Treating Migraine Headache - Migraine Headache: Headaches Migraines

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Treating migraine headache

When migraine headaches are not particularly intense, you may want to try some home remedies before seeing a doctor. For some folks, strong, caffeinated black coffee is a simple and safe solution. Caffeine acts as a vasoconstrictor, meaning it causes blood vessels to narrow (see Figure 7). A migraine headache may also respond to an OTC analgesic (see "Over-the-counter medications"), if it's taken when the pain is still mild. The prescription medication isometheptene (Midrin), which is a mild vasoconstrictor, may also be helpful. Even then, this treatment is likely to only lessen, not eliminate, the pain.

Figure 7: Caffeine as a home remedy Some people find that simply drinking a caffeinated beverage can ease their migraine headache. This is because caffeine causes blood vessels to narrow and the pain of a migraine headache is caused by the expansion of blood vessels. Therefore, caffeine offers relief by counteracting the vasodilation.

Most people with migraine headaches turn to their doctors for prescription medications, and the sooner the better. A crucial principle in treating migraine headache is that it's much easier to nip it in the bud than to end an entrenched attack. It takes a quick-acting medication to squelch migraine pain. Most physicians start by prescribing a class of drugs called selective serotonin agonists, or triptans. If this initial strategy doesn't work, other options are available.

Triptans

These medications offer most migraine sufferers significant relief with relatively few side effects (see Table 4). Triptans work by constricting blood vessels in the head and possibly by inhibiting inflammation.

In pill form, almotriptan (Axert), eletriptan (Relpax), rizatriptan (Maxalt), sumatriptan (Imitrex), or zolmitriptan (Zomig) can stop the headache within two hours, provided the drug is taken when the headache is still mild. Although naratriptan (Amerge) and frovatriptan (Frova) can take nearly twice as long to work, they have fewer side effects and are more effective in preventing the headache's return within 24 hours. Sumatriptan and zolmitriptan come in nasal sprays that cut the medication's absorption time to an hour, making them a good choice for more intense migraine headaches. An injectable form of sumatriptan can provide relief in as little as 15 minutes. It's available in an automatic injector, allowing individuals to self-administer the drug, although many are hesitant to do so. The injections also tend to cause muscle tightness, which can worsen the headache or cause chest pressure.

If one triptan doesn't work, another often will (although you may have to wait 24 hours before taking a different type). If your headache still isn't completely relieved, taking aspirin or an NSAID — such as ibuprofen, naproxen sodium, or ketoprofen (see "Over-the-counter medications") — along with the triptan may help.

When taking triptans, you may experience some mild side effects. The oral medications can cause a tingling in your fingers or tightness in your throat, while the nasal spray can leave a bad taste in your mouth. The injectable form of sumatriptan tends to cause more intense side effects. On the other hand, triptans don't cause the nausea and vomiting common to the ergots, an older class of migraine medications.

The triptans are expensive, and 30%–40% of the time, the headache returns within 24 hours. Depending on the dose, you may be able to take the same triptan again during a given 24-hour period, but you can't take a different form of triptan or a similarly working ergot. Because triptans and ergots narrow blood vessels, taking them at the same time could lead to a heart attack. Not surprisingly, people with heart disease or uncontrolled high blood pressure shouldn't take these medications at all.

Ergots

Ergots, originally derived from a rye fungus, can be useful in treating migraine headache (see Table 5). Ergots, which have been available by prescription since the 1920s, constrict blood vessels. The triptans affect blood vessels only in the head, but the ergots affect blood vessels throughout the body, which means that they carry more risks. They also cause more side effects and take longer to work than triptans. However, the beneficial effects of ergots last longer, so that you will be less likely to suffer a headache recurrence.

Nasal dihydroergotamine (Migranal) is most effective when taken at the first hint of a migraine headache. Ergotamine suppository (Cafergot) or injectable dihydroergotamine (DHE 45) may be useful for severe headaches because they're absorbed faster than ergots in traditional pill form. However, one thing to keep in mind is that ergotamine suppository, the most widely prescribed agent, tends to cause nausea and vomiting. Apart from being unpleasant, an upset stomach hinders the absorption of medications.

Something else to consider: If it's used as infrequently as once a week, ergotamine can increase the frequency of migraine headaches by causing rebound headaches. To help prevent rebound headaches, carefully follow your physician's instructions. This will also help protect you from serious side effects, including gangrene, which is rare but can result from large overdoses of the drug.

Dihydroergotamine is less likely than ergotamine to lead to nausea and vomiting. It used to be available only by injection, which made it a less popular alternative to ergotamine. Now it's available as a nasal spray. The spray, however, tends to be less effective than the injection or the ergotamine suppositories.

Prescription analgesics

Prescription painkillers are more powerful than their OTC equivalents, yet they rarely relieve severe migraine pain. In many cases, prescription analgesics just provide higher doses of standard nonprescription products, such as ibuprofen or naproxen sodium. Some prescription analgesics contain barbiturates or opioids. Opioids, such as codeine and morphine, are sometimes indispensable medications, but they have a limited role in the treatment of headache. People who use opioids regularly run the risk of developing a tolerance to them and becoming addicted. This means they need higher and higher doses to relieve the pain, and they develop withdrawal symptoms when they stop taking the medication.

Other drugs

Occasionally, a migraine headache is exceptionally stubborn: Despite treatment, it may persist for days or weeks. When this happens, a several-day course of a steroid, such as prednisone, may provide relief.

Migraine attacks often activate the sympathetic nervous system, which is probably best known for its role in the "fight or flight" response. Activating the sympathetic nervous system affects the stomach and intestines, as well as other parts of the body. As a result, nausea and vomiting often accompany migraine headaches, which prevent you from keeping down your medications. Even when vomiting does not occur, the stomach takes longer to empty into the intestines once the sympathetic nervous system is activated — which can impair the absorption of oral medications.

To prevent vomiting, your doctor may recommend that you take a prescription antinausea medication. Several options exist. The phenothiazines suppress nausea and — because they have sedative effects — also help you sleep. The antinausea medication metoclopramide (Reglan) helps empty the stomach, thereby improving the absorption of oral headache medications. Many people find it particularly effective to take metoclopramide at the first hint of a migraine headache and then, about 15 minutes later, take the first dose of headache medication. Virtually all the antinausea drugs are available in several forms. If you can't take them by mouth, you can try rectal suppositories and, in extreme cases, injections.

Last updated:	September 05, 2008