Migraine medication options include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), triptans and ergot alkaloids. Each of these works in different ways and has specific side effects; your physician will help select the ideal one for you.
Studies have demonstrated the efficacy of triptans like Eletriptan, Rizatriptan and Zolmitriptan as treatments for migraines, outperforming nonsteroidal anti-inflammatory drugs and acetaminophen. Triptans also provide relief from nausea – one of the main symptoms associated with migraine.
Non-steroidal anti-inflammatory drugs (NSAIDs)
Migraine is a recurrent headache disorder characterised by attacks of pulsatile pain in the head. The pain is often accompanied by nausea, vomiting and photo- and phonophobia. The symptoms are triggered by a specific neurogenic inflammation of the trigeminovascular system (TGV) with activation of pain-generating nociceptors. The noxious stimulation induces the release of neuropeptides like calcitonine gene-related peptide (CGRP) and sustance P, which cause blood vessels to dilate. This in turn leads to plasma protein extravasation and degranulation of mast cells releasing histamine.
NSAIDs act by blocking the chemical called cyclooxygenase, which is responsible for inflammation. Most NSAIDs are available over-the-counter, including aspirin and acetaminophen. NSAIDs are effective when taken early in an attack or soon after the onset of symptoms.
The choice of an NSAID should be based on proof of efficacy, rapid GI absorption and gastric ulcer risk. COX-2 inhibitors are less likely to lead to gastrointestinal toxicity, but have not been proven more effective than non-selective NSAIDs and may increase cardiovascular risk.
Antiemetics
Migraine medications can provide much-needed relief, but many individuals also suffer from nausea or vomiting. Anti-sickness medicines like metoclopramide, prochlorperazine or domperidone may provide helpful relief and allow any painkillers taken to work more effectively.
Studies indicate feverfew and butterbur herbal remedies could potentially prevent or decrease migraine headaches; further research needs to be completed in this area. In addition, supplements containing riboflavin (vitamin B-2) and magnesium may help protect against or relieve migraine headaches.
Attaining migraine prevention requires tracking symptoms in a headache diary and taking medicine as soon as you detect an attack starting. Avoid overuse of painkillers as this could lead to medication overuse headache, so consult your healthcare provider before taking more than two doses each week for migraines. Incorporating regular physical activity – exercise reduces stress which can trigger migraine attacks. Acupuncture and biofeedback therapies could be useful as alternative solutions.
Triptans
Migraines are neurological headaches that may cause pain, vision loss or distortion, nausea and light/sound sensitivity. Migraines may also give rise to paresthesia symptoms in hands and feet (numbness/pins & needles sensation).
Triptans like sumatriptan, naratriptan, frovatriptan or zolmitriptan work by blocking receptors activated by serotonin – a chemical messenger found both within your brain and blood vessels – which act like triggers for migraine headaches. Unlike older migraine drugs that could increase risks like drowsiness and confusion, these newer triptans don’t increase them significantly.
However, they do not prevent headaches; therefore they should only be used during an attack. Too frequently using them could worsen your headaches; your doctor may advise keeping a headache diary so they can monitor how often they need to use them. He or she might also prescribe preventive medicines like the CGRP monoclonal antibodies erenumab-aooe (Aimovig), fremanezumab-vfrm (Emgality) and galcanezumab-gnlm (Vyepti), which should be administered monthly or quarterly via injection.
Other medications
There is some evidence that herbal treatments, like feverfew and butterbur, may prevent migraine headaches or reduce their severity; however, larger studies are required. Vitamin and mineral supplements like riboflavin (vitamin B-2) and magnesium may also prove helpful; however, their effectiveness has yet to be confirmed by research studies.
Acupuncture may help some individuals manage pain, while clinical trials have demonstrated the benefits of biofeedback and cognitive behavioral therapy for relieving tension. Stress reduction techniques like meditation or yoga may also prove effective; however, to achieve maximum effect they must be practiced on an ongoing basis for maximum efficacy.
If you experience two or more headache attacks per month, your doctor may suggest beginning preventive medication to decrease both their frequency and severity. Beta blockers and calcium channel blockers could be effective, while anti-seizure drugs like topiramate and valproate might also prove helpful in protecting against future headaches. As another option for migraine sufferers with or without aura symptoms may also consider lasmiditan as an oral solution for migraine treatment.
