Migraine: Treatment and Management

By Lisa Cantkier

Migraine: Treatment and Management

The majority of people who have migraines do not seek medical care for their pain. But a variety of medications are available to treat migraines. Medications used to treat migraines either are preventive or pain-relieving. Different medications can cause various side effects. Many are not recommended for people at risk of stroke and heart attack.

“Medication helps me, but I also need a spiritual outlet. I find meditation, rest, and relaxation to be very helpful in helping me manage the pain of migraines, both before and during attacks,” said Nancy, 48, who has long-term, chronic migraine syndrome. “Yoga, deep breathing, and meditation help me to restore a level of equilibrium and calm in my body. These practices give me some sense of control over my emotions and an inner strength and belief that I will be okay.”

Here are some examples of available medications.


Pain-relieving medications

Anti-nausea: Medication for nausea is prescribed as needed and usually is combined with other medications. Examples include chlorpromazine, metoclopramide (Reglan), or prochlorperazine (Compro).

Ergots: Ergotamine and caffeine combination drugs (Migergot, Cafergot) are less effective than triptans. Ergots seem most effective for migraine pain that lasts for more than 48 hours. Dihydroergotamine (D.H.E. 45, Migranal) is an ergot derivative that is more effective and has fewer side effects than ergotamine, and it is less likely to cause medication-overuse headaches.

Glucocorticoids (prednisone, dexamethasone): This medication may be used with others to aid in pain relief. There is a risk of steroid toxicity, so they shouldn’t be used frequently.

Opioid medications: Opioid medications containing narcotics, such as codeine, sometimes are used by people who can’t take triptans or ergot medications. These are habit-forming and typically are used when other medications fail to help with pain relief.

Pain-relieving medications: These also are known as acute or abortive treatments. The medications are taken during migraine attacks. They need to be taken as soon as you experience the first signs or symptoms. Examples include:

Pain relievers: Aspirin, or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, etc.) and acetaminophen (Tylenol, etc.). The combination of acetaminophen, aspirin, and caffeine (Excedrin Migraine) also may ease moderate migraine pain but aren’t effective on their own for severe migraines. If taken too often, these medications can lead to ulcers, gastrointestinal bleeding, and medication-overuse headaches.

Triptans: Triptans are commonly prescribed medications and help constrict the blood vessels and block pain pathways in the brain. Medications include almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig). A single-tablet combination of sumatriptan and naproxen sodium (Treximet) has proved to be more effective in relieving symptoms than either medication taken individually.


Preventive medications

These drugs are taken regularly, often daily, to reduce severity or frequency. Certain medications are not safe for women who are pregnant or breastfeeding, and only a few medications are safe for children. Your doctor may recommend you take preventive medication daily or when a trigger is approaching.

If you have four or more debilitating attacks per month, if your attacks last more than 12 hours, if pain-relieving medications aren’t helping, or if your migraine signs and symptoms include a prolonged aura or numbness and weakness, these medications may be recommended. They can reduce the frequency and severity of your migraines, but they won’t necessarily eliminate your headaches completely. Here are some examples:

Cardiovascular drugs: These medications are used commonly to treat high blood pressure and coronary artery disease. It is not exactly clear why these cardiovascular medications prevent migraine attacks. The beta blockers metoprolol tartrate (Lopressor), propranolol (Inderal La, Innopran XL, etc.), timolol (Betimol), and others are effective for preventing migraines. If you are 60 or older, have certain heart or blood vessel conditions, or smoke, these medications may not be safe for you.

Calcium channel blockers are another class of cardiovascular medications used to treat high blood pressure and keep blood vessels from becoming narrow or wide. They also may be helpful in preventing migraines and relieving symptoms. Examples include Verapamil (Calan, Verelan, etc.).

Antidepressants: Certain antidepressants can help to prevent migraines, even if you do not have depression. Tricyclic antidepressants can be effective and may reduce the frequency of migraine headaches by boosting levels of serotonin and other chemicals. Amitriptyline is the only tricyclic antidepressant that has been proven to prevent migraine headaches. Research suggests one serotonin and norepinephrine reuptake inhibitor (SSRI) — venlafaxine (Effexor XR) — may help prevent migraines.

Anti-seizure drugs: Some anti-seizure drugs, such as valproate sodium (Depacon) and topiramate (Topamax), seem to reduce the frequency of migraines. Valproate products should not be used by pregnant women.

OnabotulinumtoxinA (Botox): This medication has been shown to help treat chronic migraine headaches in adults. Injections are made in the muscles of the forehead and neck. If effective, this treatment usually is recommended every three months.

Pain relievers: Nonsteroidal anti-inflammatory drugs such as naproxen (Naprosyn) may help reduce symptoms or even prevent migraines.


Alternative treatments

Alternative treatments including chiropractic, physical therapy, and massage can be effective in helping to treat migraine syndrome and control pain intensity.

According to the Association of Migraine Disorders (AMD), “Studies have shown that they might be comparable to the effectiveness of some preventive medications, but often the studies are not of the most rigorous quality.”

The AMD also views certain vitamins, minerals, and supplements as ingredients that can contribute to treating migraines. But it cautions that like all drugs, the ingredients can have side effects, and their effectiveness depends on the purity of the particular batch of the herb or supplement. The AMD specifically recommends the use of magnesium, vitamin B-2, Coenzyme Q10, melatonin, and feverfew in helping treat migraine syndrome. For more information, read this article on the website of the Association of Migraine Disorders.

Last Reviewed 3/31/2016

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Lisa Cantkier, CHN is a certified holistic nutritionist and a health and wellness editor.

Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.

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