Treatment of Migraines

Treatment of migraines is possible to stop symptoms and prevent future attacks.

Updated: August 17, 2020

Treatment of migraines is possible to stop symptoms and prevent future attacks. Medications used to reduce migraines are divided into two broad categories:


Pain-relieving medications:

This is also known as an acute or abortive treatment. These types of medicines are taken during migraine attacks to stop the symptoms.


Preventive medications:

These types of medicines are taken on a daily basis to reduce the severity or frequency of migraines.
Your treatment plan depends on the frequency and severity of your headaches, how long it lasts, its effects, and your other medical conditions.


Pain-relieving medications:

For best results take pain-relieving medicines as soon as you experience signs or symptoms of a migraine.
Medications include:

Pain relievers:

Aspirin, ibuprofen, or acetaminophen may help relieve mild migraines. A combination of acetaminophen, aspirin, and caffeine may ease moderate migraine pain. These medications can lead to gastrointestinal bleeding, ulcers, and medication-overuse headaches if taken too often or for long periods of time.
Indomethacin is a prescription pain reliever that helps relieve nausea if you have a migraine.

Triptans :

Triptans make blood vessels narrower, especially by encircling pressure and block pain pathways in the brain. Hence relieves the pain and other symptoms that are associated with migraines. Triptans are available in pill, nasal spray, and injection form. Sumatriptan, rizatriptan, almotriptan, naratriptan, zolmitriptan, frovatriptan, and eletriptan are some of the triptan medications. A combination of sumatriptan and naproxen sodium is more effective in relieving migraine symptoms then used alone. Nausea, dizziness, drowsiness, muscle weakness, and reactions at the injection site are some of the side effects of triptans. These medications are not recommended for people who are at risk of strokes and heart attacks.

Ergots:

Ergots are most effective when taken soon after migraine symptoms start and for those whose pain lasts for more than 48 hours. Migergot and Cafergot are available in a combination with ergotamine and caffeine. Nausea, vomiting, and medication-overuse headaches are the side effects of ergotamine. D.H.E. 45 and migraine are dihydroergotamine a substitute for ergotamine which has fewer side effects. These are available as a nasal spray and in injection form.

Opioid medications:

People who can not take triptans or ergots, opioid medications containing narcotics, codeine are sometimes used to treat migraine pain.

Glucocorticoids:

Glucocorticoids such as prednisone and dexamethasone can be used with other medications to improve pain relief. To avoid side effects, glucocorticoids should not be used frequently.

Anti-nausea medications:

Chlorpromazine, metoclopramide, or prochlorperazine are some of the prescribed medications for nausea that can be used in combination with other medications.


Preventive medications:

You can have preventive medications and therapy if

  • the attacks last more than 12 hours
  • you have four or more attacks a month
  • pain-relieving medications are not helping
  • your migraine signs and symptoms include a prolonged aura or numbness and weakness

Preventive medications are prescribed on a regular basis or only when a predictable trigger such as menstruation, is approaching. Preventive medications can reduce the severity, frequency, and length of migraines. Although these medications do not always stop headaches completely, may help increase the effectiveness of symptom-relieving medicines used during migraine attacks. Your doctor may recommend tapering off the medication to see if your migraines return without it if your migraines are well-controlled by using these medications. The most common preventive medications include:

Cardiovascular Medications:

The beta-blockers propranolol, metoprolol tartrate, and timolol which are commonly used to treat high blood pressure and coronary artery disease may reduce the frequency and severity of migrainesCalcium channel blockers such as verapamil used to treat high blood pressure may help prevent migraines with aura. The angiotensin-converting enzyme inhibitor lisinopril may be useful in reducing the length and severity of migraines.

Antidepressants:

Amitriptyline is the only tricyclic antidepressant which effectively prevents migraines by affecting the level of serotonin and other brain chemicals. Sleepiness, dry mouth, constipation, and weight gain are some of the side effects of this medication.

Anti-seizure drugs:

Valproate and topiramate are some of the anti-seizure drugs that can be used to reduce the frequency of migraines. Nausea, tremor, weight gain, hair loss, and dizziness are some common side effects of valproate whereas topiramate may cause diarrhea, nausea, weight loss, memory difficulties, and concentration problems if taken in high dose. Valproate products should not be used in pregnant women or women who may become pregnant.

OnabotulinumtoxinA or Botox:

Botox is helpful in treating chronic migraines in adults. OnabotulinumtoxinA is injected into the muscles of the forehead and neck during this procedure. The treatment usually needs to be repeated every 12 weeks to make it effective.

Pain relievers:

Taking nonsteroidal anti-inflammatory drugs such as naproxen (Naprosyn), may help prevent migraines and reduce symptoms.



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