Prescription Migraine Medications
Gary D. Vogin, MD
Dr. Vogin is a board-certified general internist, having completed his residency in internal medicine at Temple University Hospital in Philadelphia in June 1994. Before deciding on internal medicine, Vogin prepared for a career in pathology and was Outstanding Transitional First Year Graduate at St. Barnabas Medical Center in Livingston, N.J., in 1991.
- For what conditions are migraine medications used?
- What are the different types of migraine medications?
- What are the side effects of migraine medications?
- What are the warnings and precautions with migraine medications?
Migraine medications overview
Migraine is a serious, potentially life-threatening neurological disease that affects nearly 32 million Americans, the majority of whom are women. The hallmark symptom of migraine is an escalating, often unbearable, debilitating headache that is commonly described as intense throbbing or pulsating pain in one area of the head. The pain may be accompanied by extreme sensitivity to light and sound, nausea, and vomiting. In some people, migraines are preceded by visual disturbances known as auras that may include flashing lights, zigzag lines, or temporary blindness.
Migraine medications do not cure migraines. Instead, migraine drugs treat the symptoms using one of two approaches. Some migraine drugs relieve symptoms. Other migraine drugs are used to prevent a migraine attack.
Many migraine sufferers rely on simple pain relievers to get through an attack. These range from over-the-counter analgesics like acetaminophen to anti-inflammatories like naproxen or ibuprofen (Motrin) to prescription barbiturate combinations and narcotics. While this type of treatment provides relief, it doesn't target the physiological processes that underlie a migraine attack.
Migraine symptoms occur, in part, because of the dilation of blood vessels in the brain. Until recently, migraine sufferers had few choices when it came to drugs to counteract this effect. But newer migraine drugs known as triptans cause constriction of blood vessels and also bring about a general interruption in the chain of chemical events that leads to a migraine.
At some point, a migraine sufferer may need to move on to preventative therapy. This usually becomes necessary when migraine attacks happen more than once a week and/or abortive medications fail to work more than half the time.
No migraine drugs specifically prevent migraines. But many drugs used for other conditions can help keep migraines at bay. These include certain blood pressure medications as well as some antidepressants, antiseizure drugs, and herbals.
For what conditions are migraine medications used?
Some of the migraine medications used to treat or prevent migraine headaches are also used for other conditions. Antidepressants, anticonvulsants, antihistamines, and narcotic pain relievers are all used in migraine therapy. There are some migraines drugs, though, that are used because they directly target the pain pathways associated with migraine headaches rather than pain pathways in general.
What are the different types of migraine medications?
Migraine medications fall into two major categories. The first contains drugs which abort or stop migraines from progressing once they begin. The earlier these drugs are used in a migraine attack, the better they work. The second category contains drugs which prevent migraines from happening.
- Naproxen (Naprosyn, Anaprox, Anaprox DS)
- Acetaminophen (Tylenol)
- Or combinations of these
One drawback to using analgesics and NSAIDs is that taking them daily can make headaches worse due to medication overuse.
Prescription drugs used to provide relief from pain include NSAIDs and narcotics. Like over-the-counter medications, prescription drugs often come in combinations. A barbiturate called butalbital is often used in combination with acetaminophen, and caffeine with or without codeine (a narcotic). Barbiturates are a sedative and may be useful to help people sleep off the pain.
While analgesics, NSAIDs, and narcotics relieve pain, they don't address the underlying physiology -- primarily the dilation of blood vessels in the brain. Two classes of migraine drugs do: the ergotamines and the more recently available triptans.
Ergot alkaloids -- such as ergotamine tartrate (Cafergot) and dihydroergotamine mesylate (D.H.E. 45 Injection, Migranal Nasal Spray) -- are potent drugs that constrict blood vessels. Because nausea is a possible side effect of these migraine drugs, some people take ergotamines in combination with other drugs to prevent nausea.
Triptans target serotonin receptors. These drugs cause constriction of blood vessels and bring about a general interruption in the chain of chemical events that lead to a migraine. Triptans include:
- Almotriptan (Axert)
- Eletriptan (Relpax)
- Frovatriptan (Frova)
- Naratriptan (Amerge)
- Rizatriptan (Maxalt)
- Sumatriptan (Imitrex)
- Zolmitriptan (Zomig)
While specific triptans differ in their ability to prevent a recurrence of migraine headache, they are generally equally effective in their ability to provide relief. Triptans are more migraine-specific than the earlier ergotamines.
Another migraine drug used to abort the pain of a migraine is a combination product containing the vasoconstrictor isometheptene mucate, the sedative dichloralphenazone, and the analgesic acetaminophen (Midrin). The FDA has classified isometheptene mucate as "possibly" effective for migraines, pending further review.
Antihistamines are also used to ease migraine symptoms. These drugs counteract the effect of histamine, a substance that dilates blood vessels and causes an inflammatory response in the body -- the same kinds of response seen during a migraine attack. Antihistamines are broadly grouped into sedating and nonsedating types. An example of a sedating type is diphenhydramine; an example of the nonsedating type is loratadine.
There are no drugs that specifically prevent migraines. But certain blood pressure medications as well as some antidepressants, antiseizure drugs, and herbals have been used for that purpose. It sometimes takes weeks of trial and error to arrive at an optimal dose for these medications and even longer for the drugs to exert their full effect. Preventative migraine medications include:
Calcium channel blockers
- Amitriptyline (Elavil)
- Nortriptyline (Nortriptyline Hydrochloride, Nortriptyline Hydrochloride Oral Solution, Pamelor)
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