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 migraines 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
At one time, aspirin was almost the only available
treatment for headaches. Now there are drugs specifically designed
to treat migraines. Several drugs commonly used to treat other
conditions also may help relieve migraines in some people. All
of these medications fall into two classes — those that
reduce or prevent migraines (preventive medications), and those
that stop pain once it has started (pain-relieving medications).
Choosing a preventive strategy or a pain-relieving
strategy depends on the frequency and severity of your headaches,
the degree of disability your headaches cause and other medical
conditions you may have. You may be a candidate for preventive
therapy if you have two or more debilitating attacks a month,
if you use pain-relieving medications more than twice a week,
if pain-relieving medications aren't helping or if you have uncommon
Some medications aren't recommended if you're pregnant
or breast-feeding. Some aren't used for children. Your doctor
can help find the right medication for you.
For best results, take pain-relieving drugs as soon
as you experience migraine signs or symptoms. It may help if you
rest or sleep in a dark room after taking them:
· Mild pain relievers. Over-the-counter
(OTC) medications such as ibuprofen (Advil, Motrin, others), aspirin
and NSAIDs 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 OTC 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.
Sumatriptan (Imitrex) was the first drug specifically developed
to treat migraines. It mimics the action of serotonin by binding
to serotonin receptors and causing blood vessels to constrict.
Sumatriptan is available in oral, nasal and injection form. Injected
sumatriptan works faster than any other migraine-specific medication
— in as little as 15 minutes —and is effective in
70 percent to 80 percent of cases. But injections may be inconvenient
and painful. Since the introduction of sumatriptan, a number of
similar drugs have become available, including rizatriptan (Maxalt),
naratriptan (Amerge), zolmitriptan (Zomig), almotriptan (Axert),
frovatriptan (Frova) and eletriptan (Relpax). These newer agents
provide pain relief within two hours in 60 percent to 91 percent
of patients, have fewer side effects and cause fewer recurring
headaches. Side effects of triptans include nausea, dizziness
and muscle weakness and, rarely, stroke and heart attack.
· Ergots. Drugs
such as ergotamine (Ergomar) and dihydroergotamine (D.H.E 45)
and dihydroergotamine nasal spray (Migranal) help relieve pain.
These drugs may have more side effects than triptans.
· Medications for
nausea. Metoclopramide (Reglan) is useful for relieving
the nausea and vomiting associated with migraines, not the migraine
pain itself. It also improves gastric emptying, which leads to
better absorption and more rapid action of many oral drugs. It's
most effective when taken early in the course of your migraine
or even during the aura before your headache begins. Prochlorperazine
(Compazine) and chlorpromazine (Thorazine) also may relieve nausea
but do not affect gastric emptying.
Preventive medications can reduce the frequency,
severity and length of migraines and may increase the effectiveness
of pain-relieving medicines used during migraine attacks. In most
cases, preventive medications don't eliminate headaches completely,
and some can have serious side effects. For best results, take
these medications every day, as your doctor recommends:
· Nonsteroidal anti-inflammatory
drugs (NSAIDs). Regularly taking over-the-counter NSAIDs
such as ibuprofen (Advil, Motrin, others) and naproxen sodium
(Aleve, Anaprox) may reduce the frequency of migraines. If these
medications don't help, your doctor may suggest a stronger, prescription-only
version of the same drug. However, long-term use of these medications
can lead to ulcers and gastrointestinal problems. Talk to your
doctor before taking these medications regularly — even
the nonprescription varieties.
· Cardiovascular drugs.
Studies consistently show that beta blockers — which are
commonly used to treat high blood pressure and coronary artery
disease — can reduce the frequency and severity of migraines.
Calcium-channel blockers, another class of cardiovascular drugs,
especially verapamil (Calan, Isoptin), also may be helpful. In
addition, recent studies suggest that 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.
Beta blockers can also raise blood sugar levels and mask symptoms
of low blood sugar in people with diabetes.
Certain antidepressants are good at helping prevent all types
of headaches, including migraines. Most effective are tricyclic
antidepressants such as amitriptyline (Elavil), nortriptyline
(Pamelor) and protriptyline (Vivactil). These medications may
reduce migraines by affecting the level of serotonin and other
brain chemicals. You don't have to have depression to take these
· Antiseizure drugs.
Although the reason is unclear, some antiseizure drugs such as
divalproex sodium (Depakote), valproic acid (Depakene), topiramate
(Topamax) and gabapentin (Neurontin), which are used to treat
epilepsy and bipolar disease, seem to prevent migraines. Taken
in high doses, however, these antiseizure drugs can cause side
effects such as nausea and vomiting, diarrhea, cramps, hair loss
· Cyproheptadine (Periactin).
This antihistamine specifically affects serotonin activity.
Doctors sometimes give it to children as a preventive measure.
· Botulinum toxin
(Botox). Some people receiving Botox injections for their
facial wrinkles have noted improvement of their headaches. Some
researchers believe that Botox may work by soothing muscle tension
in your head or interfering with the neurologic changes that cause
migraines. Additional research is necessary.