Medications For Migraine Prophylaxis
SEEMA MODI, M.D., and DIONNE M. LOWDER, PHARM.D., B.C.P.S. Brody School of Medicine at East Carolina University, Greenville, North Carolina
Am Fam Physician. 2006 Jan 1 73:72-78.
Patient information: See related handout on migraine prevention, written by the authors of this article.
Sufficient evidence and consensus exist to recommend propranolol, timolol, amitriptyline, divalproex, sodium valproate, and topiramate as first-line agents for migraine prevention. There is fair evidence of effectiveness with gabapentin and naproxen sodium. Botulinum toxin also has demonstrated fair effectiveness, but further studies are needed to define its role in migraine prevention. Limited evidence is available to support the use of candesartan, lisinopril, atenolol, metoprolol, nadolol, fluoxetine, magnesium, vitaminB2 , coenzyme Q10, and hormone therapy in migraine prevention. Data and expert opinion are mixed regarding some agents, such as verapamil and feverfew these can be considered in migraine prevention when other medications cannot be used. Evidence supports the use of timed-release dihydroergotamine mesylate, but patients should be monitored closely for adverse effects.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
First-line therapies for migraine prophylaxis in adults include propranolol , timolol , amitriptyline, divalproex , sodium valproate, and topiramate .
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Algorithm for pharmacologic migraine prophylaxis.
Medications To Relieve Headache Symptoms
How do symptomatic relief medications work?
These medicines help you find relief from the symptoms that may come with headaches, such as pain, nausea and vomiting. Some of these medicines are available over the counter. Others require a prescription.
Try to avoid:
- Foods, beverages and medications containing caffeine when taking these medications.
- Medications containing barbiturates or narcotics , if possible.
- Medications with aspirin, for young children.
Can a child take medications to relieve headache symptoms?
What OTC medications can relieve headache symptoms?
These medications provide relief from headache symptoms, without a prescription:
Generic name: Aspirin
- Brand name: Bayer®, Bufferin®, Ecotrin®.
- Symptoms relieved: Fever and pain.
- Precautions and possible side effects: Heartburn, gastrointestinal bleeding, bronchospasm or constriction that causes narrowing of the airways, anaphylaxis and peptic ulcer. Dont give aspirin to children under 14 years old. It can cause a rare but serious disease called Reyes syndrome.
Generic name: Acetaminophen, paracetamol
- Brand name: Tylenol®.
- Symptoms relieved: Fever and pain.
- Precautions and possible side effects: Changes in blood counts and liver function, but side effects are rare if medication is taken as directed.
Generic name: Ibuprofen
Vestibular Migraine Not As Rare As Once Thought
Vestibular Migraine was once considered rare, but it is increasingly becoming a more widely recognized diagnosis. This type of Migraine is characterized by vertigo and dizziness. It is a common cause of headache with dizziness, but VM can occur with or without head pain.
Only about half of all patients with VM experience pain with their attacks. It can be confusing to get a diagnosis of Migraine if you have no pain, but an accurate diagnosis is key to finding the right treatment and relief.
Also Check: Migraine Meds With Caffeine
Strongest Migraine Medication Over
When discussing strength, we often refer to how much of a medication is given per dose.
Many of these OTC migraine medications are given in high doses. For example, the recommended dosages for aspirin and acetaminophen are typically around 1,000 mg.
However, when thinking about strength, you may also be considering how strongly these medications act against your migraine symptoms.
In this case, an argument can be made for the aspirin, acetaminophen, and caffeine combination. Older research has found that the combination of these three ingredients has a greater effectiveness than each individual ingredient alone.
Overall, its important to remember that the medication that most effectively alleviates acute migraine symptoms can vary by person. Because of this, focus on finding the treatment that best addresses your symptoms.
What Other Drugs Interact With Butalbital
If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.
Severe Interactions of butalbital include:
Butalbital has serious interactions with at least 51 different drugs.
Butalbital has moderate interactions with at least 301 different drugs.
Butalbital has mild interactions with at least 127 different drugs.
Butalbital has mild interactions with at least 39 different drugs.
This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine.
Treatment For Pregnant And Breastfeeding Women
In general, migraine treatment with medicines should be limited as much as possible when you’re pregnant or breastfeeding.
Instead, trying to identify and avoid potential migraine triggers is often recommended.
If medicine is essential, your GP may prescribe you a low-dose painkiller, such as paracetamol.
In some cases, anti-inflammatory medicine or triptans may be prescribed.
Speak to a GP or your midwife before taking medicine when you’re pregnant or breastfeeding.
Page last reviewed: 10 May 2019 Next review due: 10 May 2022
Some Drugs Should Rarely Be Used
Migraine attacks can last for hoursor even days. They can cause intense pain, nausea, and vomiting. They can make you sensitive to light or noise, and they can affect your life and work.
To treat migraines, you may get a prescription for an opioid or a barbiturate called butalbital. These are pain medicines. But you should think twice about using these drugs. Heres why:
Also Check: Mayo Clinic Headache
Botulinum Toxin Injections To Prevent Migraine
In July 2010 the Medicines and Healthcare products Regulatory Agency licensed the use of botulinum toxin injections for the prevention of migraine. This decision was based on research studies that seemed to show it to be an effective treatment at reducing the number of migraine attacks .
Treatment consists of up to five courses of treatment with botulinum toxin injections every 12 weeks. The injections are given into muscles around the head and neck. It is not clear how this treatment may work for migraine. Botulinum toxin relaxes muscles but it may also have some sort of action to block pain signals. The theory is that these actions may have an effect of stopping a migraine headache from being triggered.
In 2012, guidelines were issued by NICE on this treatment. NICE recommends botulinum toxin type A as a possible treatment for preventing headaches in some adults with persistent migraine. The criteria set down by NICE for people who may be considered for this treatment are:
- If you have chronic migraine and
- You have already tried at least three different medicine treatments to prevent your chronic migraine headaches, but these have not worked and
- You are not taking too many painkillers or using them too often.
Also, treatment should be stopped if:
How to use the Yellow Card Scheme
If you think you have had a side-effect to one of your medicines you can report this on the Yellow Card Scheme. You can do this online at www.mhra.gov.uk/yellowcard.
- The side-effect.
Medicines For Migraine Attacks In Children
Many of the medicines used by adults for migraine are not licensed for children. Paracetamol or ibuprofen is suitable and commonly used. Apart from these you must check with your doctor or pharmacist before giving a child any other medicine for migraine.
- Paracetamol or ibuprofen is suitable. Do not use aspirin.
- As regards anti-sickness medicines, domperidone is licensed for children of all ages, and prochlorperazine is licensed for children older than 12 years.
- Triptans are not licensed for children and so should not be used .
Recommended Reading: Medication For Seizures And Migraines
Drugs For Migraine Prevention
If you have 4 or more migraine days each month, you may take these drugs regularly to keep migraine attacks from happening. They lessen the number of headaches you have and how severe they are.
You have to follow your doctorâs directions for them to work. Your doctor may need to change the medications and adjust how much you take to figure out what works best for you.
While youâre taking these drugs, write down how often you have headaches and how bad they are to help your doctor judge how well they are working. Most need days or weeks to take full effect.
Once your headaches are under control for 6 months or a year, you might be able to taper off or stop these drugs. Your doctor will advise you.
The medications listed include both over-the-counter and prescription drugs. They aren’t habit-forming, but any medication can have side effects. Your doctor will adjust the dosage to give you the most relief with the fewest side effects.
What Are Some Risks With Otc Migraine Medications And Who Should Avoid Them
With all OTC migraine medications, theres a risk of developing whats called a medication overuse headache . MOH is a headache that happens if you use OTC migraine medications for too long, or more than 10 to 14 days a month. If you find yourself needing migraine relief this often or more, talk to your healthcare provider about whether you might need a stronger prescription migraine treatment.
In addition to preventing MOH, youll want to take a few more precautions depending on the specific ingredient your OTC migraine treatment includes.
Read Also: Migraine Forcast
What Are The Best Migraine Medications For Your Dna
When it comes to migraines, there is no one-size-fits-all treatment plan. Severe, one-sided throbbing headache, nausea, vomiting, and sensitivity to light and sound are all hallmarks of migraines. Migraines may be preceded by what is known as aura, which includes visual disturbances and dizziness, symptoms which may be confused with other more serious conditions. Migraine headaches are notoriously resistant to treatment. Their root cause is still unknown but can be associated with heredity, stress, sleeping patterns, lifestyle and dietary habits. Unfortunately, there is no universal cure for migraines. Instead, migraine treatment focuses on alleviating symptoms and preventing future attacks. Treatment options depend on the frequency and severity of symptoms as well as other medical conditions that may be contributing to them. Genetic factors also play a role in which medications will be effective for you. Pharmacogenetic analysis can help find the right mix of drugs to reduce symptoms, alleviate your pain, and potentially prevent the onset of a migraine.
Drugs For Acute Treatment
These drugs are taken at the onset of migraine symptoms or auras to relieve a headache or reduce its severity.
Taking any of these drugs too often can lead to a rebound headache, headaches that arise from the overuse of medication, which then necessitates additional medication.
If you need to use acute migraine drugs more than 9 times per month, talk to your doctor about possible preventive treatments.
Recommended Reading: Migraine Disability Allowance
There Are Three Different Classes Of Acute Migraine Medication:
These include over-the-counter pain relief medications, like ibuprofen and acetaminophen, as well as prescription pain relief medications, like opioids. Dr. Michael recommends over-the-counter analgesics for patients experiencing mild migraine symptoms.
These are migraine-specific medications. There are seven different triptans that are all available as tablets, while one is available as an injection, some as a nasal spray, and others as an oral dissolving tablet . Triptans, which have been specifically designed to treatment migraine, can be more effective for more moderate to severe migraine attacks or in those who have not responded adequately to analgesics, Dr. Michael says.
These drugs are not used commonly, and are typically reserved for patients who dont respond to analgesics or triptans, Dr. Michael says. Migranal and Ergomar are both ergot alkaloids. Dihydroergotamine is also used by specialists as an injection or intravenous infusion in patients with attacks that are not responsive to usual medications.
Acute medication should not be used more than 10 days per month, Dr. Michael says, or a patient will be at risk for medication-overuse headache, also known as rebound headache. Consult your health care provider or a headache specialist if you suspect that your current pain medicine is exacerbating your migraine symptoms.
Medicines To Prevent Migraines
Preventive medicines are taken daily to prevent migraine attacks from happening. They are not used to treat an acute attack. Medicines to prevent migraines are an option if you:
- have at least 2 attacks a month
- have significant disability even with suitable treatment for migraine
- cannot take suitable treatment for migraine attacks.
Preventative medicines help to reduce the severity and length of attacks and how often you get them, reduce disruption to your daily activities and reduce overuse of acute medicines. They must be taken every day to be effective. They may take a few weeks to start working. Many different preventive medicines are available. Which one is best for you depends on things such as:
- other medical conditions you have, including high blood pressure, asthma, diabetes or pregnancy
- potential side effects of the medicine
- your response to preventive medicines if you’ve used them before.
Also Check: Why Do I Get Headaches During My Period
What Are The Treatment Options To Prevent Menstrual Migraine
Medications used to treat menstrual migraine are the same as those used to treat other forms of migraine. However, your doctor may recommend other treatments to be take regularly, in order to prevent or reduce the severity and frequency of menstrual migraines.
Fda Approves New Migraine Drug For Fast Symptom Relief
Oral dose of Ubrelvy reduces incapacitating pain within two hours, study finds.
When a debilitating migraine strikes, there is no one-and-done medication that patients can count on to provide fast relief from this intense throbbing or pulsating headache.
Taken orally in a single tablet, Ubrelvy has been shown to eliminate migraine pain and other related symptoms in adult patients with or without aura, a sensory phenomenon or visual disturbance that may accompany the condition.
We are still searching for the perfect one-size-fits-all treatment, and medication is rarely, if ever, the whole treatment strategy, says Robert Cowan, MD, professor of neurology and chief of the division of headache medicine at Stanford University in Palo Alto, California. But this is a new arrow in our quiver and definitely merits a frank discussion with your provider.
The medication will be available in the first quarter of 2020, according to a press release from Allergan, the pharmaceutical company that manufactures Ubrelvy. The company underscores that the drug is not for preventive therapy.
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Cgrp Monoclonal Antibodies For Vestibular Migraine
People with VM were excluded from the trials of anti-CGRP Migraine treatments so not much is known about their efficacy as a Vestibular Migraine treatment, yet Dr. David Dodick remains “cautiously optimistic” about them for the future.
For Dr. Shin Beh, some initial success is being seen among dizzy patients. He says, “I’m finding that the CGRP monoclonal antibodies are helping Vestibular Migraine patients. I have a handful of patients on them at the moment. With more people using them, I’m sure we will draw a much clearer picture. For the Migraine rescue oral CGRP small-molecule blockers , I am waiting to hear back from the patients on their efficacy. They are still pretty new to the market, and I suspect insurance companies are still figuring out how to deal with them.”
Who Should Take A Medicine To Prevent Migraine Attacks
There is no definite rule. For example, you may wish to consider this option if you have:
- More than two migraine attacks per month that cause significant disruption to your life.
- Less frequent, but severe, migraine attacks.
- The need to use a lot of painkillers or triptan medicines to treat migraine attacks.
- Painkillers or triptans for migraine attacks not working very well, or you are unable to take them because of side-effects or other problems.
Before embarking on preventative treatment, it is probably best to keep a migraine diary for a few months to assess:
- How often and how bad your migraine attacks are.
- Your current use of medication to treat the migraine attacks.
This may help you to decide if preventative treatment is worth a try, and also to help assess if you may have medication-induced headache. See the leaflet called Migraine trigger diary, including a migraine diary that you may like to print out and use.
Recommended Reading: How Many Mg Of Ibuprofen For Migraine
Best Migraine Medication At An Affordable Price
There are only a few adjectives that get attached to headaches, but splitting is one of them. Not sure how that one came about, but one can guess the idea is to imagine a log being split by an axe to make firewood, and of course your head is the log. But here is the thing. You may think youve got a splitting headache, but its going to be nothing compared to a migraine headache. And the problem with migraines is that they arrive repeatedly. Maybe not every day, but frequently enough that its one heck of a nuisance. So, what is the best medication for migraines?
As is almost always the case, there are many migraine prevention medications and there is no specific one that is the best. Migraine headaches may have similar physiological causes for people, but individual brain biochemistry can alter the way migraines are experienced and dictate which migraine prevention medications are most effective for that person. The symptoms that are most pronounced and severe can play a role too, whether thats nausea, vomiting, and / or sensitivity to light and sound.
What is the best medication for migraines? Well get into that here and talk about individual ones and their benefits plus other non-medicinal approaches people can try to make these super-splitting headaches more bearable. Theres no cure for migraine headaches, but they are manageable if you know what to do.