Treatment For Migraine Headache
Not all migraine sufferers need prophylactic medications; individuals with mild or infrequent headaches that respond readily to abortive medications do not need prophylactic medications. Individuals who should consider prophylactic medications are those who:
1. Require abortive medications for migraine headaches more frequently than twice weekly.
2. Have two or more migraine headaches a month that do not respond readily to abortive medications.
3. Have migraine headaches that are interfering substantially with their quality of life and work.
4. Cannot take abortive medications because of heart disease, stroke, or pregnancy, or cannot tolerate abortive medications because of side effects.
How effective are prophylactic medications?
Prophylactic medications can reduce the frequency and duration of migraine headaches but cannot be expected to eliminate migraine headaches completely. The success rate of most prophylactic medications is approximately 50%. Success in preventing migraine headaches is defined as more than a 50% reduction in the frequency of headaches. Prophylactic medications usually are begun at a low dose that is increased slowly in order to minimize side effects. Individuals may not notice a reduction in the frequency, severity, or duration of their headaches for 2-3 months after starting treatment.
What is the proper way to use preventive medications?
* Doctors familiar with the treatment of migraine headaches should prescribe preventive medications.
* Decisions about which preventive medication to use are based on the side effects of the medication and the medical conditions that the patient may have.
* Propranolol (Inderal) often is used first, provided that the patient does not have asthma, COPD or heart disease. Amitriptyline (Elavil) also is used commonly.
* Preventive medications are begun at low doses and gradually increased to higher doses if needed. This minimizes side effects from the medications. Preventive medications are to be taken daily for months to years. When they are stopped, the dose needs to be gradually reduced rather than abruptly stopped. Abruptly stopping preventive medications can lead to headaches.
What other medications are used for treating migraine headaches?
Narcotics and butalbital-containing medications sometimes are used to treat migraine headaches; however, these medications are potentially addicting and are not used as initial treatment. They are sometimes used for patients whose headaches fail to respond to OTC medications but who are not candidates for triptans either due to pregnancy or the risk of heart attack and stroke.
In patients with severe nausea, a combination of a triptan and an anti-nausea medication, for example, prochlorperazine (Compazine) or metoclopramide (Reglan) may be used. When nausea is severe enough that oral medications are impractical, intravenous medications such as DHE-45 (dihydroergotamine), prochlorperazine (Compazine), and valproate (Depacon) are useful.