Is It Possible To Overmedicate
Its tempting and easy to rely too heavily on headache medications. Some people experience daily or almost-daily headaches. For those that get migraines, the headaches may seem to blend together, with no beginning or end. You may feel the need to reach for medications to relieve symptoms or stop headaches in their tracks.
But doing so can actually make headaches worse or more frequent. In particular:
- Daily or near-daily use of relief medications can interfere with certain parts of the brain. These parts control the flow of pain messages to the nervous system. Over-the-counter medications can pose a risk, including aspirin, acetaminophen, ibuprofen, and drugs with caffeine. So can prescription medications such as triptans, narcotics and barbiturates.
- Overmedicating with abortive therapies can lower the effectiveness of preventive drugs.
When Are Opioids Or Butalbital Useful For Migraines
Your doctor may suggest an opioid if none of the treatments listed above help, or if you have bad side effects.
It is not clear if butalbital should be used at all for treating migraines. If your doctor prescribes butalbital for your migraines, ask why. And ask if there are any other drugs that would work.
Treatment Approaches In The Er
The treatment you might receive in a hospital emergency department for a migraine headache will be based, for the most part, on your symptoms and personal health history. In other words, there’s no one-size-fits-all fix.
However, there are standards and recommendations. For one thing, medications given in the ER for migraine headache are typically administered parenterallyin some way other than by mouth, including by subcutaneous injection , intramuscularly , and intravenously .
These methods allow medications to work more quickly in the body, and they are more effective for someone who’s experiencing so much nausea and/or vomiting that keeping down a pill is almost impossible. Many people are also given fluids via IV to prevent dehydration.
In 2016, the American Headache Society put together a panel of experts to review clinical trials of the many diverse medications used in emergency settings to treat migraines in adults to determine which truly work best and are safest. The panel considered studies of 28 different medications to come up with recommendations for the acute treatment of migraines in adults.
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Limit The Use Of All Pain Medicines
- Do not use prescription pain medicine for headaches for more than nine days in a month.
- Do not use non-prescription pain medicine for more than 14 days in a month.
This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
Supplements For Vestibular Migraine
Nutritional supplements are a great option for those looking for a Vestibular Migraine natural treatment. Generally, the supplements given for all types of Migraine, such as riboflavin, magnesium, and ginger, can also be effective for Vestibular Migraine. Magnesium for Migraine is also helpful for VM, specifically Magnesium Glycinate and Magnesium Threonate.
Magnesium Glycinate elevates levels of serotonin, promoting relaxation, cognitive function, and anxiety relief, while Threonate is helpful for memory retention and cognitive impairment. Because this type of Migraine can cause significant brain fog and anxiety over instability, these two supplements could be beneficial.
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How Well Do Anticonvulsants Work For Migraine
Depakote and topiramate were studied in people with episodic migraines. These drugs prevent about 1 to 2 migraine headaches per month.4-9
These anticonvulsants cut the frequency of migraine in half for about 45% of patients.10,11
It may take up to 8 weeks at the target dose to notice an improvement.1 If you have at least some improvement, it may be worth continuing on the medication. Benefits may increase over 6 to 12 months of use.1
What Are The Warnings And Precautions With Migraine Medications
In 2006, the FDA warned about combining triptan drugs with selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors . Taking the drugs together could cause an overload of serotonin in the body, causing what is known as the “serotonin syndrome.â Symptoms of this life-threatening condition include a rapid increase in blood pressure, fast heart rate, and increased body temperature.
The use of topiramate can result in decreased sweating and increased body temperature. This may be especially concerning during hot weather. Wearing light clothes and drinking plenty of fluids while using topiramate during warmer months is very important. A physician should be consulted if body temperature rises.
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Antiemetics Available In Australia For Migraine
*Dosages apply to adults over 18. Take these medications only as directed by your doctor or pharmacist.
None of the above medications were developed specifically for migraine, except for those sold as a combined tablet with paracetamol. Metoclopramide and prochlorperazine are the antiemetics most commonly recommended for migraine, because they dont cause major blood pressure changes, require cardiac monitoring, and may themselves also bring additional pain relief .
There is also evidence to suggest that antiemetics can work synergistically with migraine treatments particularly in the setting of nausea or vomiting . One emergency department study showed that intravenous metoclopramide and prochlorperazine had a similar level of efficacy . Your doctor will be able to recommend which drug is more suitable based on your symptoms and reaction to previous medications.
Similar to triptans, ergotamine and dihydroergotamine are migraine-specific drugs that target serotonin receptors . However, triptans have mostly replaced ergotamines, because they are more effective and ergotamines tend to cause side effects such as nausea. There are no ergotamine compounds currently available in Australia .
List Of Migraine Medications: How To Pick The Best One
Written and verified by Holly Hazen
The long list of migraine medications below gives you many treatment choices. Don’t let it overwhelm you, think of it as having an arsenal of pain relief within reach. You will learn about the medications approved to target migraines and get more effective relief. If you take the wrong thing… it won’t work!
The latest thing to hit the market is the GCRP drug Aimovig. It’s FDA approved and should you be able to afford it, it could hold the key to prevent your episodic attacks. You can read about that here – The New Drug For Migraine Aimovig.
Besides the new CGRP meds there are basically three categories that I have broken down so you can easily see whats FDA approved and recommended specifically for the treatment of migraine headaches.
Here they are:
Over the Counter , Abortive and Preventative.
Headache tablets are not recommended for migraines as they perform the wrong action. I have clients that say they take Mersyndol for the pain and then take too many when they don’t work. There is a risk of overdose.
Let’s get clear on what works for migraines then you can discuss these with your doctor to find what will work best for you.
Now let’s get to the list of migraine medications. You can scroll or jump down to each section:
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What Is A Migraine Headache
Although the term “migraine” is often used to describe any severe headache, a migraine headache is the result of specific physiologic changes that occur within the brain, and lead to the characteristic pain and associated symptoms of a migraine.
Migraines usually are associated with sensitivity to sound, light, and smells. A migraine attack may be accompanied by nausea or vomiting. This type of headache often involves only one side of the head, but in some cases, patients may have pain bilaterally or on both sides. The pain is often described as throbbing or pounding and it may be made worse with physical exertion.
Not all headaches represent migraines, and migraine is not the only condition that can cause severe and debilitating headaches. For example, cluster headaches are very severe headaches that affect one side of the head in a recurrent manner . The pain is sometimes described as “drilling,” and can be worse than migraine pain in some cases. Cluster headaches are less common than migraine.
Tension headaches are a more common cause of headache. These occur due to contraction of the muscles of the scalp, face, and neck.
Types Of Drug Treatments
One drug titrated to the ideal dose .
Two drugs typically from different drug classes used to less than maximal dose, but used to complement each other and reduce the risk of side effects associated with each of the medications given in high doses.
One drug switched for another drug in order to improve tolerance or efficacy.
Three or more drugs in either maximal or submaximal doses, typically added one after another due to inadequate response. Your preferences can strongly influence the selection of this process. This is much like a trial and error process and may take a while before treatment success is identified and the desired efficacy is achieved.
Adding different medications may be a preferred treatment strategy as many patients have migraine in addition to another condition commonly associated with migraine, such as depression, anxiety or obesity.
Recognizing that there may be several medical concerns is the first step to ensuring each condition is treated optimally. Sometimes this is achieved with monotherapy, but often this may require polytherapy.
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Over The Counter And Abortives
1. Three Over The Counter Products Are Approved
Thats right three. Only three OTC products are currently on my list of migraine medications because they are approved by The USFDA to specifically treat migraines. These are:
- Excedrin Migraine®
- Advil Migraine®
- Motrin Migraine Pain®
The ingredients for Excedrin combine: acetaminophen, aspirin and caffeine. It is recommended for reducing migraine pain and the accompanying symptoms.
Both Advil and Motrin contain ibuprofen. They are recommended to treat headaches and the associated pain.
This is what drugs.com says about Motrin Migraine Pain: “This medicine may cause life-threatening heart or circulation problems such as heart attack or stroke, especially if you use it long term.”
Always discuss the side effects with your doctor before you take anything, or the pharmacist. Remember Non-steroidal anti-inflammatory agents or NSAIDs carry risks too, even though you can get them over the counter.
I never found any of these OTC combinations by themselves to help reduce my severe migraine pain. Not even a little bit!
It was not until I combined ibuprofen with the triptan Naramig that I found effective relief from the attacks and symptoms.
Please work with your doctor on finding a combination that works for you.
2. Abortive Medications
Here is the approved A-Z list of migraine medications called Triptans, with my accompanying results.
My research reveals these are all potent serotonin 5HT1 agonists:
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 .
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The Benefits Of Choosing An Fda
Choosing an FDA-approved drug for migraine prevention ensures that, according to the FDA’s website, “the agency has determined that the benefits of the product outweigh the known risks for the intended use.” Approval is granted after review of lab, animal, and human testing done by drug manufacturers .
As such, opting for an FDA-approved migraine drug is usually preferred. That said, there are times when your healthcare provider may recommend that a drug be used off-label, meaning that it is not approved by the FDA for the use your practitioner intends to prescribe it . This is often done when FDA-approved choices have proven to be ineffective and when there is at least some evidence that the medication is helpful.
Using a drug off-label may be effective and perfectly safe for you. But given that the FDA cannot verify that its pros outweigh its cons for the purpose for which you’re using it, there is more reason to use caution.
What Are Excedrin Migraines Ingredients
Excedrin Migraine contains three active ingredients acetaminophen, aspirin and caffeine. These drugs combined work together to help relieve pain. Acetaminophen acts as a pain reliever and fever reducer. Aspirin helps reduce pain, inflammation, and swelling. Caffeine increases the effectiveness and enhances the pain-relieving function of analgesics such as aspirin and acetaminophen.
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When Should I Call My Healthcare Provider About A Headache
If you have these symptoms, see your healthcare provider or go to the emergency room:
- Feeling that youre having the worst headache ever.
- Headache that comes with vision loss, vomiting or loss of consciousness.
- Headache pain lasting more than 72 hours, with less than four pain-free hours in a row while awake.
- Feeling that something is off or not right.
Dealing With Nausea And Vomiting
Migraine attacks may cause a feeling of sickness or cause you to actually be sick . The nausea makes it harder for your body to absorb migraine tablets into your body. If you take painkillers, they may remain in your stomach and not work well if you feel sick. You may even vomit the tablets back. Tips that may help include:
- Use soluble painkillers. These are absorbed more quickly from your stomach and are likely to work better.
- As mentioned, one brand of diclofenac comes as a suppository. This may be useful if you usually vomit with a migraine.
- You can take an anti-sickness medicine in addition to painkillers. A doctor may prescribe one – for example, domperidone, prochlorperazine or metoclopramide.
- Like painkillers, anti-sickness medicines work best if you take them as soon as possible after symptoms begin.
- An anti-sickness medicine, domperidone, is available as a suppository if you feel very sick or vomit during migraine attacks.
- Prochlorperazine comes in a buccal form which dissolves between the gum and cheek. This can be useful if you feel sick and do not wish to swallow a tablet.
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Migraine Home Remedies And Lifestyle Measures
There are several things you can do on your own that may help relieve your migraine symptoms once an attack has started, including:
- Applying hot or cold compresses to your head and neck may help, notes the Mayo Clinic.
- Taking a warm shower or bath can have a similar effect to hot compresses.
- Resting in a dark, quiet room can also help if you feel a migraine attack coming on.
- Meditating or doing yoga may help to reduce symptoms and can also help to prevent attacks when done regularly.
Medicines Plus Behavioural Therapy
An interesting research study published in 2010 compared two groups of people who had frequent migraines. One group took a beta-blocker medicine alone. Another group took a beta-blocker but also had a course of behavioural migraine management . BMM included education about migraine, helping to identify and manage migraine triggers, relaxation techniques and stress management. After a number of months the group of people who took the beta-blocker plus BMM had, on average, significantly fewer migraines compared with the group who took beta-blockers alone. Further research is needed to confirm this and to look at BMM combined with other medicines to prevent migraine.
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Sequence And Combination Of Therapies
Stepped care within attacks is a treatment plan in which medications are added depending on patient response. Stratified care based on severity is a treatment plan in which all of the anticipated medications are given up front. Patients have improved outcomes with stratified care.
Until we have further evidence to guide our medication combinations, treating the patient with multiple medications that have independently been found to be efficacious at the onset of his or her ED visit is recommended over stepped care .
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.
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Medicines For Migraine When Pregnant Or Breastfeeding
Many of the medicines used to treat migraine should not be taken by pregnant or breastfeeding women.
- For relief of a migraine headache:
- Paracetamol is the medicine most commonly used, as it is known to be safe during pregnancy.
- Ibuprofen is sometimes used but do not take it in the last third of the pregnancy .
- Aspirin – avoid if you are trying to conceive, early in pregnancy, in the third trimester and whilst breastfeeding.
- Triptans – should not be taken by pregnant women at all. Triptans can be used during breastfeeding, but milk should be expressed and discarded for 12-24 hours after the dose .
Check with your pharmacist or doctor if you are not sure.