People who get severe migraine headaches will tell you that they cannot function when they have one. Between the pain itself, sensitivity to light, nausea, and fatigue that can last for days, it is easy to see why a severe migraine can really affect your quality of life.
Are you a seeking treatment for migraine headaches?
PREVENTATIVE TREATMENT FOR MIGRAINES
CAN MIGRAINES BE PREVENTED?
When headaches occur a few times a month, it is best to treat them as they happen. However, when you have eight or more days with headaches in a month, preventing even half those headaches can really help. Such medications have two purposes. The first is to reduce the amount of headaches you are having per month, and the second is to make the headaches you do have less severe. You take these medications every day or every month, rather than as needed when you are having a headache. If the medication is successful, you will find yourself needing less medication to treat migraine attacks.
WHAT ARE THE DIFFERENT MEDICATIONS USED TO PREVENT MIGRAINES?
Many of these medications were first used to treat other conditions, such as seizures, depression, or high blood pressure. However, these medications have helped many patients with headaches as well.
Topiramate (Topamax) is a medication, first used for seizures, that has been shown to make migraines less frequent for many patients. Some possible side effects are weight loss, tingling in the fingers and toes, and changes in taste.
Antidepressants like amitriptyline (Elavil) or nortriptyline (Pamelor) can treat migraines and difficulty falling asleep. They can also cause dry mouth, sleepiness, constipation, and increased appetite.
Propranolol (Inderal) was first used for high blood pressure, but it is also effective in making migraines less frequent. Avoid this medication if you have asthma, and watch out for fatigue and decreased energy level.
Research in the last few years has led to the discovery of injectable medications to treat migraines. Aimovig, Emgality, and Ajovy are new to the migraine scene and may cut your number of migraines in half. These medications are injected into the thigh, arm, or abdomen once a month. They block CGRP, a substance released around the brain that causes inflammation and pain.
Finally, if none of those options work for you, botulinum toxin (Botox) injections around the head and neck are an option. Muscles can pull against the skull and contribute to headaches, so calming these muscles down with Botox can relieve your headaches.
HOW WELL DO PREVENTATIVE MIGRAINE MEDICATIONS WORK?
Medications that work for one patient may not work for another. It is important to let your doctor know what other medical conditions you have, so that they can choose the option best suited to you. In general, for at least half the patients who try them, these medications can cut the amount of headaches they have by half. If one option does not work for you, we may have better luck with a medication from a different class. When you do have a breakthrough migraine on these medications, it should also be lesser in severity.
People who get severe migraines will tell you that they cannot function when they have one. Between the pain itself, sensitivity to light, nausea, and fatigue that can last for days, it is easy to see why a severe migraine can really affect your quality of life.
ACUTE MIGRAINE TREATMENT
HOW EARLY SHOULD A MIGRAINE BE TREATED?
It is best to treat a migraine as soon as you start feeling that you might have one. This may mean different things to different patients with migraines. For patients who have auras, such as vision changes before their migraines, this means taking medication as soon as you feel your aura starting. Patients who have migraines without auras should take medication as soon as they feel the pain start. Timing can be difficult for patients who wake up with a headache, but taking a medication first thing in the morning may be the best option. The later into a headache you are, the less likely a medication aimed at stopping a headache is to work.
WHAT TREATMENTS ARE AVAILABLE FOR A MIGRAINE ATTACK?
When it comes to migraines, we have medications to stop a bad headache and other medications to prevent them from happening. Here, we will focus on medications to stop a bad headache as it starts.
For mild migraines, something that may be readily available at home or over-the-counter may be the best option. Tylenol or anti-inflammatory medications, such as naproxen (Aleve) or ibuprofen (Motrin, Advil), can sometimes provide relief. For moderate to severe headaches, prescription triptan medications such as sumatriptan (Imitrex) or rizatriptan (Maxalt) can be considered. These medications are strong and are not to be used by patients who have a history of heart disease, a stroke, or uncontrolled high blood pressure. But for other patients without those conditions, a triptan can be effective in eliminating headache pain at two hours after the headache starts in about two thirds of people with migraines.
For the most severe migraines, we have a few other options. A triptan such as sumatriptan, delivered by intranasal spray or an injection under the skin, may work when a tablet does not. Office-based procedures, such as nerve blocks over the areas of pain, may also provide relief. An injection of a high dose of an anti-inflammatory medication may also be an option in the office.
Opioids and barbiturates, on the other hand, are not as effective as the other options. Furthermore, they are not good medications to treat a migraine attack due to the risk for tolerance, dependence, and worsening headaches from medication overuse.
HOW DO WE TREAT OTHER SYMPTOMS ASSOCIATED WITH A MIGRAINE?
Nausea is a large component of a migraine for many patients. Medications to treat nausea, such as prochlorperazine (Compazine), metoclopramide (Reglan), or ondansetron (Zofran), can be helpful in providing relief from nausea and vomiting. Nausea medications can also be given through IV or IM if needed. Diphenhydramine (Benadryl) can be used with these medications to limit their side effects. Falling asleep can also be difficult with migraines, and diphenhydramine can be helpful in that regard as well.
Are you a seeking treatment for migraine headaches?
Reviewed by: Neurologist Dr. Sommer Ebdlahad