically affects serotonin activity. Doctors sometimes give it to children as a preventive measure. Botulinum toxin type A (Botox). Some people receiving Botox injections for their facial wrinkles have noted improvement of their headaches. The mechanism by which Botox might prevent migraines is unclear, although the drug may cause changes in your nervous system that modify your tendency to develop migraines. Studies using Botox injections for migraines have had mixed results. Additional research is necessary. Still, if several other preventive medications have failed to control your headaches, you might talk to your doctor about trying Botox.    They are all very similar in their action and chemical structure. The triptans are used only to treat headache pain and do not relieve other forms of pain such as that from back problems, arthritis, menstruation, or other conditions. Sumatriptan (Imitrex) Zolmitriptan (Zomig) Eletriptan (Relpax) Naratriptan (Amerge, Naramig) Rizatriptan (Maxalt) Frovatriptan (Frova) Almotriptan (Axert) The following drugs also affect serotonin, but they affect other brain chemicals also. Occasionally, one of these drugs works when a triptan does not. Ergotamine tartrate (Cafergot) Dihydroergotamine (D.H.E. 45 Injection, Migranal Nasal Spray) Acetaminophen-isometheptene-dichloralphenazone (Midrin) The following drugs are mainly used for nausea, but they sometimes have an abortive or preventive effect on headaches: Prochlorperazine (Compazine) Promethazine (Phenergan) The next drugs are weak narcotic drugs. They are not specific for migraine, but they can help relieve almost any kind of pain. Since they are habit forming, they are less desirable than the specific headache drugs listed above. These drugs should be used primarily as a "backup" for the occasions when a specific drug does not work. Butalbital compound (Fioricet, Fiorinal) Acetaminophen and codeine (Tylenol With codeine) Preventive: This type of treatment is considered if a migraineur has more than 1 migraine per week. The goal is to lessen the frequency and severity of the migraine attacks. Medication to prevent a migraine can be taken daily. Preventive treatment medications include the following: Medications used to treat high blood pressure - beta-blockers (propranolol [Inderal]), calcium-channel blockers (verapamil [Covera]) Antidepressants - Amitriptyline (Elavil), nortriptyline (Pamelor) Antiseizure medications - Gabapentin (Neurontin), valproic acid (Depakote), topiramate (Topamax) Some antihistamines and anti-allergy drugs, including diphenhydramine (Benadryl) and cyproheptadine (Periactin)