Comprehensive Guide to Migraine Treatments: Medications, Mechanisms, and Recommendations

Migraine is a neurological disorder characterized by recurrent, debilitating headaches accompanied by symptoms like nausea, sensitivity to light and sound, and visual disturbances. It affects millions worldwide, impacting daily life. Treatments for migraines vary depending on the frequency and severity of the attacks. Medications such as NSAIDs, triptans, and preventive drugs may be used. Lifestyle modifications, including trigger identification and avoidance, sleep management, stress reduction, and a healthy diet, can also help. Many people even consider turning to psychological approaches like cognitive behavioral therapy (CBT) and other relaxation techniques, as well as complementary therapies such as acupuncture. While all these therapies may help, doctors usually suggest having a personalized medication regime to help deal with your migraine headaches. Here are some of the top medicines often prescribed in migraine.

Migraines are incredibly intense and incapacitating headaches that typically manifest as a severe, throbbing or pulsating pain localized to a specific area of the head. These headaches are not mere discomfort; they have the potential to disrupt daily life significantly. ^(1,2)

In addition to the excruciating pain, migraines often bring along a range of other distressing symptoms. These can include heightened sensitivity to light, sound, and even certain smells. Visual disturbances, known as auras, may also accompany migraines. Nausea and vomiting are not uncommon experiences during a migraine episode. It is important to understand that migraines extend beyond the scope of a typical headache, profoundly impacting various aspects of an individual’s life.

Medication plays a vital role in the treatment of migraines. There are two primary categories of drugs used for this purpose: ^(3,4) 

1. Acute treatment: These medications are specifically designed to alleviate pain and alleviate other distressing symptoms experienced during a migraine attack. Their purpose is to provide immediate relief and enable individuals to manage the debilitating effects of a migraine episode effectively. ⁽⁵⁾ 

2. Preventive treatment: This category of medications aims to reduce both the frequency and severity of migraines over an extended period. By implementing preventive treatment, individuals may experience a significant decrease in the occurrence of migraines, ultimately improving their overall quality of life. ⁽⁶⁾

Let us now look at some of the top medicines prescribed in migraine treatment.

Medications for the acute treatment of migraines are intended to be taken when symptoms or auras begin, aiming to alleviate the headache and lessen its intensity.

However, it is crucial to use these drugs judiciously, as excessive and frequent usage can lead to a rebound headache. Rebound headaches occur as a result of overusing medication, which can create a cycle where additional medication is needed to address the worsening headaches. ⁽⁷⁾

If you find yourself relying on acute migraine drugs more than nine times per month, it is important to consult with your doctor about potential preventive treatments. By discussing your situation with a healthcare professional, you can explore alternative approaches to managing migraines and potentially reduce the need for acute medications. ⁽⁸⁾

Some of the top medicines prescribed in acute treatment of migraine are as follows: 

1. Ergotamines 

Ergotamines, the first class of drugs specifically used for migraines, work by constricting the blood vessels around the brain, providing relief within minutes of administration. Available in various forms such as pills, sublingual tablets, nasal sprays, suppositories, and injections, ergotamines are typically taken at the onset of migraine symptoms. Some formulations allow additional doses every 30 minutes if the headache persists. ⁽⁹⁾

Some of the most commonly used ergotamines include: 

• Dihydroergotamine (brand names: DHE-45, Migranal)
• Ergotamine (brand name: Ergomar)
• Ergotamine combined with caffeine (brand names: Cafatine, Cafergot, Cafetrate, Ercaf, Migergot, Wigraine)
• Methysergide (brand name: Sansert)
• Methylergonovine (brand name: Methergine)

It is important to note that ergotamines can have significant side effects. High doses can be toxic, and they are known to cause birth defects and heart problems. Ergotamines should not be taken by pregnant or breastfeeding individuals or those with heart disease.  Additionally, they can interact negatively with other medications, including certain antifungal and antibiotic drugs. It is never correct to start having ergotamines without consulting a healthcare professional. ⁽¹⁰⁾ 

2. Painkillers

Certain painkillers are commonly used for the treatment of migraines, and while some are available over-the-counter (OTC), many are only obtainable with a prescription. These medications include both analgesics, which relieve pain, and nonsteroidal anti-inflammatory drugs (NSAIDs), which not only alleviate pain but also reduce inflammation: ⁽¹¹⁾ 

• Acetaminophen (brand names: Excedrin, Tylenol)
• Aspirin
• Diclofenac (brand name: Cataflam)
• Ibuprofen (brand names: Advil, Motrin)
• Ketorolac (brand name: Toradol)
• Naproxen (brand name: Aleve)

OTC drugs specifically marketed for migraines or headaches often combine one or more of the above drugs with a small dose of caffeine. The inclusion of caffeine can enhance the speed and efficacy of these medications, particularly for mild migraine headaches.

It’s important to note that prolonged and excessive use of NSAIDs can potentially lead to adverse effects. Some possible side effects associated with long-term NSAID usage include heart attacks, kidney damage, strokes, and stomach ulcers. It is crucial to use these medications as directed and consult with a healthcare professional if you have any concerns or require frequent use of painkillers for migraines. 

3. Triptans

Triptans, a newer class of drugs, increase serotonin levels in the brain, reducing inflammation and constricting blood vessels, effectively putting an end to migraines. Available in pill, nasal spray, injection, and sublingual tablet forms, triptans act quickly to halt migraines. ^{(12, 13)}

Some of the commonly used triptans include: 

• Almotriptan (brand name: Axert)
• Eletriptan (brand name: Relpax)
• Frovatriptan (brand name: Frova)
• Naratriptan (brand name: Amerge)
• Rizatriptan (brand names: Maxalt, Maxalt-MLT)
• Sumatriptan (brand name: Imitrex)
• Sumatriptan and naproxen (brand name: Treximet)
• Zolmitriptan (brand name: Zomig)

Some of the potential side effects of triptans may include tingling or numbness in the toes, drowsiness, dizziness, nausea, and chest or throat tightness or discomfort. Individuals with heart problems or those at risk for stroke should avoid triptans. Additionally, combining triptans with other drugs that increase serotonin, such as antidepressants, can lead to serotonin syndrome, a potentially fatal condition. ⁽¹⁴⁾ 

4. Opioids

If other painkillers and medications like ergotamines or triptans are ineffective or unsuitable for migraines, doctors may resort to prescribing opioids, which are considerably more potent painkillers. Certain migraine drugs combine opioids with other painkillers. Common opioids used for migraines include: ⁽¹⁵⁾ 

• Codeine
• Meperidine (brand name: Demerol)
• Morphine
• Oxycodone (brand name: OxyContin)

Due to their high potential for addiction, opioids are typically prescribed sparingly and with caution. ⁽¹⁶⁾

If you experience frequent migraines, your doctor may prescribe preventive medication to reduce the frequency and intensity of your migraines. These drugs are taken regularly, usually on a daily basis, and may be prescribed alone or in combination with other medications. It’s important to note that it may take several weeks or months for these drugs to become effective.

Some common preventive medicines prescribed in migraine are as follows. 

1. CGRP Antagonists

CGRP antagonists are a recent addition to the medications approved for preventing migraines. These drugs target the calcitonin gene-related peptide (CGRP), a protein present around the brain that plays a role in migraine pain. ⁽¹⁷⁾

CGRP antagonists have shown promising results and are expected to expand in availability in the coming year. Presently, two CGRP antagonists approved for migraine prevention are: 

• Erenumab (brand name: Aimovig)
• Fremanezumab (brand name: Ajovy)

These medications offer a targeted approach to managing migraines by specifically addressing the involvement of CGRP in the migraine pathway. Consultation with a healthcare professional can help determine if CGRP antagonists are suitable for your migraine prevention needs. 

2. Beta-blockers

Beta-blockers, commonly prescribed for high blood pressure, are also utilized for the prevention of migraines. They work by reducing the impact of stress hormones on the heart and blood vessels, effectively decreasing the frequency and intensity of migraines. ⁽¹⁸⁾

Commonly prescribed beta-blockers for migraine prevention include:

• Atenolol (brand name: Tenormin)
• Metoprolol (brand name: Toprol XL)
• Nadolol (brand name: Corgard)
• Propranolol (brand name: Inderal)
• Timolol (brand name: Blocadren)

While beta-blockers can be effective, they may also come with certain side effects. Some potential side effects of beta-blockers include fatigue, nausea, dizziness upon standing, depression, and insomnia. It is important to discuss potential side effects and individual considerations with your healthcare professional when considering beta-blockers for migraine prevention. Regular monitoring and adjustment of the medication plan may be necessary to achieve optimal results. ⁽¹⁹⁾ 

3. Calcium Channel Blockers

Calcium channel blockers, originally prescribed for blood pressure management, are also used for preventing migraines. They work by regulating the constriction and dilation of blood vessels, which plays a role in migraine pain. ⁽²⁰⁾

Commonly prescribed calcium channel blockers for migraines include: 

• Diltiazem (brand names: Cardizem, Cartia XT, Dilacor, Tiazac)
• Nimodipine (brand name: Nimotop)
• Verapamil (brand names: Calan, Covera, Isoptin, Verelan)

While calcium channel blockers can be effective in migraine prevention, they may have certain side effects. Possible side effects of calcium channel blockers include low blood pressure, weight gain, dizziness, and constipation.

Consultation with a healthcare professional is important to discuss the potential benefits, side effects, and individual considerations when considering calcium channel blockers for migraine prevention. Regular monitoring and adjustment of the medication plan may be necessary to optimize results.

Migraines are not just simple headaches; they can be debilitating, severely impacting individuals’ daily lives. Medications play a vital role in the management of this neurological disorder, and the appropriate treatment depends on the frequency and severity of the attacks. From acute medications like ergotamines, painkillers, triptans, and opioids, aimed at immediate relief, to preventive treatments like CGRP antagonists, beta-blockers, and calcium channel blockers, which seek to reduce the frequency and intensity of migraines over time, there is a wide range of options available. However, self-medication can be risky due to potential drug interactions and side effects.

Therefore, a comprehensive approach to managing migraines necessitates personalized treatments and regular consultations with healthcare professionals. Such an approach ensures that individuals get the most appropriate medications and strategies tailored to their needs, ultimately improving their overall quality of life. This guide has provided insights into the myriad of options available, emphasizing the importance of individualized care and the ongoing advancements in migraine treatment. It is essential for individuals suffering from migraines to remain updated on the latest treatments and continuously seek expert advice to manage their condition effectively.

References:

Also Read:

• Migraine: Dietary Do’s and Don’ts, Diet Plan, Lifestyle Changes, Home Remedies
• Diagnosing the Migraine Headache: Types, Symptoms, Signs, Typical Migraine, Atypical Migraine
• Android Apps For Migraine
• Can Sex Help Get Rid of Migraine?
• Home & Natural Remedies for Migraine During Pregnancy
• Migraine: Stages, Causes, Symptoms, Treatment
• How Long Can a Migraine Last & How to Get Rid of it?