Migraine Treatment Options
If any factors are known to trigger your symptoms, eliminating them is often beneficial. It is helpful to keep a diary or calendar of your migraines to determine whether any cause-effect relationship is present.
Symptomatic treatment works best for people who have infrequent headaches. The use of pain medication – even over-the-counter medications – more than two or three times a week can make headaches worse and less likely to respond to preventive treatments (“analgesic rebound” or “medication overuse” headaches). The neurological and visual manifestations of migraine cannot be treated with symptomatic treatment.
The most common types of symptomatic treatment include:
- Anti-emetic medications
- Helpful for people who have nausea and vomiting. Suppositories are a good option for people with severe vomiting. Drowsiness is a common side effect.
- Anti-inflammatory/analgesic medications
- Include aspirin, ibuprofen, and similar medications (naproxen). The most common side effects of these medications are stomach upset and dizziness. Acetaminophen (Tylenol)-containing medications can also be effective.
- Combination preparations
- Compounds may contain an analgesic (aspirin or acetaminophen), narcotic analgesic, sedative, and an agent to constrict blood vessels (caffeine). Commonly used preparations include butalbital (Fiorinal, Fioricet), Excedrin, Midrin (not commercially available), or Bellergal. Over-the-counter preparations may include an analgesic, magnesium, feverfew, or riboflavin.
- Dihydroergotamine (DHE)
- DHE affects serotonin and constricts blood vessels, primarily veins. DHE produces nausea and requires pretreatment with an anti-emetic. It can be given by injection (into a vein, muscle, or below the skin), by nasal spray (Migranal), or capsule. (Capsules are not commercially available).
- Narcotics and opioids
- Include medications such as codeine, hydromorphone, oxycodone, hydrocodone – drugs that are used for severe pain control. They generally don’t work well for migraine. They also cause drowsiness, may produce or worsen nausea, and can be addictive.
- Induce sleep. Prolonged use of sedatives is not recommended.
- Include sumatriptan (Imitrex), naratriptan (Amerge), rizatriptan (Maxalt), zolmitriptan (Zomig), almotriptan (Axert), frovatriptan (Frova), eletriptan (Relpax), sumatriptan/ naproxen (Treximet). These medications are available in tablets, nasal spray, and for injection (under the skin). Relief usually occurs in 30-60 minutes (sooner with injectable form and nasal spray). Medications can be used twice daily. The triptans should not be used with basilar migraine, in people with coronary artery disease, or during pregnancy. They cannot be used within 24 hours of each other or with DHE. They work best when taken early in the headache process.
Biofeedback, relaxation therapy, stress management, cognitive behavioral therapy, physical therapy, and other treatments are beneficial in some patients.
The key to successful management of migraine is communication with your physician. If the therapy prescribed does not appear to be effective after the expected trial period, an adjustment in the dose is often successful, so do not discontinue “ineffective” medications on your own. Most physicians assume that “no news is good news” – if you are having problems, please call to report them.