Migraines can be debilitating and impact daily tasks. Medication may help prevent or alleviate symptoms.
Overusing painkillers may lead to analgesic rebound headache and medication dependency. If over-the-counter remedies fail to alleviate symptoms, your GP may prescribe stronger remedies such as triptans and anti sickness medicine.
Acetaminophen, NSAIDs, triptans, antiemetics and dihydroergotamine have all been proven effective as effective abortive medications; however, dosing and age restrictions vary for each of them.
1. Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs are pain relievers designed to block the processes responsible for migraine headaches. Available both over-the-counter (OTC) and with valid prescription, NSAIDs can be purchased in both pharmacies and supermarkets.
Multiple placebo controlled randomized trials have proven the efficacy of nonsteroidal anti-inflammatory drugs as acute treatments for migraine headache. Ibuprofen, acetaminophen and highly soluble aspirin salts were all superior to placebo in these trials; often taken together with prokinetic drugs like metoclopramide or domperidone to enhance absorption and effectiveness, especially when administered quickly after migraine symptoms appear.
Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) has been associated with medication overuse headache. Furthermore, some COX-2 inhibitors such as rofecoxib and parecoxib may increase cardiovascular risk.
2. Triptans
Migraine medicines known as triptans work to relieve your headache pain by blocking pain pathways in your brain and may help stop future migraine attacks from starting up again. Additionally, triptans may prevent further episodes once one has begun.
Aspirin-like painkillers and antisickness medicines may not relieve your symptoms effectively. You can take these as pills or nasal sprays; certain varieties, like lasmiditan (Reyvow), come packaged as pre-filled syringes to inject subdermally under the skin’s surface – this may work faster for people who struggle to swallow tablets down.
Your GP will recommend the appropriate triptan medicine based on your symptoms and duration of migraine attacks. They may not prescribe it if you have health conditions that affect heart or blood vessels such as high blood pressure or history of stroke or heart attack.
3. Antiemetics
Migraines often cause nausea and vomiting in addition to headache pain, making their treatment even more disabling. Anti-nausea drugs provide a solution to these symptoms – taken by pill, skin patch or nasal spray and they work quickly.
Your provider will choose the appropriate antiemetics based on your medical history and current medications; examples may include dihydroergotamine (Migranal/Trudhesa) and promethazine (Phenergan), both effective against radiation- and chemotherapy-induced nausea and vomiting.
Your provider may prescribe preventive medication, such as beta blockers like propranolol (Inderal), clonidine (Catapress) and verapamil (Calan, Versalone) or the antiseizure drug valproate (Topamax). Injections of onabotulinumtoxinA (Botox) every 12 weeks may help relieve migraine symptoms in certain adults but should be avoided during pregnancy.
4. Antidepressants
Antidepressants can provide effective solutions for treating mental health conditions like depression, anxiety and PTSD. Studies show they also ease headache pain for some. Antidepressants work by altering how your brain utilizes serotonin and norepinephrine; selective serotonin reuptake inhibitors (SSRIs) work by increasing serotonin levels (e.g. fluoxetine, sertraline and escitalopram); tricyclic antidepressants like Amitriptyline as well as monoamine oxidase inhibitors (MAOIs; phenelzine/tranylcypromine).
Some GPs and headache specialists are now prescribing antidepressants alongside triptans as a preventive strategy against migraine, which has proven safe and effective for many. Unfortunately, taking both medications can increase your risk of serotonin syndrome – particularly when taken together – especially if taken alongside antidepressants used to treat anxiety as well as over-the-counter drugs or natural remedies that disrupt liver metabolism like St John’s Wort.
5. Botox injections
Botox injections may provide relief for chronic migraine sufferers who have tried other preventative medicines without success, and who want a permanent solution. Plastic surgeons and dermatologists frequently employ Botox to reduce facial lines and creases.
Scientists still are unsure exactly how this treatment can relieve headaches, but believe that blocking neurotransmitters from entering nerve endings and transmitting pain signals directly to the brain helps.
Your doctor will administer botulinum toxin injections into specific areas of your face and head. They typically focus their injections around “trigger points” thought to be responsible for headache pain.
Your doctor will likely advise that, following injections, it is best not to touch or rub the areas of your face where medicine has been applied for several hours afterward, to give the medicine the chance to work and do its work effectively. This will allow the medicine time to settle in and complete its task effectively.
