Migraine can be an excruciating, debilitating condition with various symptoms. Treatment includes antiemetics and pain relievers to address them as well as certain prescription drugs.
Triptans such as sumatriptan (Imitrex) and rizatriptan (Maxalt) can block pain pathways to alleviate headaches, while also helping with associated symptoms like light and sound sensitivity.
Other medications used to treat migraine, such as Ubrelvy and Rimegepant (Nurtec ODT), also target CGRP. They can be taken either orally or nasally and come as pills.
1. Triptans
Triptans are prescription medicines used to treat acute migraine attacks by relaxing nerves and constricting blood vessels in the brain, and decreasing nausea, vomiting and light/sound sensitivity.
An effective dose should be taken within 15-30 minutes after experiencing a headache, whether this be in pill, nasal spray or pre-filled syringe form – with nasal spray and injection having the quickest onset, while pills typically take longer.
Sumatriptan (Imitrex), naratriptan (Amerge), frovatriptan (Frova), eletriptan (Relpax), almotriptan (Axert) and rizatriptan (Maxalt). A new oral medication, lasmiditan (Reyvow), has recently shown to be effective against migraine without aura. Drug trials have confirmed its efficacy.
2. Anti-emetics
Nausea and vomiting often accompany migraine headaches and can be brought on by several factors, including motion sickness, medications, toxins, pregnancy stress, psychiatric disorders or certain foods. Neurohumoral pathways may be involved and several antiemetic agents target specific receptors like serotonin histamine acetylcholine or neurokinin receptors to bring on these reactions.
Phenothiazines such as zolpidem tartrate, ergotamines and dihydroergotamine), ondansetron and metoclopramide are the primary antiemetics for migraine treatment, while alizapride stimulates peristalsis while cisapride facilitates gastric emptying. Dopamine antagonists (droperidol and meperidine) also act as effective antiemetics by blocking histamine, dopamine, acetylcholine or NK1 neurokinin receptors. Recently an oral antiemetic agent called rimegepant has received US FDA approval as an acute migraine treatment option [109]. [109]
3. Anti-seizure medications
Numerous medications prescribed to treat seizures also serve to manage migraines. Examples include topiramate (used to prevent epilepsy and treat migraines with aura); gabapentin (Neurontin); and valproic acid, used for bipolar disorder and various types of seizure disorders).
Effective treatment options depend on several factors, including severity and duration of migraine attacks; their association with nausea or vomiting; as well as any cardiovascular risk factors a patient might have.
The FDA has authorized the use of Zavegepant (Zavzpret) gepant as an effective migraine treatment, using nasal spray form. This medication works within 30 minutes to reduce pain and symptoms of migraine attacks; and can be taken at any point during an attack.
4. Neuromodulation devices
Neuromodulation devices are electronic, thermal and/or magnetic stimulators designed to target nerve function directly within the brain, acting to alter pain signals before reaching their destination in an effective and targeted fashion. Pharmaceutical drugs cannot do this as effectively.
Numerous devices have been studied as possible treatments for migraine, with several showing promise. They can be used alongside acute medications to address an outbreak quickly or act as preventative measures against future episodes.
Spring TMS can be administered when first signs of aura appear, as well as noninvasive vagus nerve stimulation (“nVS”). One study, the ACME trial, demonstrated external trigeminal nerve stimulation significantly reduces migraine pain intensity when compared to sham treatment; and other trials have proven spinal cord stimulation effective for relieving chronic nerve conditions like CRPS or post back surgery syndrome.
5. Other medications
As well as antiseizure medicines such as phenytoin or topiramate, other medications can also help treat and prevent migraine. These include anti-seizure drugs like phenytoin or topiramate as well as nonsteroidal anti-inflammatory drugs (NSAIDs). Ibuprofen and naproxen sodium tend to be effective, though their side effects can cause stomach upset in some people; Acetaminophen has proven useful against migraine in certain instances [38]. Additionally, research shows that combining aspirin, ibuprofen and caffeine can relieve headaches in some individuals [38]. Several studies have confirmed these results [38].
Before considering alternative therapies, it is wise to speak to your physician first. They can assess whether these will fit with your lifestyle, interact with any prescribed medicines and fit into a comprehensive treatment plan; additionally they can explain whether they are safe to use. They may even suggest solutions that may help reduce light and sound symptoms or ease tight muscles such as dimmed rooms or deep breathing techniques.
