Migraine — Comprehensive overview covers symptoms, causes, treatment of this debilitating variety of headache. Migraine headaches can be treated with two drug approaches: abortive and preventive. SpringTM may be another option. You hold it at the. There are numerous migraine treatment options available from conventional medicines to A device for treatment of cluster headache and migraine.
options Migraine treatment
Adapted with permission from Wilson JF. Migraine [published correction appears in Ann Intern Med. Several medications from different classes are available to treat acute migraine Table 3 7 — Because relatively few trials have directly compared the different medication classes available to treat acute migraine, definitive treatment algorithms cannot be developed. More than one-half of persons treat their migraine headaches with nonprescription medications, and patients often present to physicians after unsuccessfully trying multiple nonprescription therapies.
Headache Consortium guidelines offer a general strategy based on expert consensus. Triptans are considered first-line abortive treatment of moderate to severe migraine, or mild attacks that have not responded to nonprescription medicines.
Ergotamine-containing compounds may also be reasonable in this situation. Heartburn, gastric bleeding, ulcers, rebound headache, renal toxicity; can exacerbate heart failure and hypertension. Available without a prescription; many patients have already tried nonprescription NSAIDs before seeking medical advice. Should be avoided in patients with a history of myocardial infarction, cerebrovascular accident, Prinzmetal angina, uncontrolled hypertension, or other vascular diseases, and in pregnant women.
Dexamethasone [ corrected ]. Hyperglycemia, mood changes, insomnia; multiple adverse effects with long-term use. IV dosing can be used in combination with 10 mg metoclopramide every 8 hours as needed for nausea. Information obtained at http: Generic price listed first; brand price listed in parentheses. Medical Economics Data; Cost to the patient will be higher, depending on prescription filling fee.
Information from references 7 through Information from references 5 , 6 , 11 , 12 , and 14 through Predicting individual response to a specific medication is difficult. Complete pain relief is not always achievable. For example, studies report complete pain relief within two hours in 45 to 77 percent of patients taking triptans.
Patients with severe nausea and vomiting often require nonoral medication. Evidence suggests that abortive therapy works best if taken soon after the onset of migraine or during aura, before pain progresses. A trial using almotriptan Axert showed that early users i.
Prophylactic therapy may be appropriate for selected patients. Headache Consortium's recommended indications for prophylactic therapy in patients with migraine headache are Contraindications or intolerance to abortive therapies.
Presence of uncommon migraine conditions, including hemiplegic migraine, basilar migraine, migraine with prolonged aura, or migrainous infarction.
Its use in migraine treatment has shown favorable results when compared with 50 mg of sumatriptan Imitrex in one trial and with placebo in previous trials. NSAIDs are a convenient first-line therapy for mild to moderate migraine or historically responsive severe attacks.
A meta-analysis of ibuprofen for moderate to severe migraine showed that mg and mg doses were effective for short-term pain relief, but had hour pain-free rates similar to placebo. A study comparing ketoprofen with zolmitriptan Zomig showed zolmitriptan to be modestly more effective two-hour relief in Triptans are migraine-specific drugs that bind to serotonergic receptors.
They are considered first-line therapy for moderate to severe migraine, or mild to moderate attacks unresponsive to nonspecific analgesics. A Cochrane review found that all triptans are similar in effectiveness and tolerability. Trials suggest that nonresponders to one triptan may respond to another; therefore, switching triptans is also reasonable.
Triptans differ from one another in pharmacokinetics. Rizatriptan has a quicker onset of action than sumatriptan; frovatriptan Frova , naratriptan Amerge , and eletriptan have longer half-lives than sumatriptan. Some triptans are available as nasal sprays, rapidly dissolving tablets absorbed despite vomiting , or subcutaneous injections.
Some physicians choose a triptan by matching pharmacokinetics to the temporal pattern of their patient's migraine e. The vasoconstrictive properties of triptans preclude their use in patients with ischemic heart disease, stroke, uncontrolled hypertension, or hemiplegic or basilar migraine. However, the chest pain occurring in 3 to 5 percent of oral triptan users has not been associated with electrocardiographic changes and is rarely ischemic.
Cardiac evaluation is reasonable before triptan initiation in patients with multiple vascular risk factors. Triptans are contraindicated in patients taking monoamine oxidase inhibitors. The true incidence of serotonin syndrome in this setting is unknown.
Food and Drug Administration FDA alert cited 29 case reports over five years, although almost , patients per year are prescribed both selective serotonin reuptake inhibitors and triptans. One trial showed that the combination provided superior pain relief compared with either monotherapy. Evidence supports a role for parenteral antiemetics in acute migraine, independent of their antinausea effects. A meta-analysis of 13 randomized controlled trials concluded that intravenous metoclopramide Reglan should be considered a primary agent in the treatment of migraine in emergency departments.
No evidence supports migraine-specific effects of oral antiemetics, other than relieving nausea. Intravenous dexamethasone has been used as adjunctive therapy for migraine in emergency departments. Two meta-analyses, each with seven randomized controlled trials in which dexamethasone was added to other standard therapies, showed that about 10 patients needed treatment to prevent headache recurrence within 24 to 72 hours 12 , Like triptans, ergotamines and dihydroergotamine DHE are migraine-specific drugs that bind to serotonergic receptors.
Although their use has been largely supplanted by triptans, ergot alkaloids still have a role in selected patients. Little evidence supports the use of oral ergotamines. Poor absorption and high rates of adverse events preclude their use in most situations. Combination medications containing ergotamines e. Nine placebo-controlled trials have demonstrated the effectiveness of dihydroergotamine nasal spray Migranal , making it an option for nonoral medication.
A meta-analysis showed comparable effectiveness to opiates and ketorolac when combined with an antiemetic, but inferiority to phenothiazines and triptans when used alone. One trial showed similar effectiveness to low-dose sumatriptan when used early in mild to moderate migraine.
Intranasal lidocaine Xylocaine has a rapid onset of action and may be useful as a temporizing measure until longer-acting treatment can take effect. Acetaminophen alone is not effective therapy for acute migraine. Headache Consortium recommends limiting opiate use in migraine treatment because of its potential for abuse and rebound headache.
Calcitonin gene-related peptide is a neuropeptide thought to be central to migraine pathogenesis. Intravenous infusion of a calcitonin gene-related peptide antagonist showed promising results in one small study. A controlled trial of patients who had migraine with aura showed that this therapy is superior to sham in two-hour pain relief and sustained responses over 24 to 48 hours.
Acetaminophen, despite questionable effectiveness, is reasonable in the treatment of migraine in pregnant women because of its established safety. NSAIDs are effective and generally considered safe until the third trimester. Opiates may be used for intractable cases, but pose risks of neonatal withdrawal and maternal dependence. The safety of isometheptene in pregnancy is unknown, so its use is not recommended. Ergotamines are abortifacients and are therefore absolutely contraindicated in pregnant women and women of childbearing age who are not using reliable contraception.
Given scant data and cautions regarding medication safety, preventive approaches are key. Many women report migraine or migraine exacerbations occurring exclusively near the time of menses. Long-acting triptans frovatriptan and naratriptan, taken perimenstrually around-the-clock for short-term prevention, have been found effective in reducing frequency and severity of menstrual migraine. Limited evidence is available to guide pharmacologic treatment of acute migraine in children and adolescents.
Intranasal sumatriptan and nasal zolmitriptan, but not oral formulations, have shown effectiveness in children and adolescents, perhaps because of the quicker onset of nasal formulations and shorter duration of migraines in children. A PubMed search was completed in Clinical Queries using the key terms migraine and treatment, with separate searches for specific drug classes. A similar search was performed using Google Scholar.
The following self-care measures can help when you have a migraine. These measures can be used in addition to medicines.
People who have severe or frequent migraines more than times a month may benefit from medicines that can help prevent migraines. These medicines are more commonly associated with treatment of other conditions, such as depression, high blood pressure or seizures, but can also be effective in preventing migraines.
This type of preventive medicine is usually taken every day. Botulinum toxin type A Botox can be used to help prevent migraine headaches in certain people with chronic migraine headaches on at least 15 days per month of which at least 8 days are with migraine.
Botox is injected into specific head and neck muscle areas. Repeat injections may be needed after 12 weeks. Women who tend to get migraines around the time of their periods may be able to take preventive medicines such as NSAIDs or oestradiol gel - a hormonal treatment for several days around the time of the expected migraine attack. Talk to your doctor about treatments for migraines that are triggered by fluctuations in hormones related to your menstrual cycle.
Medicines for the prevention of migraines are not suitable for everyone and can cause side effects. Although these therapies may be useful on their own, they may be more effective when used together with preventive medicines for migraine.
Magnesium , the herb feverfew and high doses of vitamin B2 riboflavin may also help in the prevention of migraines. Always check with your doctor before starting any supplements or complementary medicines, especially if you are already taking other medicines.
A migraine is typically a headache with moderate to severe throbbing or pounding on one side of your. Taking melatonin may be an effective way of preventing migraines, Brazilian researchers have found w. People who suffer from frequent migraines show significant improvements after 20 weeks of acupunctur. Migraine sufferers, known as migraineurs, have been shown to perform better than other people on mem. Yet more evidence has emerged that migraine should be considered an important indicator of risk ris.
Although headaches are very common and rarely a sign of serious illness, certain symptoms should pro. The debilitating effects of migraine affect the lives of 4. This web site is intended for Australian residents and is not a substitute for independent professional advice. Information and interactions contained in this Web site are for information purposes only and are not intended to be used to diagnose, treat, cure or prevent any disease. Further, the accuracy, currency and completeness of the information available on this Web site cannot be guaranteed.
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If you find you can't manage your migraines using over-the-counter medicines, your GP may prescribe something stronger. Most people find that sleeping or lying in a darkened room is the best thing to do when having a migraine attack. They tend to be most effective if taken at the first signs of a migraine attack, as this gives them time to absorb into your bloodstream and ease your symptoms.
It's not advisable to wait until the headache worsens before taking painkillers as it's often too late for the medication to work. If you can't swallow painkillers because of nausea or vomiting, suppositories may be a better option. These are capsules that are inserted into the anus back passage. When taking over-the-counter painkillers, always make sure you read the instructions on the packaging and follow the dosage recommendations.
Children under 16 shouldn't take aspirin unless it's under the guidance of a healthcare professional. Aspirin and ibuprofen are also not recommended for adults who have a history of stomach problems, such as stomach ulcers , liver problems or kidney problems.
Taking any form of painkiller frequently can make migraines worse. This is sometimes called "medication overuse headache" or "painkiller headache". Speak to your GP if you find yourself needing to use painkillers repeatedly or if over-the-counter painkillers aren't effective.
If ordinary painkillers aren't helping to relieve your migraine symptoms, you should make an appointment to see your GP.
Treatment of Acute Migraine Headache
There is currently no cure for migraines, although a number of treatments are available because of nausea or vomiting, suppositories may be a better option. Discover the wide range of treatment options open to you at the Migraine Relief Center. Migraine is a complex and often debilitating disorder. There are different types of migraine, and several treatment options. Migraine treatment.