The Latest Treatments for Migraine Headaches, Medications Your Doctor Can Help You With
Putting the Latest Treatments for Migraine Headaches to Work for You
Your migraines are placing your life on hold time and time again. No matter how often you have them, you probably want to know what you can do about them. Is it time to talk to your doctor? What are the latest treatments for migraine headaches?
First of all, you need to ask what kind of treatment you are looking for. Do you just need something to take during the migraine attack to ease the pain (acute or abortive treatment), or are you having them so often that you need to try to prevent them from happening in the first place (prophylactic or preventive treatment) or both?
Acute treatments can be anything that helps alleviate the pain you experience during a migraine. They can be prescribed drug, over the counter (OTC) medications, alternative medicine (acupuncture, massage, herbal treatments, etc.), or home remedies (ice packs; cold packs; retiring to dark, quiet room, etc..). In this article, we will discuss medications used in the treatment of migraine headaches.
Prescribed Medications and Treatments
45% of people respond to any given prescribed medication. Doctors will prescribe medicines for people who have a predictable trigger that they cannot avoid such as a menstrual cycle, or for those who are experiencing headaches 4 or more times per month. This is one reason migraine headache journals are so important.
Medications generally fall into two categories; acute or abortive medication and prophylactic or preventative medications. In very few instances, a medication, or classification of medication may be given for both acute and prophylactic measures.
Keep in mind that acute medications can be given no matter how many headaches you had over a given time. However, acute medications used frequently can lead to medication overuse (rebound) headaches which can be as bad, if not worse, than the headaches which lead to the overuse of the medication.
Analgesics (pain-relieving medications) are generally bought over-the-counter (OTC) and are the worst offenders when it comes to medication overuse headaches.
- Aspirin (Bayer, Excedrin, etc..)
- Acetaminophen (Tylenol)
- ibuprofen (Advil, Motrin, etc..)
- Naproxen Sodium (Aleve) also used as a preventative
- Caffeine-Containing Analgesics (Excedrin Migraine)
- Cambia (diclofenac potassium)
Triptans are prescription medications which were developed specifically for migraine headache attacks and are very effective in doing so. Triptans work by constricting the blood vessels and block nerve pathways. Triptans some with side effects such as injection reactions, nausea, dizziness, drowsiness and muscle weakness. They are not recommended for persons at risk for heart attack and stroke.
- Imitrex (sumatriptin)
- Zomig (zolmitriptan)
- Axert (almotriptan)
- Moxalt (rizatriptan)
- Amerge (naratriptan)
- Frova (frovatriptan)
- Relpax (eletriptan)
- Treximet (sumatriptan and naproxen sodium) More effective than Triptans alone
Ergots are also medications that are prescribed just for migraine headache attacks. They are less effective than triptans, may increase nausea and vomiting, are a high risk for medication overuse headaches and are less effective on pain lasting more than 48 hours.
Dihydroergotamines are more effective than regular ergots with fewer side effects. They are less likely to cause medication overuse headaches and are given either as nasal sprays or by injection.
- DHE 45
Opioids are narcotics sometimes given for migraine headaches. While they were once commonly given, today they are only given as a last resort for migraines that do not respond to other treatments or to people who cannot tolerate Triptans and Ergots. Opioids have many side effects, are highly addictive and are a high risk for causing medication overuse headaches.
Antinausea medications are sometimes given in combination with other migraine treatments, particularly in cases when nausea and vomiting have caused or will cause dehydration.
- Phernergan (chlorpromazine)
- Reglan (metoclopramide)
- Compro (prochlorperazine)
- Zofran (ondandestron)
Glucorticoids (steroids) are sometimes used with other medications to treat status migrainous (refectory) migraines. Steroids have many side effects, some of which can be dangerous. They should not be used often to avoid these side effects.
Prophylactic Medications (preventative medications) are given to patients who experience 4 or more migraine attack per month, Have attacks that last more than 12 hours, do get relief from acute medications or if a prolonged aura is present.
Prophylactic medications can decrease the frequency and severity of a migraine headache attack and also increase the effectiveness of acute medications. They can, however, come with many side effects. Side effects include, but are not limited to weight gain, constipation, sexual dysfunction, increased thirst, and insomnia.
Your doctor will start you out on a small dose and gradually increase the dose until you either have a significant reduction of migraine attacks or reach the maximum dose that can be taken. Once you have your migraines under control for a long period of time, your doctor may gradually taper off the medication to see if they return.
You should NEVER stop taking any of these medications cold turkey as that could have serious, even life-threatening, consequences! You should consult your doctor if you want to come off these medications for any reason. He/she will inform you on how to taper the dosage.
Anticonvulsants (seizure) Medications are usually medications that were developed for the control of seizures. Many anticonvulsants are used to treat other conditions including migraine headache attacks. Higher, more therapeutic doses may cause side effects such as nausea, weight gain, tremor (which may not go away after stopping the medication) and dizziness.
- Depacon, Depakote (valporic acid)
- Topamax (topiramate)
- Lamictal (lamogritine)
- Keppra (levetiracetam)
Antidepressants come in many types or families that work in the same way. Each has their advantages and their own set of side effects.
- Tricyclic Antidepressants are very effective, particularly amitriptaline. They are often used because of their decreased side effects which include sleepiness, dry mouth constipation, and weight gain. Some examples of tricyclic antidepressants are Elavil (amitriptaline), Nopramine (desipramine), Sinequan (doxepine), Tofranil (Imipramine), Pamelor (Nortriptaline),and Vivactil (pritriptyline).
- Selective Serotonin Reuptake Inhibitors (SSRIs) can be very effective, but must be used carefully because serotonin has been linked to migraines. Some examples of SSRIs used to treat migraines are Prozac (fluoxetine), Serzone (nefazodone), Zoloft (setriline), Paxil (paroxetine), Lexapro (escitalopram), Effexor (venlafaxine), Desyrel (trazadone), Celexa (citalopram), Wellbutrin (bupropion) and Nardil (phenelzine).
- Selective Norepineprine Reuptake Inhibitors (SNRIs) can also be effective but should never be used with SSRIs as this could lead to Serotonin Syndrome which can be life threatening. Cymbalta (duloxitine) is an example of an SNRI.
Cardiac Medications can also be effective in preventing migraine headache attacks. Like antidepressants, cardiac medications come in several categories.
- Beta Blockers are generally used to decrease blood pressure and are also used to treat Coronary Artery Disease (CAD). They may decrease the frequency and severity of migraine headache attacks. However, they should not be used if you are over 60, use tobacco, or have certain heart or blood vessel conditions. Examples of Beta Blockers include Inderol LA (propranolol Innopran XL (propranolol), Lopressor (metoprolol), and Betimol (timolol).
- Calcium Channel Blockers are used to increase the blood pressure and are helpful in treating migraine with aura. Calan (verapamil) and Verelan (verapamil) are examples of calcium channel blockers.
- Angiotensin Converting Enzyme (ACE) Inhibitors may decrease the length and severity of migraine headache attacks. Zestril (lisinopril) is an example of an ACE inhibitor.
Botox (onabotulinumtoxin A) is currently used to treat chronic migraine. Botox decreases the frequency, duration, and severity of migraine headache attacks. A doctor uses a fine needle to inject the Botox into the muscles across the patient’s forehead, around over the ears, to the base of the skull and then down both sides of the neck.
Injections must be repeated every 12 weeks and it often takes two or three treatments to achieve the full effect. Botox does come with a “black box” warning from the Food and Drug Administration (FDA) because some side effects such as difficulty breathing or swallowing can be life-threatening.
On the Horizon
There are some new medications on the horizon. Research into the cause of migraine headaches has lead to new discoveries. As a result, migraines are now viewed as a brain disorder.
Brain imaging such as the positron emission topography (PET) scans and functional magnetic resonance imaging (fMRIS) have shed light on the brain processes during migraine. They highlight the role of certain amino acids like calcitonin gene-related peptides (CGRPs) and pituitary adenylate cyclase-activating polypeptides (PACAPs) during migraines.
Several pharmaceutical companies have new drugs either in testing (by the FDA) or in the development stage. These include CGRP Receptor Antagonists and PACAP Inhibitors to be used both for acute and preventative treatment. These drugs are being touted as being safer than other drugs to treat migraine.
Some of these drugs could hit the market in late 2017 or early 2018. The main drawback is going to be their cost (starting at around $8500 per prescription) coupled with the fact that it may take a while before insurance companies add them to their formulary (list of drugs that are covered).
As you can see there are many medications available to treat migraines. It is important that you discuss the latest migraine treatments with your doctor and with your pharmacist as well. While it would be nice to think that doctors know everything there is to know about the medications they use to treat any ailment, it simply is not the case.
Your pharmacist is your expert on medication interactions. This why it is important to inform your pharmacist of any allergies you have along with all OTC medications, supplements or herbal medications that you take.
You must also keep in mind that while medications taken for abortive measures may kick in right away, preventative medications, in general, must be taken for a period of time before you will get the full effect.
Be sure to ask your doctor or pharmacist what time of day is best to take these medications and whether you should take them with food or on an empty stomach.
I hope that you find this article both informative and helpful. Finding the right treatment(s) can be a time-consuming effort but it is worth the prize when you find the one that works for you. I hope that you will come back often as I will be adding articles on all things migraine.